[Motor evoked potentials in thoracoabdominal aortic surgery].
Thoracoabdominal aortic disease (aneurysm or dissection) has increased in recent decades. Surgery is the curative treatment but is associated to high perioperative morbidity and mortality risks. Paraplegia is one of the most severe complications, whose incidence has decreased significantly with the implementation of spinal cord protection strategies. No single method or combination of methods has proven to be fully effective in preventing paraplegia. This review is intended to analyse the scientific evidence available on the role of intraoperative monitoring with motor evoked potentials in the neurological outcome of patients undergoing thoracoabdominal aortic surgery. An online search (PubMed) was conducted. Relevant references were selected and reviewed. Intraoperative monitoring with motor evoked potentials (MEP) allows early detection of ischemic events and a targeted intervention to prevent the development of spinal cord injury, significantly reducing the incidence of postoperative paraplegia. MEP monitoring may undergo several intraoperative interferences which may compromise their interpretation. Neuromuscular blockade is the main limiting factor of anesthetic origin. It is essential to strike a balance between monitoring conditions and surgical and anesthetic needs as well as to evaluate the risks and benefits of the technique for each patient. MEP monitoring improves neurological outcome when integrated in a multidisciplinary strategy which must include multiple protective mechanisms that should be tailored to each hospital reality.
Serviços de Anestesiologia do Instituto Português de Oncologia de Lisboa e do Hospital de Santa Maria e Unidade de Cuidados Intensivos do Hospital de Vila Franca de Xira, Portugal.
Cátia
C
Magro
David
D
Nora
Miguel
M
Marques
Angela Garcia
AG
Alves
D000784:Aortic Dissection / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019054:Evoked Potentials, Motor / Q000502:physiology*; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods; D010264:Paraplegia / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D013119:Spinal Cord Injuries / Q000209:etiology / Q000517:prevention & control