K. Grabitz et al., SPINAL EVOKED-POTENTIAL IN PATIENTS UNDERGOING THORACOABDOMINAL AORTIC RECONSTRUCTION - A PROGNOSTIC INDICATOR OF POSTOPERATIVE MOTOR DEFICIT, Journal of clinical monitoring, 9(3), 1993, pp. 186-190
We studied 76 patients who had thoracoabdominal aortic reconstruction
between january 1981 and March 1991. Evoked potential monitoring of th
e spinal cord (peridural bipolar catheter stimulation at level L4-L5,
recording via a second bipolar catheter at level Th4) was used to pred
ict intraoperatively a possible motor deficit. There was a close linea
r correlation of r = 0.892 between postoperative motor deficit (normal
, paraparesis, paraplegia) and the time from declamping to reappearanc
e of the potential. Forty-three of 76 patients received prostaglandin
E1 (5 ng/kg/min) for pharmacologic protection of the spinal cord 15 mi
nutes before onset of clamping and through the entire clamping period.
Patients with protection had a loss of their potential significantly
later (20.2 min; p < 0.05) than those patients who had not received an
y pharmacologic treatment (15.2 min). Pharmacologic protection also re
sulted in a reduced incidence of postoperative neurologic deficit and
paraplegia when compared with patients receiving no treatment (25% vs
5%). These data suggest that spinal evoked potentials may be very usef
ul for monitoring during these hazardous cases. They also suggest that
pharmacologic protection before clamping may help preserve the functi
on of the spinal cord during aortic clamping.