Is intrathecal lactate concentration monitoring helpful for postoperative paraplegia after descending aorta surgery?

Giustiniano, Enrico; Ruggieri, Nadia

doi:10.1016/j.jclinane.2014.03.009

Cited by 7 publications

(5 citation statements)

References 11 publications

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“…In our experience, we already found a significant increase of Lac CSF in a patient submitted to open TAA repair who experienced SCI post-operatively 20,21 . Unfortunately, at that time we did not monitor rSO 2 , and consequently we cannot compare the two cases.…”

Section: Discussionmentioning

confidence: 66%

Near-infrared spectroscopy to monitor spinal cord oxygenation in οpen thoraco-abdominal aortic surgery. A case series

Giustiniano

Nisi

Palma

et al. 2022

HJVES

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Objectives. We adopted the near-infrared spectroscopy (NIRS) technology to monitor the spinal oxygen supply through the paraspinous muscles oxygenation in agreement with the concept of “collateral network” circulation. We retrospectively investigated our database of subjects who underwent thoraco-abdominal aorta open repair assessing for the reliability of this monitoring to predict spinal cord injury. Methods. Consecutive patients who underwent elective thoraco-abdominal aorta open repair between March 2019 and September 2021. In addition to standard monitoring, patients received the monitoring of the paraspinous muscles oxygenation by NIRS. Results. In one patient a significant drop of the mean arterial pressure (49 mmHg) and the spinal-cord perfusion pressure (31 mmHg) occurred after the aortic clamping, with a contemporary lowering of the left-side oxygenation of paraspinous muscles (<40%). Both the blood pressure and the spinal cord perfusion pressure were restored within 10 minutes, but the oxygenation remained at an unsafe level (<55%) until the end of the surgery. This same patient experienced a lower-limb paralysis post-operatively. It did not happen in the other 11 cases of the sample. Conclusions. The main finding of our retrospective analysis indicates reliability of this technology to monitor the spinal cord oxygenation during open thoraco-abdominal aortic surgery and possibly predict spinal cord injury. Still, several questions need to be addressed about the suitability of this technology to the anatomic and pathophysiology of the spinal cord circulation

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Section: Discussionmentioning

confidence: 66%

Near-infrared spectroscopy to monitor spinal cord oxygenation in οpen thoraco-abdominal aortic surgery. A case series

Giustiniano

Nisi

Palma

et al. 2022

HJVES

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“…During the operation we monitored intratecal pressure (P csf ) and the spinal cord perfusion pressure (PP csf ) along with Lactate concentration into CSF (Lac csf ) because it may be a marker of local ischemic suffering [5][6][7][8]. Lac csf and P csf did not showed significant alterations, intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

Transient Unilateral Lower Limb Palsy after Open Surgery Thoraco-Abdominal Aorta Repair

Corazzi¹,

Stefania²,

Giustiniano³

et al. 2018

Int J Anesthetic Anesthesiol

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Paraplegia is one of the most devastating complication after Thoraco-abdominal Aorta (TAA) repair both in open surgery and in endovascular procedure, caused by critical obstruction to blood perfusion of the Spinal Cord.Spinal Cord Ischemia (SCI) may be due to hemodynamic impairment and/or to segmental artery occlusion during aortic clamping [1,2].We report a case of chronically dissected Thoraco-abdominal Aortic Aneurysm (TAAA) which showed unilateral transient neurological impairment of the left lower limb, postoperatively. KeywordsSpinal cord injury, Aorta, Surgery chronic obstructive pulmonary disease (COPD) with FEV1/FVC ratio 0.43 and FEV1 1.12 L (44%).The pre-operative echocardiogram showed: Mild hypertrophy of left ventricle walls (13-14 mm), left ventricle end-diastolic volume at upper limit (LVEDVi = 74 ml/ m 2 ), inferior wall and interventricular septum were akinetic providing a reduced ejection fraction (LVEF 0.38) that did ameliorate at dobutamine echo-stress (LVEF 0.47); furthermore it showed mild aortic valve stenosis (medium pressure gradient 20 mmHg with valve area 1.2 cm 2 ).He underwent general anesthesia that was inducted by Midazolam 5 mg iv, Fentanyl 200 mcg iv. After myorelaxation with cis-Atracurium 12 mg iv a double-lumen endotracheal tube n.41 was inserted to connect the patient's airways to mechanical ventilator (Vt 560; respiratory rate 12; positive end-expiratory pressure 5 cm H 2 O); he received a gas mixture of oxygen/air (FiO 2 40-60%) and Sevoflurane 1-2%, as appropriate. Myorelaxation continued with cis-Atracurium 1 mg/kg/h. Remifentanil 0.1-0.2 mcg/kg/min was administered.

