Risk of Spinal Cord Dysfunction in Patients Undergoing Thoracoabdominal Aortic Replacement

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

“…Spinal cord perfusion pressure optimization using techniques, such as proximal aortic pressure maintenance and distal aortic perfusion, is reasonable as an integral part of the surgical, anesthetic, and perfusion strategy in open and endovascular thoracic aortic repair patients at high risk of spinal cord ischemic injury. Institutional experience is an important factor in selecting these techniques (138,(191)(192)(193). (Level of Evidence: B) 2.…”

“…Adjunctive techniques to increase the tolerance of the spinal cord to impaired perfusion may be considered during open and endovascular thoracic aortic repair for patients at high risk of spinal cord injury. These include distal perfusion, epidural irrigation with hypothermic solutions, high-dose systemic glucocorticoids, osmotic diuresis with mannitol, intrathecal papaverine, and cellular metabolic suppression with anesthetic agents (193,(195)(196)(197). (Level of Evidence: B) 2.…”

Assessment of intraoperative motor evoked potentials for predicting postoperative paraplegia in thoracic and thoracoabdominal aortic aneurysm repair

“…Finally, in this study there were no patients with delayed paraplegia, i.e., paraplegia that occurred after confirming normal motor function in the lower extremities postoperatively. The reported incidence of delayed paraplegia overall in patients with SCI is 20-40% [19][20][21][22]. The reason that we did not have patients with delayed paraplegia is unclear; however, a possible reason is that the postoperative hemodynamic management was adequate.…”

Prolonged loss of leg myogenic motor evoked potentials during thoracoabdominal aortic aneurysm repair, without postoperative paraplegia

“…Tsutsumi et al [14] reported that post-ischemic hypothermia (rectal temperature, 32.5 ± 0.5°C) induced immediately after reperfusion significantly reduced ischemically induced neural damage. Modest hypothermia, for the specific purpose of spinal cord protection during thoracoabdominal aortic aneurysm repair, was achieved by allowing core temperatures to drift into the 32°C-34°C range, which, in animals, has been shown to provide protection [15].…”