Cold blood spinal cord plegia for prediction of spinal cord ischemia during thoracoabdominal aneurysm repair.
BACKGROUND
This clinical study was undertaken to evaluate changes in motor evoked potentials (MEPs) during cold blood infusion into a thoracoabdominal aortic aneurysm. We also determined the efficacy of this infusion method for predicting spinal cord injury during thoracoabdominal aortic aneurysmal surgery.


METHODS
We monitored descending evoked spinal cord potentials (ESCPs), segmental ESCPs, and MEPs during the prosthetic replacement phase of thoracoabdominal aneurysmal surgery. We perfused cold blood (4 degrees C, 300 to 450 mL) into aneurysms after clamping the aorta, while monitoring spinal cord potentials in 6 cases of thoracoabdominal aortic aneurysm. If the spinal cord potentials decreased during infusion of cold blood, we reconstructed the intercostal arteries in the aneurysm. If the potentials did not change during the infusion of cold blood and after the aneurysmectomy, we did not reconstruct the intercostal arteries and ligated all of them.


RESULTS
Postoperative paraplegia did not occur in any case. The MEPs decreased in amplitude after infusion of cold blood in 3 cases, but amplitude recovered after reconstruction of the intercostal arteries. The other 3 cases did not show any change after infusion of cold blood, and all of the intercostal arteries in the aneurysm were ligated.


CONCLUSIONS
Cold blood infusion into the aneurysm while monitoring MEPs was a useful adjunct to detect the presence of critical intercostal arteries and to facilitate thoracoabdominal aortic aneurysmal surgery.
Sueda
Taijiro
T
First Department of Surgery, Hiroshima University, School of Medicine, Japan. sueda@hiroshima-u.ac.jp
Okada
Kenji
K
Orihashi
Kazumasa
K
Sugawara
Yuji
Y
Kouchi
Kazuhiro
K
Imai
Katsuhiko
K
D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery*; D001769:Blood; D019917:Blood Vessel Prosthesis Implantation; D003080:Cold Temperature; D004558:Electric Stimulation; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis*; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009044:Motor Cortex / Q000502:physiology; D013116:Spinal Cord / Q000098:blood supply* / Q000502:physiology