Adverse Neurologic Sequelae : Central Neurologic Impairment

Case Synopsis

A 68-year-old man with a history of insulin-dependent diabetes mellitus, hypertension, and an 80 pack-year smoking history is scheduled for four-vessel coronary artery bypass grafting (CABG). After uneventful induction of anesthesia, severe aortic atheromatous disease is observed via transesophageal echocardiography in the aortic arch, so epiaortic ultrasound scanning is performed before aortic cannulation to ascertain the optimal location. The patient is maintained during cardiopulmonary bypass at a temperature of 32°C with a mean arterial pressure of 50 to 60 mm Hg. No transfusion is necessary to maintain the hemoglobin above 7 mg/dL. Despite technical success of the surgery, the postoperative course is complicated by significant short-term memory loss and impaired manual dexterity. The patient is discharged first to a skilled nursing facility and eventually to an assisted-living home.