Perioperative Management to Improve Neurologic Outcome in Thoracic or Thoracoabdominal Aortic Stent-Grafting
| Autor: | Ronen Sircar, M Hartert, Maximilian Luehr, Michael P. Siegenthaler, Patrick von Samson, Gábor Szabó, Nicholas A. Beckmann, Christian D. Etz, Ernst Weigang, Friedhelm Beyersdorf |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Adult
Pulmonary and Respiratory Medicine Thorax medicine.medical_specialty Blood Vessel Prosthesis Implantation Aortic aneurysm Cerebrospinal fluid Monitoring Intraoperative medicine.artery medicine Humans Evoked potential Evoked Potentials Aged Cerebrospinal Fluid Aged 80 and over Paraplegia Aorta Aortic Aneurysm Thoracic business.industry Perioperative Middle Aged medicine.disease Spinal cord Surgery medicine.anatomical_structure Spinal Cord Anesthesia Drainage Stents Cerebrospinal fluid pressure Hypotension Cardiology and Cardiovascular Medicine business Aortic Aneurysm Abdominal |
| Zdroj: | The Annals of Thoracic Surgery. 82:1679-1687 |
| ISSN: | 0003-4975 |
| Popis: | Background Thoracic or thoracoabdominal aortic stent-graft repair has shown a reduction in morbidity and mortality rates due to the procedure's advantages (no aortic cross-clamping, continuous distal aortic perfusion, no reperfusion injury). However, 3% to 12% of the patients are at risk of spinal cord ischemia. We investigated spinal cord protective measures with evoked potentials, cerebrospinal fluid drainage, and prevention of hypotension to minimize postoperative neurologic deficit. Methods Between November 2000 and July 2005, vital parameters and spinal cord function were monitored, including cerebrospinal fluid pressure and transcranial motor-evoked and somatosensory-evoked potentials in 36 stent-graft procedures (31 patients) on the thoracic or thoracoabdominal aorta. Results Stent-graft placement was technically successful in all patients. We achieved a survival rate of 100% without neurologic deficit after fast-track extubation. Eleven of 31 patients exhibited changes in evoked potentials during stent-graft deployment. In 12 of 31 patients (including the 11 with evoked potential alterations), cerebrospinal fluid pressure exceeded 15 mm Hg. Cerebrospinal fluid drainage and vital parameter adjustment were executed in those instances. We observed intraoperative evoked potential total recovery in 10 of 11 patients after these interventions. Conclusions Interventions to improve spinal cord perfusion led to total recovery of spinal function in most patients (10/11). Therefore, spinal cord protective measures with motor- and somatosensory-evoked potential monitoring, cerebrospinal fluid drainage, and prevention of hypotension can reduce the incidence of spinal cord ischemia and improve the neurologic outcome of patients undergoing endovascular thoracic or thoracoabdominal aortic repair. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|