title: Intrathecal lactate concentration and spinal cord injury in thoracoabdominal aortic surgery.
abstract: 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.
authors.affiliation: Department of Anesthesia and Intensive Care, Milan, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Casiraghi
authors.forename: Davide
authors.initials: D
authors.lastname: Poli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Luca
authors.initials: L
authors.lastname: Buratti
authors.forename: Roberto
authors.initials: R
authors.lastname: Imberti
authors.forename: Valentina
authors.initials: V
authors.lastname: Plumari
authors.forename: Stefano
authors.initials: S
authors.lastname: Turi
authors.forename: Roberta
authors.initials: R
authors.lastname: Mennella
authors.forename: Melissa
authors.initials: M
authors.lastname: Messina
authors.forename: Remo Daniel
authors.initials: RD
authors.lastname: Covello
authors.forename: Andrea
authors.initials: A
authors.lastname: Carozzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Motta
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: 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*
chemical_list: D015415:Biomarkers; D019344:Lactic Acid