Regional deep hypothermia of the spinal cord protects against ischemic injury during thoracic aortic cross-clamping

Salzano, Richard; Ellison, Lee H.; Altonji, Paul F.; Richter, James J.; Deckers, Peter J.

doi:10.1016/0003-4975(94)90366-2

Cited by 50 publications

(19 citation statements)

References 33 publications

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“…Eventually, the inflammatory response is perpetuated via the production of cytokines by microglia and activated neutrophils, thereby leading to further generation of these radicals [9,21] . Consequently, preventing lipid peroxidation appears to be important in the maintenance of cellular structural integrity and the prevention of neuronal injury associated with I/R [2][3][4] .…”

Section: Discussionmentioning

confidence: 99%

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Methylene Blue Decreases Ischemia-Reperfusion (I/R)-Induced Spinal Cord Injury: An in vivo Study in an I/R Rabbit Model

Bardakçi¹,

Kaplan²,

Karadeniz³

et al. 2006

Eur Surg Res

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Objectives: To evaluate the effects of intravenous methylene blue (MB) administration on ischemia-reperfusion (I/R) injury of the spinal cord (SC). Methods: 16 rabbits were randomly assigned either to group M (n = 8; receiving MB, intervention group) or group C (n = 8; control group) and underwent a 30-min period of SC ischemia by clamping the abdominal aorta between the left renal artery and the aortic bifurcation. 15 min before clamping, rabbits received either intravenous MB (10 mg/kg; group M) or normal saline (group C). The two groups were compared 24 h postoperatively both histologically and for neurological function, using a Tarlov score. Measurements to determine levels of malondialdehyde (MDA) and glutathione (GSH) in the SC tissue were also performed. Results: Neurological impairment and spinal tissue MDA levels were significantly lower in animals treated with MB (p < 0.001). In contrast, spinal GSH levels were significantly higher in group M (p < 0.001). Histological examination revealed that the integrity of the SC was better preserved in the MB group, whereas cords from the control group exhibited evidence of acute neuronal injury. Conclusions: The prophylactic use of MB reduces neurological injury and improves clinical outcomes in the rabbit SC I/R model. These effects are probably mediated by the drug’s antioxidant properties.

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Section: Discussionmentioning

confidence: 99%

“…Different operative and non-operative strategies have been developed in order to protect patients from neurological damage. However, none of these strategies has provided a universally satisfactory solution [3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

Methylene Blue Decreases Ischemia-Reperfusion (I/R)-Induced Spinal Cord Injury: An in vivo Study in an I/R Rabbit Model

Bardakçi¹,

Kaplan²,

Karadeniz³

et al. 2006

Eur Surg Res

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“…Hypothermia acts by decreasing oxygen consumption and inhibiting excitatory neurotransmitter release. [43][44][45][46] Motoyoshi et al 47 reported that hypothermia also extended the production of heat shock protein in spinal cord motor neurons after reperfusion, and inhibited the level of apoptosis. There is a linear relationship between temperature and the duration of ischemia that may be tolerated by the spinal cord.…”

Section: Distal Perfusionmentioning

confidence: 97%

Spinal Cord Protection During Thoracoabdominal Aneurysm Repair

Tabayashi

2005

Surg Today

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Spinal cord injury after thoracoabdominal aortic surgery remains a devastating and unpredictable complication, caused by clamping of the thoracoabdominal aorta, resulting in exclusion of blood flow in critical and essential intercostal arteries. Various protective methods against spinal cord ischemia have been proposed and performed clinically. These include preoperative spinal angiography, distal aortic perfusion, hypothermia, reattachment of the intercostal artery, cerebrospinal fluid drainage, administration of neuroprotective agents, and monitoring of somatosensory and motor-evoked potentials. The information to date suggests that multimodality approaches should be used to prevent spinal cord injury after thoracic and thoracoabdominal aneurysm repair.

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“…Experiments have shown that regional hypothermic perfusion applied to the epidural or intrathecal space may protect the spinal cord during cross-clamping of the aorta. 81 A clinically applicable closed epidural infusion system to achieve moderate spinal cord hypothermia (26°-28°C) has been described in dogs. The principal component of the system is an epidural catheter placed at the T10-T12 level with infusion of iced (4°C) normal saline.…”

Section: Hypothermiamentioning

confidence: 99%

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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Regional deep hypothermia of the spinal cord protects against ischemic injury during thoracic aortic cross-clamping

Cited by 50 publications

References 33 publications

Methylene Blue Decreases Ischemia-Reperfusion (I/R)-Induced Spinal Cord Injury: An in vivo Study in an I/R Rabbit Model

Methylene Blue Decreases Ischemia-Reperfusion (I/R)-Induced Spinal Cord Injury: An in vivo Study in an I/R Rabbit Model

Spinal Cord Protection During Thoracoabdominal Aneurysm Repair

Fighting spinal cord complication during surgery for thoracoabdominal aortic disease

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