title: Extended Motor Evoked Potentials Monitoring Helps Prevent Delayed Paraplegia After Aortic Surgery.
abstract: OBJECTIVE
  Motor evoked potentials (MEPs) monitoring can promptly detect spinal cord ischemia (SCI) from aortic clamping during open thoracoabdominal aneurysm repair (OTAAR) with distal aortic perfusion (DAP) and thus help decrease the risk of immediate postoperative SCI (IP-SCI). However, neither stable MEPs during aortic clamp interval (ACI) nor absence of IP-SCI eliminate the possibility of delayed postoperative SCI (DP-SCI). We hypothesized that extension of MEPs monitoring beyond ACI can also help decrease the risk of DP-SCI.
  
  
  METHODS
  We identified 150 consecutive patients at our institution between April 2005 and October 2014 who underwent OTAAR with DAP and MEPs monitoring and had no IP-SCI. Using logistic regression analysis, we studied the independent effect of extended MEPs monitoring on the risk of developing DP-SCI. We used a propensity score analysis to adjust for potential confounders, such as poorly controlled hypertension, previous aneurysm surgery, splenectomy, acute aortic dissection, aneurysm type, older age, and history of diabetes and smoking.
  
  
  RESULTS
  From the 150 patients, 129 (86%) remained neurologically intact whereas 21 (14%) developed DP-SCI. Nineteen of these twenty-one patients (90%) had no extended monitoring. Fifty-seven of fifty-nine (97%) patients who benefited from extended monitoring had no DP-SCI (p = 0.003). Extended MEPs monitoring was independently associated with decreased risk of DP-SCI (odds ratio = 0.14; 95% confidence interval: 0.03, 0.65; p = 0.01).
  
  
  CONCLUSIONS
  MEPs detect the lowest systemic blood pressure that ensures appropriate spinal cord perfusion in the postoperative period. Thus, they inform the hemodynamic management of patients post-OTAAR, particularly in the absence of a reliable neurological exam.
authors: Department of Neurology, Massachusetts General Hospital, Boston, MA.
authors: Reiner B
authors: RB
authors: See
authors: Department of Neurology, Massachusetts General Hospital, Boston, MA.|National Institute of Neurological Disorders and Stroke/National Institutes of Health, Bethesda, MD.
authors: Oluwole O
authors: OO
authors: Awosika
authors: Department of Vascular Surgery, Massachusetts General Hospital, Boston, MA.
authors: Richard P
authors: RP
authors: Cambria
authors: Department of Vascular Surgery, Massachusetts General Hospital, Boston, MA.
authors: Mark F
authors: MF
authors: Conrad
authors: Department of Vascular Surgery, Massachusetts General Hospital, Boston, MA.
authors: Robert T
authors: RT
authors: Lancaster
authors: Department of Vascular Surgery, Massachusetts General Hospital, Boston, MA.
authors: Virendra I
authors: VI
authors: Patel
authors: Department of Anesthesia, Massachusetts General Hospital, Boston, MA.
authors: Hovig V
authors: HV
authors: Chitilian
authors: Department of Neurology, Beth Israel Deaconess Center, Boston, MA.
authors: Sandeep
authors: S
authors: Kumar
authors: Department of Neurology, Massachusetts General Hospital, Boston, MA.
authors: Mirela V
authors: MV
authors: Simon
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064926:Neurophysiological Monitoring / Q000379:methods*; D010264:Paraplegia / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D020760:Spinal Cord Ischemia / Q000175:diagnosis* / Q000209:etiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*