Hypothermic cerebral protection for a patient undergoing aorto-carotid bypass
DOI:
https://doi.org/10.3126/jsan.v3i2.15624Keywords:
Cardiac valve prosthesis, cerebral revascularization, Takayasu arteritisAbstract
We present a case of Takayasu arteritis with a history of double valve replacement undergoing aorto-carotid bypass and describe the anaesthetic management aimed at preserving cerebral function and protecting the cardiovascular system. The 17-year-old girl presented with recurrent loss of consciousness and absent bilateral radial artery pulses. She had total occlusion of the bilateral carotid arteries and cerebral blood flow was completely dependent on the vertebral artery. Partially clamping the aorta and carotid artery along with hemodynamic effects of general anaesthesia may further compromise the critical cerebral blood flow leading to cerebral injury. So we planned hypothermia for cerebral protection. Since she had to undergo re-sternotomy and with the possibility of haemorrhage during re-sternotomy; femoral artery and vein cannulation was done and cardiopulmonary bypass pump was started before sternotomy. Cooling was started effectively on cardiopulmonary bypass. Our aim was to provide cerebral protection by induced hypothermia at 25 degree Celsius and support of circulation with cardiopulmonary bypass. Aorto-left carotid artery bypass graft was placed with postoperative improvement in symptoms of the patient at one year follow up. A brief review of the perioperative anticoagulant management in such patients with prosthetic mechanical valves is also mentioned. Hence hypothermia and support of circulation with cardiopulmonary bypass can be considered in a patient with critical cerebral blood flow.References
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</ol>
<li>Warner MA, Hughes DR, Messick JM. Anesthetic management of a patient with pulseless disease. Anesth Analg 1983;62:532-5. <a href="http://dx.doi.org/10.1213/00000539-198305000-00013">http://dx.doi.org/10.1213/00000539-198305000-00013</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/6132565">[PMid:6132565]</a></li>
<li>Todd MM, Hindman BJ, Clark WR, Torner JC. Mild intraoperative hypothermia during surgery for intracranial aneurysm. N Engl J Med 2005;352:135-45. <a href="http://dx.doi.org/10.1056/NEJMoa040975">http://dx.doi.org/10.1056/NEJMoa040975</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/15647576">[PMid:15647576]</a></li>
<li>Saccani S, Beghi C, Fragnito C, Barboso G, Fesani F. Carotid endarterectomy under hypothermic extracorporeal circulation: a method of brain protection for special patients. J CardiovascSurg 1992;33:311-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1601914">[PMid:1601914]</a></li>
<li>Biller J, Feinberg WM, Castaldo JE, Whittemore AD, Harbaugh RE, Dempsey RJ, et al. Guideline for carotid endarterectomy: a statement for health care professionals from a special writing group of the stroke council, American heart association. Circulation 1998;97:501-9. <a href="http://dx.doi.org/10.1161/01.CIR.97.5.501">http://dx.doi.org/10.1161/01.CIR.97.5.501</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/9490248">[PMid:9490248]</a></li>
<li>Chaturvedi S, Bruno A, Feasby T, Holloway R, Benavente O, Cohen SN, et al. Carotid endarterectomy- an evidence based review: Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 2005;65:794-801. <a href="http://dx.doi.org/10.1212/01.wnl.0000176036.07558.82">http://dx.doi.org/10.1212/01.wnl.0000176036.07558.82</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/16186516">[PMid:16186516]</a></li>
<li>Douketis JD, Spencer FA, Spyropoulos AC, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians Evidence-based clinical practice guidelines. Chest 2012;141:326S-350S. <a href="http://dx.doi.org/10.1378/chest.11-2298">http://dx.doi.org/10.1378/chest.11-2298</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/22315266">[PMid: 22315266]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278059/">[PMCid: PMC3278059]</a></li>
</ol>
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Published
2016-09-17
How to Cite
Bhusal, S., Amatya, A. G., Pokharel, J. N., Timala, R., & Shakya, S. (2016). Hypothermic cerebral protection for a patient undergoing aorto-carotid bypass. Journal of Society of Anesthesiologists of Nepal, 3(2), 96-98. https://doi.org/10.3126/jsan.v3i2.15624
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