Paraplegia following thoracic aortic cross-clamping in dogs. No difference in neurological outcome with a barbiturate versus isoflurane.
OBJECTIVE
We compared the incidence and severity of paraplegia following thoracic aortic cross-clamping in dogs for two anesthetic regimens. Animals were randomly assigned to receive methohexital (group M; n = 9) or isoflurane (group I; n = 9). We expected a better neurological outcome in animals administered methohexital because of superior neuronal protection and greater spinal cord perfusion pressure (mean arterial pressure below the cross-clamp site minus mean cerebrospinal fluid pressure).


METHODS
After surgical preparation and a 30-minute stabilization period, dogs in group M received 14 +/- 6 mg.kg-1 i.v. methohexital to induce an isoelectric electroencephalogram followed by a continuous infusion of methohexital at 20 mg.kg-1 x h-1. Dogs in group I received 1.4 +/- 0.2% end-tidal isoflurane (1 minimum alveolar concentration). The thoracic aorta was then occluded 2.5 cm distal to the left subclavian artery for 30 minutes and then released. Hemodynamics and cerebrospinal fluid pressure were measured at (1) baseline, (2) 2 minutes after aortic cross-clamping, (3) 20 minutes after aortic cross-clamping, (4) 5 minutes after aortic unclamping, and (5) 30 minutes after resuscitation. At 24 hours a neurological assessment was performed. After the clinical assessment the dogs were killed and the spinal cord removed immediately for histopathologic study.


RESULTS
There were no differences in nasopharyngeal temperature, PaCO2, pH, or hemoglobin at any time between groups. With cross-clamping, the spinal cord perfusion pressure decreased precipitously. However, there was no difference in spinal cord perfusion pressure between groups at any time (P = .5555). The neurological outcome, assessed at 24 hours after thoracic aortic cross-clamping by a veterinarian unaware of the anesthetic protocol, was not different between groups (P > .5, two-tailed Mann-Whitney rank-sums test). When anesthetized with methohexital 5 of 9 dogs were paraplegic; with isoflurane 7 of 9 dogs were paraplegic. By Spearman's rank test, a strong inverse correlation between the Tarlov score and the ratio of dead to total lumbar anterior spinal cord neurons was seen (Spearman's correlation coefficient = -.8358; P = .0001).


CONCLUSIONS
We conclude that no advantage was offered by the choice of anesthesia to neurological outcome after 30 minutes of thoracic aortic cross-clamping in this canine model.
Department of Anesthesia, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
W A
WA
Mutch
M R
MR
Graham
W C
WC
Halliday
J M
JM
Teskey
I R
IR
Thomson
D000704:Analysis of Variance; D000818:Animals; D001013:Aorta, Thoracic / Q000502:physiology*; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood; D015170:Cerebrospinal Fluid Pressure; D004285:Dogs; D004569:Electroencephalography / Q000187:drug effects*; D007530:Isoflurane / Q000494:pharmacology* / Q000627:therapeutic use; D008723:Methohexital / Q000494:pharmacology* / Q000627:therapeutic use; D009474:Neurons / Q000187:drug effects / Q000473:pathology / Q000502:physiology*; D010264:Paraplegia / Q000473:pathology / Q000503:physiopathology* / Q000517:prevention & control*; D010313:Partial Pressure; D013116:Spinal Cord / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*
D002245:Carbon Dioxide; D007530:Isoflurane; D008723:Methohexital