Neuropathy After Coronary Artery Bypass Surgery
Swenson JD, Bull DA,
Postoperative Ulnar Neuropathy Associated with Prolonged Ischemia in the Upper Extremity During Coronary Artery Bypass Surgery
Anesth Analg 85: 1275-1277, 1997
AS many as 37% of cardiac surgery patients experience an injury to the ulnar nerve. A case of ulnar neuropathy, after a period [3.5 hours approximately] of decreased arterial blood pressure in the right arm is reported.
Man, 63 years of age, having coronary artery bypass surgery, experienced severe right radial artery waveform dampening about 10 minutes into surgery. The left radial artery waveform was normal. The right radial artery catheter was suspected to have a fold at the hub of the catheter. Cardiopulmonary bypass was completed uneventfully, using the left radial artery catheter to monitor blood pressure; the right radial artery blood pressure remained low. On the first postoperative day, the patient complained of sensory loss in the right hand, with wrist flexion, finger adduction, and abduction weakness. After 3 months, the patients strength and sensory function returned to near normal; but he reported waking up frequently with numbness and weakness. His symptoms were reproduced in the left arm when brachial artery blood flow was occluded. Failure to ensure adequate arterial perfusion to the arms, increases the sensitivity of the ulnar nerve to ischemia.