[Perioperative management of off-pump CABG for a 93-year-old man]

Area of Science:

• Cardiovascular Surgery
• Geriatric Medicine
• Anesthesiology

Background:

• The number of surgical procedures on the very elderly is increasing due to population aging and advancements in surgical and anesthetic techniques.
• Off-pump coronary artery bypass grafting (CABG) is a complex procedure, particularly in nonagenarian patients.

Observation:

• A 93-year-old male patient undergoing off-pump CABG experienced intraoperative hypotension and a significant drop in bispectral index (BIS) to 1 during heart displacement.
• The patient developed challenging postoperative delirium during the perioperative period.

Findings:

• Despite the intraoperative events and postoperative delirium, the patient was discharged on postoperative day 21 without complications.
• Effective perioperative management was key to the patient's successful recovery.

Implications:

• This case highlights the critical importance of meticulous intraoperative cerebral circulatory management, focusing on cerebral perfusion.
• Proactive strategies for preventing and managing postoperative delirium are essential for improving outcomes in very elderly surgical patients.
• The successful management of this nonagenarian patient suggests that carefully selected very elderly individuals can benefit from advanced cardiac surgical procedures.