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Ann Thorac Surg 1992;54:74-79
© 1992 The Society of Thoracic Surgeons

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Articles

Spinal oxygenation, blood supply localization, cooling, and function with aortic clamping

Department of Surgery, Baylor College of Medicine, Houston, Texas USA

^_* Address reprint requests to Dr Svensson, Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.

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 < 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 < 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. Preservation of hydrogen-localized arteries maintains oxygenation of the spinal cord and is accurate in both animals and humans. Segmental infusion of a "spinoplegia" prevented the loss of spinal motor evoked potentials. Further research may identify improved spinal cord preservation techniques, including "spinoplegia," and effective agents.

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