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J Thorac Cardiovasc Surg 2001;121:0316-0323
© 2001 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Monitoring of intrathecal oxygen tension during experimental aortic occlusion predicts ultrastructural changes in the spinal cord

Anders Hellberg, MDa, A. Tulga Ulus, MDa, Lennart Christiansson, MDb, Jan Westman, MD, PhDc, Olli Leppänen, MDa, David Bergqvist, MD, PhDa, Sadettin Karacagil, MD, PhDa

From the Departments of Surgerya and Anesthesiology,b University Hospital, and the Department of Medical Cell Biology,c Uppsala University, Uppsala, Sweden.

This study was supported by research grants from Swedish Medical Research Council (00759 and 02710).

Received for publication May 16, 2000. Revisions requested Aug 22, 2000; revisions received Sept 15, 2000. Accepted for publication Sept 29, 2000. Address for reprints: Anders Hellberg, MD, Department of Surgery, University Hospital, Uppsala, SE-751 85, Sweden.

Objective: To study the correlation between intrathecal PO2 and ultrastructural changes in the spinal cord during thoracic aortic occlusion in pigs.
Material and methods: In 18 pigs, online intrathecal oxygenation was monitored by a multiparameter Paratrend catheter (Biomedical Sensors, High Wycombe, United Kingdom) during 60 minutes' clamping of the proximal and distal descending thoracic aorta. The animals were randomly divided into 2 groups (A and B) depending on the level of distal aortic clamping. Distal aortic perfusion was restored through an aorto-iliac shunt, which also maintained low thoracic segmental perfusion of the spinal cord in group B. Perfusion-fixation technique was used before harvesting the spinal cord specimens, which later were evaluated with light and electron microscopy by an independent observer. Intrathecal parameters were interpreted as normal if PO2 was more than 0.8 kPa and PCO2 was less than 12 kPa, as intermediate ischemia if PO2 was 0.8 or less or PCO2 was more than 12 kPa, and as absolute ischemia if PO2 was 0.8 or less and PCO2 was more than 12 kPa.
Results: Among 6 animals with ultrastructural changes of absolute spinal cord ischemia-reperfusion injury, 5 also had absolute ischemia according to variables derived by the Paratrend catheter. The 2 methods were in agreement in 3 of 5 animals with intermediate ischemia-reperfusion changes and in 5 of 6 animals with normal findings. The accuracy of cerebrospinal fluid PO2 and PCO2 to predict electron microscopy–verified intermediate or absolute ischemia-reperfusion injury was 94%.
Conclusions: Monitoring of intrathecal PO2 after clamping of the descending aorta correlated with ultrastructural changes in the spinal cord in this pig model.






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