Paralysis after aortic surgery: In search of lost cord function
During the early 1980s, the rate of paralysis after aortic surgery was as high as 41% in patients for the most complex thoracoabdominal aortic operations. After comparing human and chacma baboon ( papio ursinus) spinal cord vascular anatomy, an animal model was established to study the pathophysiol-...
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| Veröffentlicht in: | The surgeon (Edinburgh) 2005-12, Vol.3 (6), p.396-405 |
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| description | During the early 1980s, the rate of paralysis after aortic surgery was as high as 41% in patients for the most complex thoracoabdominal aortic operations. After comparing human and chacma baboon (
papio ursinus) spinal cord vascular anatomy, an animal model was established to study the pathophysiol-ogy of aortic cross-clamping and the aetiology of the paralysis. Techniques, including motor evoked responses for monitoring spinal cord function, were developed that were tried in humans and later culminated in prospective and randomized studies. These established that the following were protective: combining cerebrospinal fluid with intrathecal papaverine; cooling systemically to moderate or profound hypothermia; minimizing intercostal ischaemia time; using a sequential segmental repair approach; re-attaching all patent and segmental intercostal arteries below T8 for descending thoracic aortic repair and from T6 to L2 for thoracoabdominal repairs; continuing cerebrospinal fluid drainage for at least two days and maintaining patients hypertensive after surgery. The net result has been that, in two of our recent series, the risk of permanent paralysis has been reduced to between 3.1% and 3.8% |
| doi_str_mv | 10.1016/S1479-666X(05)80050-2 |
| format | Article |
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papio ursinus) spinal cord vascular anatomy, an animal model was established to study the pathophysiol-ogy of aortic cross-clamping and the aetiology of the paralysis. Techniques, including motor evoked responses for monitoring spinal cord function, were developed that were tried in humans and later culminated in prospective and randomized studies. These established that the following were protective: combining cerebrospinal fluid with intrathecal papaverine; cooling systemically to moderate or profound hypothermia; minimizing intercostal ischaemia time; using a sequential segmental repair approach; re-attaching all patent and segmental intercostal arteries below T8 for descending thoracic aortic repair and from T6 to L2 for thoracoabdominal repairs; continuing cerebrospinal fluid drainage for at least two days and maintaining patients hypertensive after surgery. The net result has been that, in two of our recent series, the risk of permanent paralysis has been reduced to between 3.1% and 3.8%</description><subject>aneurysm</subject><subject>Animals</subject><subject>Aorta</subject><subject>Aorta - anatomy & histology</subject><subject>Aorta - surgery</subject><subject>Aortic Aneurysm - surgery</subject><subject>aortic dissection</subject><subject>Aortic Rupture - surgery</subject><subject>aortic surgery</subject><subject>Biological and medical sciences</subject><subject>Cerebrospinal Fluid</subject><subject>Disease Models, Animal</subject><subject>Drainage</subject><subject>Evoked Potentials, Motor</subject><subject>General aspects</subject><subject>Humans</subject><subject>Injections, Spinal</subject><subject>injury</subject><subject>Medical sciences</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Nervous system as a whole</subject><subject>Neurology</subject><subject>Papaverine - administration & dosage</subject><subject>Papio ursinus</subject><subject>paralysis</subject><subject>Paraplegia - etiology</subject><subject>Paraplegia - prevention & control</subject><subject>paroplegic</subject><subject>Perfusion - methods</subject><subject>spinal cord</subject><subject>Spinal Cord Ischemia - etiology</subject><subject>Spinal Cord Ischemia - physiopathology</subject><subject>Spinal Cord Ischemia - prevention & control</subject><subject>Vascular Surgical Procedures - adverse effects</subject><subject>Vascular Surgical Procedures - methods</subject><subject>Vasodilator Agents - administration & dosage</subject><issn>1479-666X</issn><issn>2405-5840</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0E1P3DAQgGELFcHy8ROofGlFD4GxEztxLwihtiCtBBKtxM2atSfUVTYGO0Haf0-WXZUjJ1-eGY9exk4EnAkQ-vxeVLUptNYPp6C-NQAKCrnDZrICVaimgk9s9p_ss4Oc_wFIVYLaY_tCl6psNMzYxR0m7FY5ZI7tQIljTENwPI_pkdLqO7_peSZM7i-PLe9iHriLyfN27N0QYn_EdlvsMh1v30P25-eP31fXxfz2183V5bxwlTJDIUgK77WqJBitSEnwpS6NaAE81qaVplr4BULtQTWIrhGlcJVBkkjop2MP2dfN3qcUn0fKg12G7KjrsKc4Zqubxkio6gmqDXQp5pyotU8pLDGtrAC7Lmffytl1FgvKvpWzcpr7vP1gXCzJv09tU03gyxZgdti1CXsX8rurpWmmvJO72DiacrwESja7QL0jHxK5wfoYPjjlFVv3iis</recordid><startdate>20051201</startdate><enddate>20051201</enddate><creator>Svensson, L.G.