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J Thorac Cardiovasc Surg 1994;107:1519-1527
© 1994 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Clinical application of evoked spinal cord potentials elicited by direct stimulation of the cord during temporary occlusion of the thoracic aorta

Hokkaido, Japan

From the Department of Cardiovascular Surgery and Second Department of Surgery, Hokkaido University of Medicine, Hokkaido, Japan.

Received for publication March 25, 1993. Accepted for publication Nov. 2, 1993. Address for reprints: Yoshiro Matsui, MD, Department of Cardiovascular Surgery, Hokkaido University of Medicine, Kita-14, Nishi-5, Kita-ku, Sapporo, Hokkaido, Japan.

Abstract

Evoked spinal cord potentials elicited by direct stimulation of the cord were used to monitor spinal cord ischemia in 68 patients undergoing temporary occlusion of the thoracic aorta (29 thoracic nondissecting aortic aneurysms, 9 nondissecting thoracoabdominal aneurysms, and 30 dissecting aneurysms). "Immediate" postoperative paraplegia developed in three patients and "immediate" paraparesis developed in one, whereas "delayed" paraplegia developed in two others. During aortic crossclamping, four response patterns of the spinal cord potentials were obtained: (1) no change ( n = 53), (2) change with return ( n = 10), (3) change with inconsistent return ( n = 2), and (4) change without return ( n = 3). Neurologic complications occurred in 2%, 0%, 100%, and 100% of these groups, respectively. Delayed paraplegia developed on the second postoperative day in only one patient with a false-negative result, and the potentials correlated well with this patient's clinical neurologic recovery. The aortic crossclamp time was significantly longer in the patients with "change with inconsistent return" and "change without return" than in the other two groups ( p < 0.01). Femoral artery pressure and the cardiopulmonary bypass flow rate were also significantly lower in these groups than in the other two groups ( p < 0.02 and p < 0.01, respectively). We conclude that intraoperative monitoring of direct spinal cord responses is useful for the early detection of spinal cord ischemia for assessing the efficacy of surgical countermeasures. (J THORAC CARDIOVASC SURG 1994;107:1519-27)

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