Korean J Anesthesiol.  2009 Jan;56(1):102-105. 10.4097/kjae.2009.56.1.102.

Perioperative cerebral infarct during cardiac surgery and changes in jugular venous O2 saturation and cerebral oximetry using near-infrared spectroscopy: A case report

• Choi ES
• Kim JH
• Gil NS
• Lee JH
• Jeon YS
• Kim KH
• Bahk JH

• KMID: 2031871
• DOI: http://doi.org/10.4097/kjae.2009.56.1.102

Abstract

Despite reductions in surgical mortality, neurologic sequelae remain a devastating complication after cardiac surgery with cardiopulmonary bypass. Neurologic complications may be induced by a massive air embolism during cardiopulmonary bypass, even with extensive monitoring. This report describes a patient who had a fatal cerebral infarct during aortic valve and ascending aorta replacement surgery. We monitored jugular venous O2 saturation (SjvO2) and cerebral oximetry using near-infrared spectroscopy in the perioperative period. The operation and anesthesia were uneventful until the deep hypothermic total arrest for the replacement of the ascending aorta. However, restarting the cardiopulmonary bypass after deep hypothermic total arrest produced a brief (less than 10 seconds) but large amount of air in the root cannula. At this time, although cerebral oximetry did not show any changes, the SjvO2 decreased to 21% for about 3 minutes and then normalized. At 8 hours after surgery, the patient showed seizures and severe edema in both cerebral hemispheres on the MRI. The patient died 21 days after surgery.

Keyword

Aortic valve replacement; Cardiopulmonary bypass; Cerebral infarct; Cerebral oximetry; Neurologic complication; SjvO2

MeSH Terms

Anesthesia
Aorta
Aortic Valve
Cardiopulmonary Bypass
Catheters
Cerebrum
Edema
Embolism, Air
Humans
Oximetry
Perioperative Period
Seizures
Spectroscopy, Near-Infrared
Thoracic Surgery