Can entropy predict neurologic complications after cardiac surgery?
A 65-year-old, 85 kg, 152 cm, male was presented with a ST segment elevation myocardial infarction. Preoperative echocardiography showed an EF of 25%, and LV akinetic apex and anterolateral wall and dyskinetic of the inferior wall. Cardiac catheterization showed 95% occlusions of both RCA and left main coronary artery with severely impaired LV function. Circulatory support was achieved with intra-aortic balloon pump counter-pulsations (IABP), dobutamine, and nitroglycerin. Heparin infusion was going on.\nHe underwent an emergent bypass grafting for the LAD, diagonal and RCA under the standardized TCI propofol-sufentanil anesthesia, and cisatracurium infusion. After heparinization, mild hypothermic CPB was established. An abrupt decreases of RE and SE values from 52 and 48, respectively, to isoelectric silence was noted. Propofol Ce and sufentanil Ce were lowered to 1 and 0.1 μg/mL, respectively, till the end of surgery. This was followed with gradual increases in RE and SE toward the low 10 s that persisted till the end of surgery.\nThe cross-clamp time was 120 min and the CPB time was 240 min. The patient was subsequently successfully separated from CPB with IABP and intravenous infusions of epinephrine (18 μg/min), dobutamine (5 μg/kg/min), and nitroglycerin (1 μg/kg/min). The cisatracurium, sufentanil, and propofol infusions were discontinued.\nStable MAP, CVP, and SaO2, normocapnia, and euglycemia were maintained throughout the perioperative period. Normothermia (rectal temperature >36°C) was maintained before and after bypass.\nThe patient was shifted to the ICU ventilated with SIMV. He did not wake up even seven days after surgery. His Glasgow Coma Scale (GCS) was 4/15. Brain CT showed an extensive nonhemorrhagic left tempro-parietal infarction. His postoperative course was complicated with vasodilatory shock, renal failure, and sepsis. The patient passed away on the seventh postoperative day.