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“…[27] When the spinal cord experiences an ischemic event, lactate release is the epiphenomenon of cellular impairment due to insufficient oxygen delivery, whereas lactate production occurs as neurons switch to anaerobic metabolism. [28] To avoid injury to the blood supply to the spinal cord, the microcirculation around the intervertebral foramen should be protected when ligating the vertebral segmental vessels.…”

Section: Discussionmentioning

confidence: 99%

The incidence and risk factors of postoperative neurological deterioration after posterior decompression with or without instrumented fusion for thoracic myelopathy

Wang

Xue

et al. 2016

Medicine

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The aim of this study was to explore the incidence and risk factors of postoperative neurological deterioration after posterior decompression with or without instrumented fusion for thoracic myelopathy, and hope to provide references in decision-making and surgical planning for both spinal surgeon and thoracic stenosis patients.By retrieving the medical records from January 2001 to November 2015, 168 patients were retrospectively reviewed. According to the occurrence of postoperative neurological deterioration, patients were divided into 2 groups: neurological deterioration (ND) group and non-ND group. To investigate risk values for the occurrence of ND, 3 categorized factors were analyzed statistically: patient characteristics—preoperative data of age, sex, body mass index, bone mineral density, the duration of disease (from first symptoms to operation), the preoperative neurological function (Frankel grade), and diagnosis; surgical variables—surgery time, the amount of bleeding, mean arterial pressure, intervertebral fusion or not, and instrumentation or not; radiographic parameters—the spinal canal occupancy ratio, location of the lesion, thoracic kyphosis, and kyphosis correction.Postoperative neurological deterioration was developed in 23 of 168 patients (13.7%), and were enrolled as ND group. There was no statistically significant difference between the 2 groups in age at operation, sex composition, body mass index, and bone mineral density. The preoperative diagnosis presented significant difference between the 2 groups, because ossification of posterior longitudinal ligament combined with ossification of the ligamentum flavum was more common in ND group, whereas ossification of the ligamentum flavum alone was more common in non-ND group. There was no difference between the 2 groups in mean surgery time, the incidence of intraoperative direct trauma, and the number of patients that received instrumentation. The mean bleeding was much more in ND group than that in non-ND group, and the mean arterial pressure was lower in ND group than that in non-ND group. Also, the mean spinal canal occupancy ratio was more severe in ND group than that in non-ND group. There were no statistically significant difference between the 2 groups in stenosis location and preoperative thoracic kyphosis. The mean kyphosis correction was more significant in ND group. When included in a multivariate logistic regression model, thoracic disc herniation + ossification of posterior longitudinal ligament, spinal canal occupancy ratio more than 70%, bleeding more than 800 mL, and mean arterial pressure less than 81 mm Hg were independently associated with the postoperative neurological deterioration.In conclusion, ossification of posterior longitudinal ligament combined with ossification of the ligamentum flavum, spinal canal occupancy ratio more than 70%, intraoperative bleeding more than 800 mL, and mean arterial pressure less than 81 mm Hg are risk factors for the occurrence of postoperative neurologic deterioration. Improving s...

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Is intrathecal lactate concentration monitoring helpful for postoperative paraplegia after descending aorta surgery?

Cited by 7 publications

References 11 publications

Near-infrared spectroscopy to monitor spinal cord oxygenation in οpen thoraco-abdominal aortic surgery. A case series

Near-infrared spectroscopy to monitor spinal cord oxygenation in οpen thoraco-abdominal aortic surgery. A case series

Transient Unilateral Lower Limb Palsy after Open Surgery Thoraco-Abdominal Aorta Repair

The incidence and risk factors of postoperative neurological deterioration after posterior decompression with or without instrumented fusion for thoracic myelopathy

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