title: Remote ischemic preconditioning protects the spinal cord against ischemic insult: An experimental study in a porcine model.
abstract: OBJECTIVE
  Surgical repair of thoracoabdominal aneurysm jeopardizes the vascularization of the spinal cord, and therefore, despite improvement in surgical techniques, still carries the risk of paraplegia. This study aimed to demonstrate the possible protective effects of remote ischemic preconditioning (RIPC) on the preservation of spinal cord function after segmental artery (SA) occlusion.
  
  
  METHODS
  Twenty piglets were randomized into the RIPC group (n = 10) and the control group (n = 10). The RIPC group underwent transient left hind limb ischemia before systematic left subclavian artery and SA occlusion at the level of the diaphragm. Motor-evoked potential (MEP) monitoring was performed from the hind limbs. Afterward, the thoracic and lumbar spinal cords were harvested and analyzed.
  
  
  RESULTS
  The elevation of the MEP amplitude after RIPC was statistically significant, whereas amplitude was consistently decreased in the control group. Additionally, the onset latency was significantly shorter after RIPC during SA occlusion. The control group reached a 50% decrease of MEP amplitude in the right hind limb sooner than did the experimental group.
  
  
  CONCLUSIONS
  Remote ischemic preconditioning preserves spinal cord function after left subclavian artery and SA occlusion, as indicated by the MEP amplitudes.
authors: Department of Surgery, Oulu University Hospital (MRC) and University of Oulu, Oulu, Finland.
authors: Henri
authors: H
authors: Haapanen
authors: Department of Surgery, Oulu University Hospital (MRC) and University of Oulu, Oulu, Finland.
authors: Johanna
authors: J
authors: Herajärvi
authors: Department of Surgery, Oulu University Hospital (MRC) and University of Oulu, Oulu, Finland.
authors: Oiva
authors: O
authors: Arvola
authors: Department of Surgery, Oulu University Hospital (MRC) and University of Oulu, Oulu, Finland.
authors: Tuomas
authors: T
authors: Anttila
authors: Department of Clinical Neurophysiology, Oulu University Hospital (MRC) and University of Oulu, Oulu, Finland.
authors: Tuomo
authors: T
authors: Starck
authors: Department of Clinical Neurophysiology, Oulu University Hospital (MRC) and University of Oulu, Oulu, Finland.
authors: Mika
authors: M
authors: Kallio
authors: Department of Surgery, Oulu University Hospital (MRC) and University of Oulu, Oulu, Finland.
authors: Vesa
authors: V
authors: Anttila
authors: Department of Pathology, Oulu University Hospital (MRC) and University of Oulu, Oulu, Finland.
authors: Hannu
authors: H
authors: Tuominen
authors: Department of Anesthesiology, Oulu University Hospital (MRC) and University of Oulu, Oulu, Finland.
authors: Kai
authors: K
authors: Kiviluoma
authors: Department of Surgery, Oulu University Hospital (MRC) and University of Oulu, Oulu, Finland. Electronic address: tatu.juvonen@oulu.fi.
authors: Tatu
authors: T
authors: Juvonen
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D004195:Disease Models, Animal; D019054:Evoked Potentials, Motor; D005260:Female; D006439:Hemodynamics; D006614:Hindlimb / Q000098:blood supply*; D064795:Intraoperative Neurophysiological Monitoring; D019194:Ischemic Preconditioning / Q000379:methods*; D009460:Neurologic Examination; D011930:Reaction Time; D012039:Regional Blood Flow; D013116:Spinal Cord / Q000098:blood supply*; D020760:Spinal Cord Ischemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013348:Subclavian Artery / Q000503:physiopathology / Q000601:surgery; D013552:Swine; D013997:Time Factors
keywords: cardiovascular procedures; motor-evoked potentials; remote ischemic preconditioning; spinal cord