Document Detail


Efficacy of transcranial motor-evoked myogenic potentials to detect spinal cord ischemia during operations for thoracoabdominal aneurysms.
MedLine Citation:
PMID:  9011706     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Motor-evoked myogenic potentials after transcranial electrical stimulation monitor the vulnerable motoneuronal system of the spinal cord. This study reports our initial experiences with motor-evoked potentials to assess the adequacy of spinal cord perfusion during operations for thoracoabdominal aneurysms. METHODS: In 20 patients undergoing thoracoabdominal aneurysm operations, myogenic motor-evoked potentials were recorded. In 18 patients retrograde aortic perfusion was used. When spinal cord ischemia was detected, distal flow or mean arterial pressure was increased in an attempt to restore cord perfusion. By means of sequential crossclamping, motor-evoked potentials were also used to identify intercostal or lumbar arteries that needed to be reimplanted. RESULTS: Reproducible motor-evoked potentials could be recorded in all patients. During retrograde perfusion, nine patients showed a rapid decrease in the amplitude of motor-evoked potentials to less than 25% of baseline, indicating spinal cord ischemia. In five patients ischemic changes in motor-evoked potentials could be reversed by increasing distal and proximal blood pressures. In four patients ischemic changes during crossclamping necessitated segmental artery reimplantation. In three of these four patients intercostal or lumbar arteries were reattached. In one patient reimplantation of segmental arteries was not possible; this patient awoke paraplegic. Segmental arteries were ligated after confirmation of intact motor-evoked potentials during aortic clamping in eight patients. None of these patients had a neurologic deficit. The absence of motor-evoked potentials at the end of the procedure always indicated a postoperative motor deficit. CONCLUSION: During operations for thoracoabdominal aneurysms, monitoring of motor-evoked potentials is an effective technique to detect spinal cord ischemia within minutes. This modality can be used to guide the management of distal aortic perfusion techniques and may also help to identify segmental arteries that need to be reattached.
Authors:
P de Haan; C J Kalkman; B A de Mol; L H Ubags; D J Veldman; M J Jacobs
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  113     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-02-04     Completed Date:  1997-02-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  87-100; discussion 100-1     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Academic Hospital, University of Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aortic Aneurysm, Abdominal / physiopathology*,  surgery
Aortic Aneurysm, Thoracic / physiopathology*,  surgery
Evoked Potentials*
Humans
Ischemia / diagnosis*,  physiopathology*
Middle Aged
Spinal Cord / blood supply*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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