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The Annals of Thoracic Surgery, Vol 54, 74-79, Copyright © 1992 by The Society of Thoracic Surgeons
LG Svensson, ES Crawford, V Patel, TR McLean, JW Jones and ME DeBakey
Similar to other methods of organ preservation, "spinoplegia" may protect
the spinal cord from the effects of oxygen desaturation during aortic
cross-clamping. In porcine experiments, spinal cord O2 saturation was
studied during intraoperative localization of the blood supply to the
spinal cord using hydrogen; division of arteries not supplying the spinal
cord; aortic cross-clamping for 60 minutes; and 60 minutes after
unclamping. In 5 animals, 120 mL of cold saline solution with lidocaine
(100 mg/dL) was infused into the aorta during aortic cross-clamping. During
sequential localization, O2 saturation dropped by 40.02% (standard
deviation, 20.16%) for T-14 artery testing versus a decrease of 17.27%
(standard deviation, 11.88%; p = 0.0075) for L-5 artery segment testing in
the control animals and returned to baseline thereafter. During aortic
cross-clamping maximal O2 desaturation was 5% of baseline (15.7%; p less
than 0.0001), which improved slightly by 30 minutes after clamping (48% of
baseline +/- 37.37%; p = 0.048 versus maximum) and then returned to
baseline (97.1% of baseline +/- 41%) with unclamping; 5 minutes later,
hyperoxygenation occurred with a progressive decline thereafter (68% of
baseline +/- 29.3%; p = 0.025, 45 minutes after unclamping versus
baseline). The decrease in spinal motor evoked potentials was significantly
less (p less than 0.02) in the treated group. Intraoperative hydrogen
testing in 8 patients was demonstrated to be safe. It accurately localized
reattached arteries, and O2 saturation of the spinal cord fell by 56%
(standard deviation, 29%; p = 0.0025) with aortic cross-clamping. We
conclude that spinal cord ischemia occurs with aortic cross-clamping in
both animals and humans.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Spinal oxygenation, blood supply localization, cooling, and function with aortic clamping
Department of Surgery, Baylor College of Medicine, Houston, Texas 77030.
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