HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cunningham, J. N. Articles by Spencer, F. C. Search for Related Content PubMed PubMed Citation Articles by Cunningham, J. N., Jr Articles by Spencer, F. C.

The Journal of Thoracic and Cardiovascular Surgery, Vol 94, 275-285, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Monitoring of somatosensory evoked potentials during surgical procedures on the thoracoabdominal aorta. IV. Clinical observations and results

JN Cunningham Jr, JC Laschinger and FC Spencer

Thirty-three patients undergoing operations on the descending thoracic or thoracoabdominal aorta were monitored to evaluate causes and effects of spinal cord ischemia as manifested by changes in somatosensory evoked potentials. Maintenance of distal aortic perfusion pressure (greater than 60 mm Hg) by either shunt or bypass techniques in 17 patients resulted in preservation of somatosensory evoked potentials and a normal postoperative neurologic status, irrespective of the interval of thoracic cross-clamping (range 23 to 105 minutes). In 16 other patients in whom cross-clamp time ranged from 16 to 124 minutes, evoked potential loss was observed because of failure to provide distal perfusion (n = 8), inadequate maintenance of distal perfusion pressure (less than 60 mm Hg) despite shunt/bypass (n = 6), or interruption of critical intercostal arteries (n = 2). Incidence of paraplegia in the entire group was 15.1% (5/33) and was limited to only those patients in whom evoked potential loss occurred (5/16, 31.2%) (p = 0.02). Loss of somatosensory evoked potentials for more than 30 minutes resulted in a 71.2% (5/7) incidence of paraplegia, whereas no neurologic deficit was noted in patients (0/26) in whom evoked potential loss was either prevented or limited in duration to 30 minutes (p less than 0.001 versus loss for more than 30 minutes). Intraoperative monitoring of somatosensory evoked potentials is a sensitive indicator of spinal cord ischemia. Simple aortic cross-clamping, failure to maintain distal perfusion pressure above 60 mm Hg, and inability to reimplant critical intercostals in a timely fashion result in a high rate of paraplegia if duration of spinal cord ischemia as measured by somatosensory evoked potentials exceeds 30 minutes. Routine evoked potential monitoring during thoracoabdominal procedures appears useful in assessing the adequacy of spinal cord perfusion. Furthermore, it can alert the surgeon to the necessity for critical intercostal artery reimplantation as well as the need for adjustment or regulation of distal aortic perfusion.

This article has been cited by other articles:

				T. B. Reece, G. R. Green, and I. L. Kron Aortic Dissection Card. Surg. Adult, January 1, 2008; 3(2008): 1195 - 1222. [Full Text]

				C. D. Etz, J. C. Halstead, D. Spielvogel, R. Shahani, R. Lazala, T. M. Homann, D. J. Weisz, K. Plestis, and R. B. Griepp Thoracic and Thoracoabdominal Aneurysm Repair: Is Reimplantation of Spinal Cord Arteries a Waste of Time? Ann. Thorac. Surg., November 1, 2006; 82(5): 1670 - 1677. [Abstract] [Full Text] [PDF]

				B. Makkad and S. Pilling Management of Thoracic Aneurysm Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2005; 9(3): 227 - 240. [Abstract] [PDF]

				L. Lang-Lazdunski, J. Bachet, and C. Rogers Repair of the descending thoracic aorta: impact of open distal anastomosis technique on spinal cord perfusion, neurological outcome and spinal cord histopathology Eur. J. Cardiothorac. Surg., August 1, 2004; 26(2): 351 - 358. [Abstract] [Full Text] [PDF]

				Y. Kuniyoshi, K. Koja, K. Miyagi, M. Shimoji, T. Uezu, K. Arakaki, S. Yamashiro, K. Mabuni, S. Senaha, and Y. Nakasone Prevention of postoperative paraplegia during thoracoabdominal aortic surgery Ann. Thorac. Surg., November 1, 2003; 76(5): 1477 - 1484. [Abstract] [Full Text] [PDF]

				H. S. Maniar, T. M. Sundt III, S. M. Prasad, C. M. Chu, C. J. Camillo, M. R. Moon, B. G. Rubin, and G. A. Sicard Delayed paraplegia after thoracic and thoracoabdominal aneurysm repair: a continuing risk Ann. Thorac. Surg., January 1, 2003; 75(1): 113 - 120. [Abstract] [Full Text] [PDF]

