Abstract
Background. Impaired spinal cord circulation during thoracic aortic clamping may result in paraplegia.
Reliable and fast responding methods for intraoperative monitoring are needed to facilitate
the evaluation of protective measures and efficiency of revascularization. Methods. In 11 pigs, a multiparameter PO2, PCO2, and pH sensor (Paratrend 7, Biomedical Sensors Ltd, United Kingdom) was introduced
into the intrathecal space for continuous monitoring of cerebrospinal fluid (CSF)
oxygenation during thoracic aortic cross-clamping (AXC) distal to the left subclavian
artery. A laser-Doppler probe was inserted into the epidural space for simultaneous
measurements of spinal cord flux. Registrations were made before and 30 minutes after
clamping and 30 and 60 minutes after declamping. The same measuring points were used
for systemic hemodynamic and metabolic data acquisition. Results. The mean CSF PO2 readings of 41 mm Hg (5.5 kPa) at baseline decreased within 3 minutes to 5 mm Hg
(0.7 kPa) during AXC (P <.01). Spinal cord flux measurement responded immediately in the same way to AXC.
Both methods indicated normalization of circulation during declamping. Significant
(P <.01) changes were also observed in the CSF metabolic parameters PCO2 and pH. Conclusions. In this experimental model of spinal ischemia by AXC, online monitoring of intrathecal
PO2, PCO2, and pH showed significant changes and correlated well with epidural laser-Doppler
flowmetry (P <.01). (Surgery 2000;127:571–6.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Paraplegia following aortic surgery.J Cardiothorac Vasc Anesth. 1993; 7: 81-94
- Experience with 1509 patients undergoing thoracoabdominal aortic operations.J Vasc Surg. 1993; 17: 357-370
- Monitoring of somatosensory evoked potentials during surgical procedures on the thoracoabdominal aorta. IV. Clinical observations and results.J Thorac Cardiovasc Surg. 1987; 94: 275-285
- Clinical application of evoked spinal cord potentials elicited by direct stimulation of the cord during temporary occlusion of the thoracic aorta.J Thorac Cardiovasc Surg. 1994; 107: 1519-1527
- Spinal evoked potentials are predictive of neurologic function in a porcine model of aortic occlusion.Anesth Analg. 1994; 78: 257-266
- A new technique using somatosensory evoked potential guidance during descending and thoracoabdominal aortic repairs.J Cardiac Surg. 1994; 9: 662-672
- Efficacy of transcranial motor-evoked potentials to detect spinal cord ischemia during operations for thoracoabdominal aneurysms.J Thorac Cardiovasc Surg. 1997; 113: 87-101
- Identification and selective perfusion of the spinal cord-feeding arteries by intrathecal PO2 monitoring for spinal cord protection.Eur J Vasc Endovasc Surg. 1999; 18: 17-24
- Constants for use in surface area formula: mammals.in: Biology Data Book. Federation of American Societies for Experimental Biology, 1964: 120-121
- Continuous thermodilution cardiac output measurement in sheep.J Thorac Cardiovasc Surg. 1992; 104: 315-320
- A multi-parameter sensor for continuous intra-arterial blood gas monitoring: a prospective evaluation.Crit Care Med. 1994; 22: 588-594
- The evaluation of a new intravascular blood gas monitoring system in the pig.J Clin Monit. 1994; 10: 387-391
- Validation of laser-Doppler flowmetry in measurement of spinal cord blood flow.Am J Physiol. 1989; 257 (Heart Circ Physiol 26): H674-H680
- Laser-Doppler flowmetry in monitoring regulation of rapid microcirculatory changes in spinal cord.Am J Physiol. 1992; 263 (Heart Circ Physiol 32): H285-H292
- Transient spinal ischemia in rat; characterization of spinal cord blood flow, extracellular amino-acid release and concurrent histopathological damage.J Cereb Blood Flow Metab. 1994; 14: 604-616
- Spinal cord blood flow and pathophysiological changes after spinal cord ischemia in cats.Neurosurgery. 1998; 42: 624-634
- Direct measurements of oxygen tension on the spinal cord surface of pigs after occlusion of the descending aorta.J Thorac Cardiovasc Surg. 1985; 89: 787-794
- Oxygen pressure measurements in cerebrospinal fluid.mt-Medizintechnik. 1990; 110: 44-53
- Monitoring cerebral oxygenation: experimental studies and preliminary clinical results of continuous monitoring of cerebrospinal fluid and brain tissue oxygen tension.Acta Neurochir. 1993; 59: 50-57
- Preliminary report of localization of spinal cord blood supply by hydrogen during aortic operations.Ann Thorac Surg. 1990; 49: 528-536
- Spinal oxygenation, blood supply localization, and function with aortic clamping.Ann Thorac Surg. 1992; 54: 74-79
- Intraoperative identification of spinal cord blood supply during repairs of descending aorta and thora-coabdominal aorta.J Thorac Cardiovasc Surg. 1996; 112: 1455-1461
- Spinal epidural oxygen pressure and evoked spinal cord potential in relation to the severity of spinal ischemia during cross-clamping of the thoracic aorta.Acta Med Okayama. 1993; 47: 369-376
- Intrathecal oxygen concentration as a new indicator of spinal cord ischemia.Acta Med Okayama. 1997; 51: 71-77
- Relationship of brain tissue PO2 to outcome after severe head injury.Crit Care Med. 1998; 26: 1576-1581
- Brain tissue oxygenation, carbon dioxide, and pH in neurosurgical patients at risk for ischemia.Anesth Analg. 1996; 82: 582-586
- Cerebral interstitial tissue oxygen tension, pH, HCO3, CO2.Surg Neurol. 1997; 48: 414-417
- A new method for continuous intramucosal pCO2 measurement in the gastrointestinal tract.Anesth Analg. 1996; 83: 6-11
- Comparison of tissue oxygen-tension measurements by different devices. An experimental study in pigs.Scand J Clin Invest. 1998; 58: 63-72
- Continuous monitoring of intrathecal pO2, pCO2 and pH during surgical replacement of type II thoracoabdominal aortic aneurysm. Technical note.Eur J Vasc Endovasc Surg. 1998; 15: 78-81
- Monitoring cerebral oxygenation in the twilight years of the decade of the brain. Editorial views.Crit Care Med. 1998; 26: 1482-1484
- Biological basis for PCO2 as a detector of ischemia.Acta Anaesthesiol Scand. 1997; 41: 659-669
- Guide for the Care and Use of Laboratory Animals.7th ed. : National Academy Press, Washington, DC1996
Article info
Publication history
Accepted:
December 7,
1999
Footnotes
*Supported by The Laerdal Foundation for Acute Medicine (1460/96), the Swedish Medical Research Council (00759), and the Departments of Anesthesiology and Surgery, Uppsala University Hospital.
**Reprint requests: Lennart Christiansson, MD, Department of Anesthesiology, University Hospital, Uppsala SE - 751 85, Sweden.
★Surgery 2000;127:571–6
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
