title: Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management.
abstract: OBJECTIVE
  The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker.
  
  
  METHODS
  Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov: NCT01385384.
  
  
  RESULTS
  The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day.
  
  
  CONCLUSIONS
  The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Thoracic Surgery Department, São Paulo/SP, Brazil. tedde@usp.br
authors.forename: Miguel L
authors.initials: ML
authors.lastname: Tedde
authors.forename: Paulo
authors.initials: P
authors.lastname: Vasconcelos Filho
authors.forename: Ludhmila Abrahão
authors.initials: LA
authors.lastname: Hajjar
authors.forename: Juliano Pinheiro
authors.initials: JP
authors.lastname: de Almeida
authors.forename: Gustavo Fagundes
authors.initials: GF
authors.lastname: Flora
authors.forename: Erica Mie
authors.initials: EM
authors.lastname: Okumura
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Osawa
authors.forename: Julia Tizue
authors.initials: JT
authors.lastname: Fukushima
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.forename: Filomena Regina Barbosa Gomes
authors.initials: FR
authors.lastname: Galas
authors.forename: Fabio Biscegli
authors.initials: FB
authors.lastname: Jatene
authors.forename: José Otávio Costa
authors.initials: JO
authors.lastname: Auler
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000379:methods*; D003964:Diaphragm; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D010138:Pacemaker, Artificial; D019990:Perioperative Care / Q000379:methods; D059035:Perioperative Period; D019919:Prosthesis Implantation / Q000379:methods*; D011782:Quadriplegia / Q000628:therapy; D012121:Respiration, Artificial / Q000379:methods*; D013119:Spinal Cord Injuries; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult