Risk of spinal cord dysfunction in patientsundergoing thoracoabdominal aortic replacement
| Autor: | Francis J. Kazmier, Donald E. Harmon, Samuel R. Money, Larry H. Hollier, Robert J. Marino, C. Daniel Procter, William C. Buhrman, Thomas C. Naslund |
|---|---|
| Rok vydání: | 1992 |
| Předmět: |
Adult
Male Risk medicine.medical_specialty Aortic Diseases Ischemia Aorta Thoracic Spinal Cord Diseases Postoperative Complications medicine.artery medicine Humans Aorta Abdominal Prospective Studies Prospective cohort study Spinal cord injury Aged Retrospective Studies Aged 80 and over Aorta business.industry Incidence General Medicine Perioperative Middle Aged medicine.disease Spinal cord Aortic Aneurysm Surgery medicine.anatomical_structure Anesthesia Female Paraplegia business Reperfusion injury |
| Zdroj: | The American Journal of Surgery. 164:210-214 |
| ISSN: | 0002-9610 |
| DOI: | 10.1016/s0002-9610(05)81072-4 |
| Popis: | The records of 150 consecutive patients undergoing thoracoabdominal aortic replacement from 1980 to 1991 were retrospectively reviewed. There were 89 men and 61 women; mean age was 67.8 years (range: 33 to 88 years). Since June 1989, a multimodality prospective perioperative protocol was used to reduce the risk of spinal cord dysfunction. Ischemia is minimized by complete intercostal reimplantation whenever possible, cerebrospinal fluid drainage, and maintenance of proximal hypertension during cross-clamping. Spinal cord metabolism is reduced by moderate hypothermia, high-dose barbiturates, and avoidance of hyperglycemia. Reperfusion injury is minimized by the use of mannitol, steroids, and calcium channel blockers. Ninety-seven percent of patients survived long enough for evaluation of their neurologic function. Spinal cord dysfunction was reduced from 6 of 108 (6%) in the preprotocol group to 0 of 42 in the protocol group (0%) (p less than 0.01). The overall 30-day operative mortality was not significantly different between the groups (9% versus 12%, p = NS). A multimodality protocol appears to be effective in reducing the risk of spinal cord injury during thoracoabdominal aortic replacement. |
| Databáze: | OpenAIRE |
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