Brain function monitoring during off-pump cardiac surgery: a case report

Area of Science:

• Cardiovascular Surgery
• Neurology
• Anesthesiology

Background:

• Postoperative stroke is a significant complication following coronary bypass surgery.
• Cerebral ischemia during off-pump coronary artery bypass grafting (OPCAB) is often linked to hemodynamic instability.
• Managing cerebral blood flow is critical in high-risk patients undergoing OPCAB.

Purpose of the Study:

• To investigate the relationship between cardiac index and cerebral ischemia during OPCAB.
• To evaluate the utility of somatosensory evoked potentials (SSEPs) in monitoring cerebral function during OPCAB.
• To identify strategies for preventing perioperative stroke in patients undergoing OPCAB.

Main Methods:

• A case presentation of a 67-year-old male patient with multiple cardiovascular risk factors undergoing OPCAB.
• Continuous bilateral somatosensory evoked potentials monitoring.
• Pharmacological intervention to manage blood pressure and cardiac index.
• Correlation of SSEP changes with hemodynamic parameters.

Main Results:

• A decrease in cardiac index during the procedure was associated with SSEP alterations, indicating cerebral ischemia.
• Increased blood pressure through pharmacological treatment led to the reappearance of SSEPs.
• The findings suggest a direct link between reduced cardiac index and compromised cerebral blood flow in this patient.

Conclusions:

• Lower cardiac index during OPCAB surgery increases the risk of cerebral blood flow reduction in patients with multiple stroke risk factors.
• Intraoperative SSEP monitoring provides crucial information on the functional status of the somatosensory cortex.
• SSEP monitoring can guide interventions to reverse brain ischemia during OPCAB.