BIS-rSO2 combination as convenient ischemia monitor (第7回大会 2002年一般演題)

一般演題

セッション：ポスター　６
セッション名：脳・神経
日時：9月21日 16：10-17：10
場所：503会議室
演題順序：5番目

BIS-rSO2 combination as convenient ischemia monitor

東京大学付属病院麻酔科
○唐先南、林田眞和、藤原治子、碓井久子、富岡哲也、花岡一雄

We simultaneously monitored the Bispectral Index (BIS) with a processed EEG monitor (A-1050, Aspect Medical Systems) and cerebral oxygen saturation (rSO2) by bear-infrared spectroscopy (PSA-3N, Biomedical Science) during major cardiovascular surgery, and found that this combination could be used as a convenient ischemic monitor.
[Case 1] A 68-year-old female underwent off-pump CABG. When ventricular fibrillation lasting only for 30 seconds occurred intraoperatively, a profound decrease in BIS followed and lasted for several minutes.
[Case 2] A 72-year-old male underwent replacement of the descending thoracic aorta. During partial cardiopulmonary bypass (CPB), simultaneous profound decreases in BIS and rSO2 immediately followed acute hypotension.
[Case 3 & 4] Seventy-five and 79-year-old males underwent replacement of the aortic arch. Simultaneous profound decreases in BIS and rSO2 occurred immediately following acute hypotension or compression on the carotid arteries.
[Case 5] A 15-year-old male underwent Fontane procedure for tricuspid atresia. Simultaneous profound decreases in BIS and rSO2 occurred 3 times following acute hypotension due to massive hemorrhage from the ascending aorta, following initial hypotension at the start of CPB via the femoral cannulae, and following intentional circulatory arrest for 10 minutes performed during moderate hypothermia in an attempt to control hemorrhage from the damaged aorta. Our experiences suggest that simultaneous profound decreases in BIS and rSO2 indicate development of cerebral ischemia. Decreased BIS due to deepened anesthesia or hypothermia not accompanied by a decrease in rSO2 can be easily distinguished from that due to cerebral ischemia if rSO2 is simultaneously monitored.