Intrathecal lactate concentration and spinal cord injury in thoracoabdominal aortic surgery.
OBJECTIVE
The aim of this study was to evaluate the role of lactate as an early predictor of spinal cord injury during thoracoabdominal aortic aneurysm repair.


METHODS
Observational study.


METHODS
University hospital.


METHODS
Sixteen consecutive patients (10 men and 6 women) scheduled to undergo thoracoabdominal aortic aneurysm repair were enrolled in the study. All patients were affected by atherosclerotic aneurysmal pathology.


METHODS
None.


RESULTS
During surgery, the authors simultaneously withdrew samples of cerebrospinal fluid and arterial blood to evaluate pO(2), pCO(2), pH, and lactate concentration. Samples were collected at 5 fixed times during and after surgery: T1 (before aortic cross-clamping), T2 (15 minutes after clamping), T3 (just before unclamping), T4 (end of surgery), and T5 (4 hours after the end of surgery). Lactate levels in cerebrospinal fluid rose consistently during aortic cross-clamping (T1 = 1.89 mmol/L, T2 = 2.21 mmol/L, T3 = 2.88 mmol/L, T4 = 3.655 mmol/L, and T5 = 3.16 mmol/L). Lactate concentrations in the cerebrospinal fluid were significantly higher in the 4 patients who developed neurologic injury, even at T1 (before surgery), than in those who did not end in spinal cord injury with the 4 highest values belonging to the 4 patients who later developed spinal cord injury.


CONCLUSIONS
This study has the potential to elucidate the time course of early lactate level elevation during thoracoabdominal aortic aneurysm repair and its clinical use in predicting the development of postoperative spinal cord injury.
Casiraghi
Giuseppina
G
Department of Anesthesia and Intensive Care, Milan, Italy.
Poli
Davide
D
Landoni
Giovanni
G
Buratti
Luca
L
Imberti
Roberto
R
Plumari
Valentina
V
Turi
Stefano
S
Mennella
Roberta
R
Messina
Melissa
M
Covello
Remo Daniel
RD
Carozzo
Andrea
A
Motta
Andrea
A
Zangrillo
Alberto
A
D000328:Adult; D000768:Anesthesia, General; D001012:Aorta, Abdominal / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000134:cerebrospinal fluid / Q000601:surgery; D015415:Biomarkers; D003422:Critical Care; D004211:Disseminated Intravascular Coagulation; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D019344:Lactic Acid / Q000134:cerebrospinal fluid*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications / Q000134:cerebrospinal fluid* / Q000209:etiology*; D011229:Preanesthetic Medication; D011237:Predictive Value of Tests; D012772:Shock, Septic / Q000209:etiology; D013119:Spinal Cord Injuries / Q000134:cerebrospinal fluid* / Q000209:etiology*; D013908:Thoracotomy; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D015415:Biomarkers; D019344:Lactic Acid