Document Detail


Thoracic and thoracoabdominal aortic aneurysm repair: use of evoked potential monitoring in 118 patients.
MedLine Citation:
PMID:  11743557     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Paraplegia is the most dreaded and severe complication of surgery on the descending thoracic aorta (TAA) and thoracoabdominal aorta (TAAA). The functional integrity of the spinal cord can be monitored by means of intraoperative recording of myogenic-evoked responses after transcranial electrical stimulation (tcMEP) and somatosensory-evoked potential (SEP) monitoring. In this study, we evaluated the results of evoked potential monitoring and the adequacy of the strategy followed.
METHOD: The spinal cord of 118 patients (78 men; age, 65 +/- 12 years; 79 TAAAs, 39 TAAs) undergoing surgery on the TAA or TAAA was monitored with tcMEP and SEP. Spinal cord protection was achieved by means of a multimodality approach: moderate hypothermia (32 degrees C rectal temperature), continuous cerebrospinal fluid drainage to keep the pressure less than 10 mm Hg, reimplantation of intercostal arteries, left ventricular bypass grafting, and staged clamping. In the case of evoked potential changes more than 50% of baseline, the strategy was adjusted: reattachment of more segmental arteries when technically feasible, higher distal and proximal perfusion pressures, and enhanced cerebrospinal fluid drainage.
RESULTS: Forty-two of 118 patients (35.6%) had a more than 50% of baseline tcMEP reduction during cross-clamping. At this point, only 5 of those 42 cases were also associated with SEP reduction of more than 50% of baseline. On the basis of the tcMEP findings, the strategy was adjusted. Five patients had postoperative paraplegia (4.2%).
CONCLUSION: tcMEP monitoring seems to be a useful adjunct of the protective techniques and may cause substantial adjustments in strategy, reducing the incidence of postoperative paraplegia.
Authors:
E P van Dongen; M A Schepens; W J Morshuis; H T ter Beek; L P Aarts; A de Boer; E H Boezeman
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Publication Detail:
Type:  Journal Article; Validation Studies    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  34     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2001 Dec 
Date Detail:
Created Date:  2001-12-14     Completed Date:  2002-01-18     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1035-40     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Aneurysm, Abdominal / mortality,  surgery*
Aortic Aneurysm, Thoracic / mortality,  surgery*
Blood Vessel Prosthesis Implantation / methods
Constriction
Electric Stimulation / instrumentation,  methods*
Evoked Potentials, Somatosensory*
Female
Hospital Mortality
Humans
Intraoperative Complications / diagnosis*,  etiology,  prevention & control
Logistic Models
Male
Middle Aged
Monitoring, Intraoperative / instrumentation,  methods*,  standards
Paraplegia / diagnosis*,  etiology,  prevention & control
Prognosis
Risk Factors
Sensitivity and Specificity
Thoracotomy / methods
Time Factors
Treatment Outcome

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


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