Pré-condicionamento isquêmico e monitorização da função medular na abordagem da aorta torácica descendente

Abstract

SummaryObjectives: To evaluate the effectiveness of acute ischemic preconditioning (IP), based on somatosensory evoked potentials (SSEP) monitoring, as a method of spinal cord protection and to asses SSEP importance in spinal cord neuromonitoring.Methods: Twenty-eight dogs were submitted to spinal cord ischemic injury attained by descending thoracic aorta cross-clamping. In the C45 group, the aortic cross-clamping time was 45 min (n=7); in the IP45 group, the dogs were submitted to IP before the aortic cross-clamping for 45 min (n=7). In the C60 group, the dogs were submitted to 60 min of aortic cross-clamping (n=7), as in the IP60 group that was previously submitted to IP. The IP cycles were determined based on SSEP changes.Results: Tarlov scores of the IP groups were significantly better than those of the controls (p = 0.005). Paraplegia was observed in 3 dogs from C45 and in 6 from C60 group, although all dogs from IP45 group were neurologically normal, as 4 dogs from IP60. There was a significant correlation between SSEP recovery time until one hour of aortic reperfusion and the neurological status (p = 0.011), showing sensitivity of 75% and specificity of 83%.Conclusion: Repetitive acute IP based on SSEP is a protection factor during spinal cord ischemia, decreasing paraplegia incidence. SSEP monitoring seems to be a good neurological injury assessment method during surgical procedures that involve spinal cord ischemia.

Changes in transcranial electrical motor‑evoked potentials during the early and reversible stage of permanent spinal cord ischemia predict spinal cord injury in a rabbit animal model

“…SEP monitoring has been reported to be a useful and non-invasive method for protecting spinal cord function and detecting spinal cord ischemic injury ( 24 ). SEPs have been used frequently because they may be recorded intraoperatively under general anesthesia ( 25 ). However, SEPs primarily examine the sensory pathway of the dorsal column, and the specificity and sensitivity of SEPs for monitoring the motor neuron pathways has been questioned ( 26 , 27 ).…”

Incomplete Anterior Spinal Artery Syndrome Responsive to Intrathecal Baclofen

“…Spinal cord monitoring is a well-documented mechanism for detecting intraoperative spinal cord injury. It has also been suggested that ischemic preconditioning of the spinal cord before EVAR may be protective against neurological injury [12]. ACS is a well-documented complication of these procedures [2,5,[7][8][9].…”

Isoflurane Preconditioning Induces Neuroprotection by Up-Regulation of TREK1 in a Rat Model of Spinal Cord Ischemic Injury

“…Some studies have indicated that ischemic preconditioning has protective actions in many organs (Zheng and Zuo, 2004; Wakeno-Takahashi et al ., 2005; Mônaco et al ., 2007). However, ischemic preconditioning is impractical for clinical practice (Tong et al ., 2014).…”