				G. R. Green and I. L. Kron Aortic Dissection Card. Surg. Adult, January 1, 2003; 2(2003): 1095 - 1122. [Full Text]

				T. Sueda, K. Okada, K. Orihashi, Y. Sugawara, K. Kouchi, and K. Imai Cold blood spinal cord plegia for prediction of spinal cord ischemia during thoracoabdominal aneurysm repair Ann. Thorac. Surg., April 1, 2002; 73(4): 1155 - 1159. [Abstract] [Full Text] [PDF]

				E. A. Hessel Bypass Techniques for Descending Thoracic Aortic Surgery Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2001; 5(4): 293 - 320. [Abstract] [PDF]

				K. Shibata, S. Takamoto, Y. Kotsuka, T. Miyairi, T. Morota, K. Ueno, and H. Sato Doppler ultrasonographic identification of the critical segmental artery for spinal cord protection Eur. J. Cardiothorac. Surg., September 1, 2001; 20(3): 527 - 532. [Abstract] [Full Text] [PDF]

				I. Y.P. Wan, G. D. Angelini, A. J. Bryan, I. Ryder, and M. J. Underwood Prevention of spinal cord ischaemia during descending thoracic and thoracoabdominal aortic surgery Eur. J. Cardiothorac. Surg., February 1, 2001; 19(2): 203 - 213. [Abstract] [Full Text] [PDF]

				A. Hellberg, A. T. Ulus, L. Christiansson, J. Westman, O. Leppanen, D. Bergqvist, and S. Karacagil Monitoring of intrathecal oxygen tension during experimental aortic occlusion predicts ultrastructural changes in the spinal cord J. Thorac. Cardiovasc. Surg., February 1, 2001; 121(2): 0316 - 323. [Abstract] [Full Text] [PDF]

				T. Sueda, S. Morita, K. Okada, K. Orihashi, H. Shikata, and Y. Matsuura Selective intercostal arterial perfusion during thoracoabdominal aortic aneurysm surgery Ann. Thorac. Surg., July 1, 2000; 70(1): 44 - 47. [Abstract] [Full Text] [PDF]

				M. J.H.M. Jacobs, P. de Haan, S. A. Meylaerts, B. A. de Mol, and C. J. Kalkman Benefits of Monitoring Motor-Evoked Potentials during Thoracoabdominal Aortic Aneurysm Repair: Technique of Choice to Assess Spinal Cord Ischemia? Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 2000; 12(2): 1 - 16. [Abstract] [PDF]

				J.-M. Guerit, C. Witdoeckt, R. Verhelst, A. J. Matta, L. M. Jacquet, and R. A. Dion Sensitivity, specificity, and surgical impact of somatosensory evoked potentials in descending aorta surgery Ann. Thorac. Surg., June 1, 1999; 67(6): 1943 - 1946. [Abstract] [Full Text] [PDF]

				J. D. Galla, M. A. Ergin, S. L. Lansman, J. N. McCullough, K. H. Nguyen, D. Spielvogel, J. J. Klein, and R. B. Griepp Use of somatosensory evoked potentials for thoracic and thoracoabdominal aortic resections Ann. Thorac. Surg., June 1, 1999; 67(6): 1947 - 1952. [Abstract] [Full Text] [PDF]

				M. K. Heinemann, F. Brassel, T. Herzog, C. Dresler, H. Becker, and H. G. Borst The Role of Spinal Angiography in Operations on the Thoracic Aorta: Myth or Reality? Ann. Thorac. Surg., February 1, 1998; 65(2): 346 - 351. [Abstract] [Full Text] [PDF]

				A. C. Galloway, D. S. Schwartz, A. T. Culliford, G. H. Ribakove, E. A. Grossi, R. A. Esposito, F. G. Baumann, J. Delianides, F. C. Spencer, and S. B. Colvin Selective Approach to Descending Thoracic Aortic Aneurysm Repair: A Ten-Year Experience Ann. Thorac. Surg., October 1, 1996; 62(4): 1152 - 1157. [Abstract] [Full Text]

				J. S. Coselli Thoracoabdominal Aortic Aneurysms Ann. Thorac. Surg., January 1, 1996; 61(1): 269 - 270. [Full Text]

				O. E. Dapunt, J. D. Galla, A. M. Sadeghi, S. L. Lansman, C. K. Mezrow, R. A. de Asla, C. Quintana, S. Wallenstein, A. M. Ergin, and R. B. Griepp The natural history of thoracic aortic aneurysms J. Thorac. Cardiovasc. Surg., May 1, 1994; 107(5): 1323 - 1333. [Abstract] [Full Text]

				J. A. Herold, I. L. Kron, S. E. Langenburg, L. H. Blackbourne, and C. G. Tribble Complete prevention of postischemic spinal cord injury by means of regional infusion with hypothermic saline and adenosine J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 536 - 542. [Abstract] [Full Text]