title: [Two cases showing the absence of motor evoked potentials without developing postoperative paraplegia following thoracoabdominal aortic repair--role of epidural cooling, spinal drainage and aorto-iliac side-arm conduit distal perfusion].
abstract: We describe two cases which developed loss of motor evoked potentials from bilateral lower limbs following thoracoabdominal aortic repair. Paraplegia was suspected in both cases; however, one case of Crawford type 2 aneurysm showed transient left leg monoplegia with a sensory deficit and the other case of aortic pseudoaneurysm showed no neurologic dysfunction postoperatively. We employed epidural cooling and spinal drainage for spinal protection and distal perfusion was provided through aorto-iliac side-arm conduit. Despite the prolonged spinal ischemia during thoracoabdominal aortic repair, spinal drainage and epidural cooling were very helpful for protecting the spinal cord from ischemia. The interpretation of MEPs seems very difficult especially when the potentials remain absent even after reconstruction or reperfusion of segmental arteries, because variety of intraoperative factors may affect them.
authors.affiliation: Department of Anesthesiology, Critical Care Medicine, Tokyo Medical and Dental University, Tokyo 113-8519.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakazawa
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Inatomi
authors.forename: Yudai
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobinata
authors.forename: Koshi
authors.initials: K
authors.lastname: Makita
mesh_terms: D001012:Aorta, Abdominal / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D004322:Drainage / Q000379:methods*; D004824:Epidural Space; D019054:Evoked Potentials, Motor / Q000502:physiology*; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010264:Paraplegia; D010477:Perfusion / Q000379:methods*; D019990:Perioperative Care; D011183:Postoperative Complications; D013116:Spinal Cord