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Ann Thorac Surg 1992;54:818-825
© 1992 The Society of Thoracic Surgeons

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Articles

Intrathecal perfusion of an oxygenated perfluorocarbon prevents paraplegia after aortic occlusion

^a Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn, New York, USA
^b Polyclinic Medical Center, Harrisburg, Pennsylvania, USA

^_* Address reprint requests to Dr Marini, Polyclinic Medical Center, Harrisburg, PA 17110.

A canine model was used to evaluate the effects of continuous intrathecal perfusion of an oxygenated perfluorocarbon emulsion on systemic and cerebral hemodynamics and neurologic outcome after 70 minutes of normothermic aortic occlusion. Twelve mongrel dogs were instrumented to monitor proximal and distal arterial blood pressure, cerebrospinal fluid pressure, spinal cord perfusion pressure, and somatosensory evoked potentials. The intrathecal perfusion apparatus consisted of two perfusing catheters, placed in the intrathecal space through a laminectomy, and a draining catheter percutaneously inserted in the cisterna cerebellomedullaris. The aorta was cross-clamped just distal to the left subclavian artery for 70 minutes. Animals were randomized into two groups: group 1 (n = 6) animals were treated with intrathecal perfusion of saline solution, whereas group 2 (n = 6) animals received oxygenated Fluosol-DA 20%. Data were acquired at baseline, during the cross-clamp period, and after reperfusion. Normothermic Fluosol or saline solution was infused at a rate of 15 mL/min beginning 15 minutes before cross-clamping and continued throughout the ischemic interval. There was no difference in proximal arterial blood pressure (97.2 versus 95.4 mm Hg; p > 0.05) or distal arterial blood pressure (14.6 versus 15.0; p > 0.05) between the two groups throughout the cross-clamp interval. Cerebrospinal fluid pressure rose significantly in both groups with the onset of intrathecal perfusion of either saline solution or Fluosol (7 ± 1 versus 24 ± 5 and 8 ± 1 versus 40 ± 4 mm Hg, respectively; p < 0.05). The rise in cerebrospinal fluid pressure was sustained throughout the perfusion interval in both groups. Negative spinal cord perfusion pressure values were recorded in both groups throughout the cross-clamp interval. All Fluosol-treated animals regained electrophysiologic conduction within 10 minutes of reperfusion and were spared neurologic injury. In contrast, all but 1 animal treated with saline solution suffered spastic paraplegia. Based on the results of this study, we conclude that the intrathecal space can be used as an alternate vascular tree to perfuse the spinal cord with an oxygenated perfluorocarbon emulsion. In this canine model, paraplegia after 70 minutes of normothermic aortic occlusion can be uniformly prevented by the intrathecal perfusion of normothermic Fluosol-DA 20%.

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