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Perfusion
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research-article

Cerebral venous congestion during cardio-pulmonary bypass: role of bispectral index monitoring

GD Puri

Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India gdpuri007{at}hotmail.com

J Agarwal

Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India

A Solanki

Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India

SS Rana

Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

A 58-year-old male patient was posted for double valve replacement under hypothermic cardiopulmonary bypass (CPB). During aortic cross-clamp (AXC), the central venous pressure (CVP) was found to have increased to 22 mmHg. After 4 minutes of sustained increase in CVP, burst suppression (SR) started increasing. After 5 min of increase in SR, bispectral index (BIS) declined rapidly to 17. Propofol infusion was stopped and re-evaluation of signs of facial congestion showed changes to that effect. The perfusionist noted steadily decreasing venous return. As soon as the superior vena cava (SVC) cannula was withdrawn by 3 cm, CVP immediately declined to 6 mmHg. The venous return in the CPB reservoir normalized and BIS returned to 42 after a transient rise to a maximum of 58 and SR decreased to 0 within 2 min of repositioning of the venous cannula. The patient was successfully extubated after 7 hours without any sequelae.

Key Words: bispectral index • burst suppression ratio • central venous pressure

Perfusion, Vol. 23, No. 3, 153-155 (2008)
DOI: 10.1177/0267659108099047
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