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Cerebral Oximetry in CABG patient PowerPoint Presentation

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Description : The use of intraoperative cerebral oximetry in Cardiac Surgery

Tags : TCVS, TCVA

Published on : Feb 29, 2020 | Views : 1382 | Downloads : 2

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Slide 1-

Cerebral Oximetry Ana Larissa H. Guerrero, M.D. 3rd Year Resident – UP Philippine General Hospital Department of Anesthesiology
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Case of 3 vessel coronary artery disease for CABG BM, 65/M ASA 4 (3 Vessel CAD, NSTE ACS, HF, t2DM, AKI, CKD, PTB on treatment, Pneumonia) Dx: 3 Vessel Coronary Artery Disease Hx: 1 month history of exertional dyspnea and persistent difficulty of breathing and diaphoresis. Admitted at PGH for 3 vessel CAD s/p NSTE ACS, HFrEF FC II, t2DM uncontrolled, AKI from cardiorenal syndrome type 1 on top of possible CKD from DM, PTN on 2 weeks HRZE treatment. PMH: T2DM x 15 years on Metformin, poorly compliant, no vices, no allergies, no previous surgeries BFC: >4 METS Reassuring airway Upon evaluation at room: PE: Awake alert on NIV 110/80 HR 104 RR 24 99% O2 sat Anicteric sclerae, pink palpebral conjunctiva Equal chest expansion, clear breath sounds Adynamic precordium, normal rate regular rhythm Soft nondistended abdomen nontender full and equal pulses
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Labs: Coronary Angiography L main coronary artery 30-40% distal narrowing 20% ostial stenosis LAD 70-80% ostial stenosis 50-60% proximal stenosis 80-90% distal segment diffuse disease totally occluded near apex, 3 diagonal disease with 95% osteal stenosis LCX totally occluded at ostium RCA diffuse mild to moderate luminal irregularities PLB 70-80% proximal stenosis and is totally occluded after giving a side branch PDA 80-90% proximal stenosis Perfusion scintigraphy - Partial thickness fibrosis (with viable myocardium demonstrated) noted in the basal to midventricular anterolateral, inferolateral and inferior, mid-anterior, apical lateral and inferior LV segments, and the apex. (10/17 LV segments); Viable myocardium in the remainder of the LV segments; Dilated LV cavity with depressed systolic function at rest Chest CT - PTB with cicatricial and bronchiectatic changes; Intercurrent non Kochs pneumonia considered; Minimal pleural effusion B 2D echo - EF 37, eccentric LVH with hypokinesia of anterior and inferior interventricular septum, anterior and lateral LV free wall mid to apex, mild MR mild TR normal PA pressure
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OR Plan 5-Vessel Coronary Artery Bypass Graft
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Received at the OR…. Awake, arousable, responsive 110/60 HR 89 RR 30 99% O2 sat, dyspneic in sitting position, speaks in phrases Attached to ASA Standard monitors, cerebral oximetry Arterial line, aortic balloon and central line inserted General endotracheal anesthesia done with Midazolam, Fentanyl, Rocuronium, and intubated with ETT 8.0 level 20, cuffed
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Induction
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During Bypass
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Off Bypass
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Observed Trends During Cardiopulmonary Bypass
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Observed Trends in Cerebral Oximetry During Cardiopulmonary Bypass
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