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Ann Thorac Surg 2002;73:1155-1159
© 2002 The Society of Thoracic Surgeons

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Original article: cardiovascular

Cold blood spinal cord plegia for prediction of spinal cord ischemia during thoracoabdominal aneurysm repair

^a First Department of Surgery, Hiroshima University, School of Medicine, Hiroshima, Japan

Accepted for publication December 18, 2001.

* Address reprint requests to Dr Sueda, First Department of Surgery, Hiroshima University, School of Medicine, 1-2-3 Kasumi, Minami-ku, Hiroshima 734, Japan
e-mail: sueda{at}hiroshima-u.ac.jp

Background. This clinical study was undertaken to evaluate changes in motor evoked potentials (MEPs) during cold blood infusion into a thoracoabdominal aortic aneurysm. We also determined the efficacy of this infusion method for predicting spinal cord injury during thoracoabdominal aortic aneurysmal surgery.

Methods. We monitored descending evoked spinal cord potentials (ESCPs), segmental ESCPs, and MEPs during the prosthetic replacement phase of thoracoabdominal aneurysmal surgery. We perfused cold blood (4°C, 300 to 450 mL) into aneurysms after clamping the aorta, while monitoring spinal cord potentials in 6 cases of thoracoabdominal aortic aneurysm. If the spinal cord potentials decreased during infusion of cold blood, we reconstructed the intercostal arteries in the aneurysm. If the potentials did not change during the infusion of cold blood and after the aneurysmectomy, we did not reconstruct the intercostal arteries and ligated all of them.

Results. Postoperative paraplegia did not occur in any case. The MEPs decreased in amplitude after infusion of cold blood in 3 cases, but amplitude recovered after reconstruction of the intercostal arteries. The other 3 cases did not show any change after infusion of cold blood, and all of the intercostal arteries in the aneurysm were ligated.

Conclusions. Cold blood infusion into the aneurysm while monitoring MEPs was a useful adjunct to detect the presence of critical intercostal arteries and to facilitate thoracoabdominal aortic aneurysmal surgery.

This article has been cited by other articles:

				M. Hamaishi, K. Orihashi, S. Takahashi, M. Isaka, K. Okada, and T. Sueda Transcranial motor-evoked potentials following intra-aortic cold blood infusion facilitates detection of critical supplying artery of spinal cord Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 695 - 699. [Abstract] [Full Text] [PDF]

				T. Fleck, C. Hamilton, M. P. Ehrlich, D. Hutschala, H. Koinig, E. Wolner, and M. Grabenwoger Thoracoabdominal Aortic Aneurysm Repair: Reducing Adverse Outcome with Left Heart Bypass, Selective Visceral Perfusion and Renal Protection Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2002; 6(4): 287 - 291. [Abstract] [PDF]