Augmentation of systemic blood pressure during spinal cord ischemia to prevent postoperative paraplegia after aortic surgery in a rabbit model

Izumi, Shigeki; Okada, Kenji; Hasegawa, Tomomi; Omura, Atsushi; Munakata, Hiroshi; Matsumori, Masamichi; Okita, Yutaka

doi:10.1016/j.jtcvs.2009.08.038

Cited by 21 publications

(25 citation statements)

References 22 publications

(27 reference statements)

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“…The fiber optic probe and monitoring device reliably detected spinal cord responses to pharmacological and physiological interventions; the detected responses were in line with published data 29 . Boluses of hypertensive agents created brief periods of hypertension, which were accompanied by brief increases in spinal cord blood flow and oxygenation.…”

Section: Discussionsupporting

confidence: 85%

Fiber-optic Monitoring of Spinal Cord Hemodynamics in Experimental Aortic Occlusion

et al. 2015

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BACKGROUND Spinal cord ischemia occurs frequently during thoracic aneurysm repair. Current methods to detect ischemia, based upon electrophysiology techniques, are indirect, non-specific, and temporally slow. Here we report the testing of a spinal cord blood flow and oxygenation monitor, based on Diffuse Correlation and Optical Spectroscopies, during aortic occlusion in a sheep model. METHODS Testing was carried out in sixteen Dorset sheep. Sensitivity in detecting spinal cord blood flow and oxygenation changes during aortic occlusion, pharmacologically induced hypotension and hypertension, and physiologically induced hypoxia/hypercarbia were assessed. Accuracy of the Diffuse Correlation Spectroscopy measurements was determined via comparison to microsphere blood flow measurements. Precision was assessed through repeated measurements in response to pharmacologic interventions. RESULTS The fiber optic probe can be placed percutaneously, and is capable of continuously measuring spinal cord blood flow and oxygenation preoperatively, intraoperatively, and postoperatively. The device is sensitive to spinal cord blood flow and oxygenation changes associated with aortic occlusion, immediately detecting a fall in blood flow (−65 ± 32%, n=32) and blood oxygenation (−17 ± 13%, n=11) in 100% of trials. Comparison of spinal cord blood flow measurements by the device with microsphere measurements led to a correlation of R2=0.49, p<0.01 and the within-sheep coefficient of variation was 9.69%. Finally, Diffuse Correlation Spectroscopy is temporally more sensitive to ischemic interventions than motor evoked potentials. CONCLUSIONS The first generation spinal fiber optic monitoring device offers a novel and potentially important step forward in the monitoring of spinal cord ischemia.

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Section: Discussionsupporting

confidence: 85%

Fiber-optic Monitoring of Spinal Cord Hemodynamics in Experimental Aortic Occlusion

et al. 2015

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“…The lower incidence of spinal cord injury after endovascular stent-grafting compared to that after open aortic surgery may be attributed to hemodynamic stability while inserting the graft. 70 On the other hand, we also found that high reperfusion pressure in the same models may be deleterious to the spinal cord. 71 Nowadays, every effort is made to maintain the systemic blood pressure regardless of whether we are reconstructing the intercostal arteries or sacrifi cing them.…”

Section: Effect Of Systemic Blood Pressure On Spinal Perfusionsupporting

confidence: 50%

Fighting spinal cord complication during surgery for thoracoabdominal aortic disease

Okita

2011

Gen Thorac Cardiovasc Surg

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Paraplegia or paraparesis after otherwise successful thoracic or thoracoabdominal aortic reconstruction is a devastating complication for both patient and physician. Various strategies have been developed to minimize the incidence of neurological complications after aortic surgery. The incidence of spinal cord ischemia and subsequent neurological complications has been correlated with (1) the duration and severity of ischemia, (2) failure to establish a spinal cord blood supply, and (3) reperfusion injury. Preoperative identification of the arteria radicularis magna, the artery of Adamkiewicz, facilitates identification of critical intercostal vessels for reimplantation, resulting in reestablishing spinal cord blood flow. Techniques for monitoring spinal cord function using evoked potentials have been developed, and surgical techniques have evolved to reduce the duration of ischemia. Furthermore, sequentially sacrificing all the intercostal arteries while maintaining collateral circulation to the cord has produced good outcomes. The severity of ischemia can be minimized by using cerebrospinal fluid drainage, hypothermia, distal bypass, managing the blood pressure, and adjunctive pharmacological therapy. Reperfusion injury can be reduced with the use of antioxidant therapy. Recent advances in endovascular stentgrafting have reduced the incidence of postoperative spinal complications, especially among high-risk patients.

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“…88 described the effect of maintaining high MAP on spinal cord protection in a rabbit model of aortic cross clamping by comparing high and low blood pressure animal groups to a control group; mean (standard deviation) arterial blood pressure during ischemia were controlled at 121.9 (2.8), 50.8 (4.3), and 82.3 (10.7) mmHg in high blood pressure, low blood pressure, and control groups, respectively. They observed higher spinal cord blood flow, lower markers of oxidative stress, faster recovery of transcranial MEPs, and less histological damage of the motor neurons in the animal group treated with higher MAPs.…”

Section: Perioperative Anesthetic Managementmentioning

confidence: 99%

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Awad

Ramadan

Sayed

et al. 2017

Can J Anesth/J Can Anesth

104

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Purpose Thoracic endovascular aortic aneurysm repair (TEVAR) has become a mainstay of therapy for aneurysmal and other disorders of the thoracic aorta. The purpose of this narrative review article is to summarize the current literature on the risk factors, pathophysiology of spinal cord injury (SCI) following TEVAR, and to discuss various intraoperative monitoring and treatment strategies. Source Articles considered in this review were identified through PubMed using the following search terms: thoracic aortic aneurysm, TEVAR, paralysis+TEVAR, risk factors+TEVAR, spinal cord ischemia+TEVAR, neuromonitoring+thoracic aortic aneurysm, spinal drain, cerebrospinal fluid drainage, treatment of spinal cord ischemia. Principal findings Spinal cord injury continues to be a challenging complication after TEVAR. Its incidence after TEVAR is not significantly reduced compared to open TAAA repair. However, compared to open procedures, delayed paralysis/paresis is the predominant presentation of SCI after TEVAR. The pathophysiology of SCI is complex and remains not fully understood though the evolving concept of the importance of the spinal cord’s collateral blood supply network and its imbalance after TEVAR is emerging as a leading factor in the development of SCI. Cerebrospinal fluid drainage, optimal blood pressure management, and newer surgical techniques are important components of the most current spinal cord protection strategies. Conclusion Further experimental and clinical research is needed to aid in the discovery of novel neuroprotective strategies for protection and treatment of SCI following TEVAR.

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Augmentation of systemic blood pressure during spinal cord ischemia to prevent postoperative paraplegia after aortic surgery in a rabbit model

Abstract: Augmentation of systemic blood pressure during spinal cord ischemia can reduce ischemic insult and postoperative neurologic adverse events.

Cited by 21 publications

References 22 publications

Fiber-optic Monitoring of Spinal Cord Hemodynamics in Experimental Aortic Occlusion

Fiber-optic Monitoring of Spinal Cord Hemodynamics in Experimental Aortic Occlusion

Fighting spinal cord complication during surgery for thoracoabdominal aortic disease

Spinal cord injury after thoracic endovascular aortic aneurysm repair

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