Ischemic preconditioning and spinal cord function monitoring in the descending thoracic aorta approach.

Publisher: Sociedad Brasileira De Cardiologia Country of Publication: Brazil NLM ID: 0421031 Publication Model: Print Cited Medium: Internet ISSN: 1678-4170 (Electronic) Linking ISSN: 0066782X NLM ISO Abbreviation: Arq Bras Cardiol Subsets: MEDLINE

Original Publication: Sao Paulo : Sociedad Brasileira De Cardiologia

Aorta, Thoracic/*surgery ; Evoked Potentials, Somatosensory/*physiology ; Ischemic Preconditioning/*standards ; Spinal Cord Ischemia/*diagnosis ; Spinal Cord Ischemia/*prevention & control; Analysis of Variance ; Animals ; Dogs ; Female ; Ischemic Preconditioning/methods ; Male ; Models, Animal ; Monitoring, Intraoperative/methods ; Paraplegia/etiology ; Reperfusion/methods ; Sensitivity and Specificity ; Spinal Cord/blood supply ; Spinal Cord/physiopathology ; Spinal Cord Ischemia/etiology ; Spinal Cord Ischemia/physiopathology ; Statistics, Nonparametric ; Time Factors ; Vascular Surgical Procedures/adverse effects

Objectives: 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.

Date Created: 20070530 Date Completed: 20080306 Latest Revision: 20190606

20231215

10.1590/s0066-782x2007000300007

17533470