Spinal cord protection and thoracic aortic surgery

Current Opinion in Anaesthesiology
Ashish C Sinha, Albert T Cheung

Abstract

Spinal cord ischemia remains an important complication of open surgical and endovascular stent graft repair of thoracic and thoracoabdominal aortic aneurysm despite advances in operative technique. Identification of risk factors and interventions to prevent and treat spinal cord ischemia has the potential to prevent spinal cord infarction and the morbidity and mortality associated with paraplegia. Risk factors for spinal cord ischemia are aneurysm extent, open surgical repair, prior distal aortic operations, and perioperative hypotension. Augmenting spinal cord perfusion by increasing arterial pressure, lumbar cerebrospinal fluid drainage, and reattachment of segmental arteries are effective for the treatment of spinal cord ischemia. Early detection of spinal cord ischemia by intraoperative neurophysiologic monitoring and postoperative neurological examination is important to enable immediate treatment to prevent permanent paraplegia. Permanent paraplegia after thoracic and thoracoabdominal aortic aneurysm repair can be prevented in many high-risk patients by early detection and immediate treatment of spinal cord ischemia before it evolves to infarction. The mortality and morbidity associated with permanent paraplegia justifies...Continue Reading

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Citations

Apr 25, 2012·Der Anaesthesist·R NitzschkeM S Goepfert
Dec 20, 2015·Neurochemistry International·Edyta MerissonJonas Åkeson
May 29, 2013·Anesthesiology Clinics·Georghios NicolaouDavy Cheng
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Sep 18, 2021·Journal of Biomedical Informatics·James RaffertyRowena Bailey

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