| Excessively high systemic blood pressure in the early phase of reperfusion exacerbates early-onset paraplegia in rabbit aortic surgery. | |
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MedLine Citation:
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PMID: 20537355 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: We have demonstrated that therapeutic augmentation of systemic blood pressure during spinal cord ischemia plays an important role in minimizing spinal cord injury in both experimental and clinical aortic surgery. However, there remain concerns that excessively high blood pressure during spinal cord reperfusion may aggravate the reperfusion injury. The purpose of this study is to investigate the effect of high blood pressure during spinal cord reperfusion on postoperative neurologic outcomes after aortic surgery in rabbits. METHODS: Experiments were performed using a rabbit spinal cord ischemia-reperfusion model in 2 randomly divided groups: (1) In the HR group, the mean blood pressure was maintained at a high level (121 +/- 1.3 mm Hg) during reperfusion with intravenously administered phenylephrine; and (2) in the CR group, the mean blood pressure was not medically controlled (75 +/- 9.1 mm Hg) during reperfusion. Neurologic and histologic assessments and evaluation of early reperfusion injury were performed. RESULTS: In the HR group, slow and incomplete recovery of transcranial motor-evoked potentials (P = .02) and low neurologic scores (P < .005) were observed during spinal cord reperfusion compared with the CR group. At 48 hours of reperfusion, there were significantly fewer viable neuron cells, more apoptosis, and more perivascular edema with gray matter vacuolation in the HR group (P < .001 for each). At 3 hours, myeloperoxidase activity (P = .0021), vascular permeability (P = .0012), and superoxide generation (P < .0001) were significantly increased in the HR group. CONCLUSION: Excessively high blood pressure in the early phase of spinal cord reperfusion increased reperfusion injury in the spinal cord, leading to exacerbation of early-onset paraplegia. Avoidance of spinal cord reperfusion with high blood pressure may be one management strategy in thoracoabdominal aortic surgery. |
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Authors:
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Bishow Pokhrel; Tomomi Hasegawa; So Izumi; Atsushi Ohmura; Hiroshi Munakata; Yutaka Okita; Kenji Okada |
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Publication Detail:
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Type: Journal Article Date: 2010-05-27 |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 140 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-19 Completed Date: 2010-08-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 400-7 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Animals Aorta / physiopathology, surgery* Apoptosis Blood Pressure* / drug effects Capillary Permeability Cell Survival Disease Models, Animal Evoked Potentials, Motor Motor Neurons / metabolism, pathology Neurologic Examination Paraplegia / etiology*, metabolism, pathology, physiopathology Peroxidase / metabolism Phenylephrine / administration & dosage Rabbits Recovery of Function Reperfusion Injury / etiology*, metabolism, pathology, physiopathology Spinal Cord / blood supply*, metabolism, pathology, physiopathology Spinal Cord Ischemia / etiology*, metabolism, pathology, physiopathology Superoxides / metabolism Time Factors Vascular Surgical Procedures / adverse effects* Vasoconstrictor Agents / administration & dosage |
| Chemical | |
Reg. No./Substance:
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0/Vasoconstrictor Agents; 11062-77-4/Superoxides; 59-42-7/Phenylephrine; EC 1.11.1.7/Peroxidase |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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