</creator><general>Elsevier Ltd</general><general>Royal College of Surgeons of Edinburgh</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20051201</creationdate><title>Paralysis after aortic surgery: In search of lost cord function</title><author>Svensson, L.G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-1e21dd65420965e520d36391f00da79f294bdba07d058aac8131c49ae2aead353</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>aneurysm</topic><topic>Animals</topic><topic>Aorta</topic><topic>Aorta - anatomy & histology</topic><topic>Aorta - surgery</topic><topic>Aortic Aneurysm - surgery</topic><topic>aortic dissection</topic><topic>Aortic Rupture - surgery</topic><topic>aortic surgery</topic><topic>Biological and medical sciences</topic><topic>Cerebrospinal Fluid</topic><topic>Disease Models, Animal</topic><topic>Drainage</topic><topic>Evoked Potentials, Motor</topic><topic>General aspects</topic><topic>Humans</topic><topic>Injections, Spinal</topic><topic>injury</topic><topic>Medical sciences</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Nervous system as a whole</topic><topic>Neurology</topic><topic>Papaverine - administration & dosage</topic><topic>Papio ursinus</topic><topic>paralysis</topic><topic>Paraplegia - etiology</topic><topic>Paraplegia - prevention & control</topic><topic>paroplegic</topic><topic>Perfusion - methods</topic><topic>spinal cord</topic><topic>Spinal Cord Ischemia - etiology</topic><topic>Spinal Cord Ischemia - physiopathology</topic><topic>Spinal Cord Ischemia - prevention & control</topic><topic>Vascular Surgical Procedures - adverse effects</topic><topic>Vascular Surgical Procedures - methods</topic><topic>Vasodilator Agents - administration & dosage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Svensson, L.G.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The surgeon (Edinburgh)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Svensson, L.G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Paralysis after aortic surgery: In search of lost cord function</atitle><jtitle>The surgeon (Edinburgh)</jtitle><addtitle>Surgeon</addtitle><date>2005-12-01</date><risdate>2005</risdate><volume>3</volume><issue>6</issue><spage>396</spage><epage>405</epage><pages>396-405</pages><issn>1479-666X</issn><eissn>2405-5840</eissn><abstract>During the early 1980s, the rate of paralysis after aortic surgery was as high as 41% in patients for the most complex thoracoabdominal aortic operations. After comparing human and chacma baboon (
papio ursinus) spinal cord vascular anatomy, an animal model was established to study the pathophysiol-ogy of aortic cross-clamping and the aetiology of the paralysis. Techniques, including motor evoked responses for monitoring spinal cord function, were developed that were tried in humans and later culminated in prospective and randomized studies. These established that the following were protective: combining cerebrospinal fluid with intrathecal papaverine; cooling systemically to moderate or profound hypothermia; minimizing intercostal ischaemia time; using a sequential segmental repair approach; re-attaching all patent and segmental intercostal arteries below T8 for descending thoracic aortic repair and from T6 to L2 for thoracoabdominal repairs; continuing cerebrospinal fluid drainage for at least two days and maintaining patients hypertensive after surgery. The net result has been that, in two of our recent series, the risk of permanent paralysis has been reduced to between 3.1% and 3.8%</abstract><cop>Edinburgh</cop><pub>Elsevier Ltd</pub><pmid>16353860</pmid><doi>10.1016/S1479-666X(05)80050-2</doi><tpages>10</tpages></addata></record> |
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| subjects | aneurysm Animals Aorta Aorta - anatomy & histology Aorta - surgery Aortic Aneurysm - surgery aortic dissection Aortic Rupture - surgery aortic surgery Biological and medical sciences Cerebrospinal Fluid Disease Models, Animal Drainage Evoked Potentials, Motor General aspects Humans Injections, Spinal injury Medical sciences Nervous system (semeiology, syndromes) Nervous system as a whole Neurology Papaverine - administration & dosage Papio ursinus paralysis Paraplegia - etiology Paraplegia - prevention & control paroplegic Perfusion - methods spinal cord Spinal Cord Ischemia - etiology Spinal Cord Ischemia - physiopathology Spinal Cord Ischemia - prevention & control Vascular Surgical Procedures - adverse effects Vascular Surgical Procedures - methods Vasodilator Agents - administration & dosage |
| title | Paralysis after aortic surgery: In search of lost cord function |
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