title: Intrathecal lactate as a predictor of early- but not late-onset spinal cord injury in thoracoabdominal aneurysmectomy.
abstract: OBJECTIVE
  To evaluate the role of intrathecal lactate as an early predictor of spinal cord injury during thoracoabdominal aortic aneurysmectomy.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Forty-four consecutive patients scheduled to undergo thoracoabdominal aortic aneurysmectomy. Two patients had a type-B dissecting aneurysm while the other 42 patients suffered from degenerative aneurysm.
  
  
  METHODS
  None.
  
  
  METHODS
  During surgery, samples of cerebrospinal fluid and arterial blood were withdrawn simultaneously to evaluate lactate concentration. Samples were collected at 4 fixed times during and after surgery: T1 (beginning of the intervention), T2 (15 minutes after aortic cross-clamping), T3 (just before unclamping), T4 (end of surgery).
  
  
  RESULTS
  Mean lactate levels in cerebrospinal fluid rose consistently and steadily from the beginning of the intervention until after surgery (T1 = 1.83 mmol/L), T2 = 2.10 mmol/L, T3 = 2.72 mmol/L, T4 = 3.70 mmol/L). Seven patients developed spinal cord injury; two of them had delayed injury occurring 24 hours after the end of surgery; the remaining 5 had early onset. In this group of 5 patients, preoperative cerebrospinal fluid lactate levels were significantly (p = 0.04) higher than those of the other 37 patients preoperatively (2.12 ± 0.35 v 1.79 ± 0.29 mmol/L).
  
  
  CONCLUSIONS
  Preoperative cerebrospinal lactate concentration is elevated in patients who will develop early-onset spinal cord injury after thoracoabdominal aortic aneurysmectomy. This may allow a better stratification of these patients, suggesting a more aggressive strategy of spinal cord function preservation, such as systematic reimplanting of intercostal arteries, and possibly obtaining a better outcome.
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Buratti
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Carozzo
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Casiraghi
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Lembo
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pasin
authors.affiliation: Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Marone
authors.affiliation: Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Germano
authors.initials: G
authors.lastname: Melissano
authors.affiliation: Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Chiesa
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D003422:Critical Care / Q000379:methods; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood / Q000134:cerebrospinal fluid*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000134:cerebrospinal fluid*; D011237:Predictive Value of Tests; D013119:Spinal Cord Injuries / Q000134:cerebrospinal fluid* / Q000209:etiology*; D015607:Stents; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods
chemical_list: D019344:Lactic Acid
keywords: aortic aneurysm; cerebrospinal fluid; lactic acid; paraplegia; spinal cord injury