A marked decrease in bispectral index with elevation of suppression ratio by cervical haematoma reducing cerebral perfusion pressure.

Abstract

A 77-year-old man with a ruptured abdominal aortic aneurysm undergoing aneurysmectomy were anaesthetised with ketamine under bispectral index (BIS) monitoring, which is a clinical EEG monitor for measurement of depth of anaesthesia/sedation. First marked BIS reduction with elevation of suppression ratio (SR) was observed following severe hypotension by deflation of the aortic occlusion balloon. The re-inflation and rapid blood transfusion improved haemodyanamics and BIS and SR. At second marked BIS reduction with SR elevation, a heavy cervical swelling due to a massive subcutaneous haematoma around the previously mis-punctured right carotid artery extending throughout the whole neck was observed without hypotension. Cervical relief incision improved the BIS and SR. The present case suggests that BIS monitor may be a simple and convenient monitor for cerebral ischaemia detection.

• Authors: N Umegaki, K Hirota, M Kitayama, Y Yatsu, H Ishihara, A Mtasuki
• Journal: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia (J Clin Neurosci) Vol. 10 Issue 6 Pg. 694-6 (Nov 2003) ISSN: 1532-2653 [Electronic] Scotland
• PMID: 14592622 (Publication Type: Case Reports, Journal Article)

Topics

• Aged
• Aortic Aneurysm, Abdominal (complications, pathology, surgery)
• Blood Pressure (physiology)
• Carcinoma (complications)
• Carotid Artery Injuries (complications)
• Catheterization, Central Venous (adverse effects)
• Cerebrovascular Circulation (physiology)
• Cerebrovascular Disorders (diagnosis, etiology, physiopathology)
• Emergency Medical Services (methods)
• Fatal Outcome
• Hematoma (complications, physiopathology, surgery)
• Hemorrhage (complications, surgery)
• Humans
• Hypoxia-Ischemia, Brain (diagnosis, etiology, physiopathology)
• Intracranial Hypotension (diagnosis, etiology, physiopathology)
• Jugular Veins (injuries)
• Male
• Monitoring, Intraoperative (methods, standards)
• Neck (blood supply, pathology, physiopathology)
• Neck Injuries (complications, pathology, physiopathology)
• Prostheses and Implants
• Shock, Hemorrhagic (etiology, physiopathology, surgery)
• Stomach Neoplasms (complications)