Somatosensory-evoked potentials during aortic coarctation repair

Objective: To determine the incidence of somatosensory-evoked potential (SS EP) changes and the interventions based on these changes during aortic coar ctation repair. Design: Retrospective review, Setting: Single-institution, university hospital, Participants:Eighty-four children who had undergone surgical repair of aort ic coarctation from January 1984 to May 1996, Interventions: SSEPs were monitored in all patients throughout the procedur e. A persistent decrease in amplitude greater than 50% from baseline was co nsidered significant. Duration of SSEP changes in relation to the time cour se of surgical repair and whether a surgical or anesthetic intervention res ulted from a change in SSEPs were documented. Measurements and Main Results: Eighty-four patients underwent 87 surgical p rocedures. SSEP changes occurred in 40% of the procedures: 38.5% with repai r and 15% with test clamp, with 9% occurring during both test clamp and rep air. Interventions, which included repositioning the aortic crossclamp, ele vating blood pressure, and aborting surgery, occurred in 26.4% of all proce dures based on SSEP changes. No patient sustained a neurologic deficit. Conclusion: This is the largest series to date describing the use of SSEPs in aortic coarctation repair. These SSEP changes were often immediately ame nable to changes in surgical and anesthetic management. SSEP changes and in terventions based on these changes occurred with a considerable frequency. Copyright (C) 1999 by W.B. Saunders Company.