Appraisal of cerebrospinal fluid alterations during aortic surgery with intrathecal papaverine administration and cerebrospinal fluid drainage.
We have previously described a technique for intrathecal administration of papaverine and cerebrospinal fluid drainage to prevent paraplegia after aortic surgery. Herein we report the cerebrospinal fluid and hemodynamic alterations that occurred in 11 patients who had 30 mg of a specially prepared papaverine hydrochloride 10% dextrose solution injected before aortic cross-clamping and also had cerebrospinal fluid drainage. A mean of 26.6 ml (SD +/- 7.1 ml) was drained before and 34.6 ml (SD +/- 24.1 ml) was drained during aortic cross-clamping. The cerebrospinal fluid pressure increased significantly with anesthetic induction (p less than 0.03), during the period between anesthetic induction and cerebrospinal fluid drainage (p less than 0.005), and with aortic cross-clamping (p less than 0.05). These cerebrospinal fluid pressure alterations were similar to central venous pressure increases with a significant linear correlation between cerebral spinal fluid pressure and central venous pressure before anesthetic induction (r2 = 0.81, p less than 0.005), and both before (r2 = 0.94, p less than 0.005) and after (r2 = 0.74, p less than 0.005) aortic cross-clamping. As expected, cerebrospinal fluid pressure was significantly reduced by cerebrospinal fluid drainage before aortic cross-clamping (p less than 0.001). The administration of intrathecal papaverine had no significant effect on mean arterial pressure, systemic vascular resistance, cerebrospinal fluid pressure, nor the pH of cerebrospinal fluid. Neither were there any complications noted related to the technique. All the patients survived, and no new immediate postoperative paraparesis or paraplegia occurred.(ABSTRACT TRUNCATED AT 250 WORDS)
Svensson
L G
LG
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio.
Grum
D F
DF
Bednarski
M
M
Cosgrove
D M
DM
Loop
F D
FD
D001011:Aorta / Q000601:surgery*; D002555:Cerebrospinal Fluid / Q000502:physiology*; D015170:Cerebrospinal Fluid Pressure; D004322:Drainage; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D007430:Intraoperative Care; D007511:Ischemia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010208:Papaverine / Q000008:administration & dosage / Q000627:therapeutic use*; D010264:Paraplegia / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D013116:Spinal Cord / Q000098:blood supply
D010208:Papaverine