Subarachnoid venous hemorrhage in a patient with retrograde cerebral perfusion during surgery for a thoracic aortic aneurysm

Abstract

Intraoperative coursePrior to surgery, a silicone subarachnoidal drainage tube [Silascon (Kaneka Medix, Osaka, Japan), 5 Fr] was inserted from L3 to L4 (5 cm on the cephalad side) to monitor cerebrospinal pressure and to facilitate the suction of cerebrospinal fluid. The patient was positioned for left posterolateral thoracotomy. The cardiopulmonary bypass was obtained by cannulating the right femoral artery and vein, and the pulmonary artery. The venous cannula was advanced to the right atrium, and then the patient was cooled until a blood temperature of 23.5°C and rectal temperature of 25.4°C were reached. Methylprednisolone (1 g) and pentobarbital (250 mg) were given during cooling. Upon circulatory arrest, the patient was placed in the Trendelenburg position and his head was wrapped in a cold ice bag. The circulation was arrested for 28 min. Simultaneously, retrograde cerebral perfusion was performed through the right atrium, and the flow rate was controlled at around 600 ml·min Ϫ1