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Changes of motor evoked potentials during descending thoracic and thoracoabdominal aortic surgery with deep hypothermic circulatory arrest

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An Editorial to this article was published on 23 February 2012

Abstract

Background

Paraplegia is a serious complication of descending and thoracoabdominal aortic aneurysms (dTAAs and TAAAs) surgery. Motor evoked potentials (MEPs) enable monitoring the functional integrity of motor pathways during dTAA and TAAA surgery. Although MEPs are sensitive to temperature changes, there are few human data on changes of MEPs during mild and deep hypothermia. Therefore, we investigated changes of MEPs in deep hypothermic circulatory arrest (DHCA) in dTAA and TAAA surgery.

Methods

Fifteen consecutive patients undergoing dTAA and TAAA surgery using DHCA were enrolled. MEPs were elicited and recorded during each degree Celsius change in nasopharyngeal temperature during both the cooling and rewarming phases. Hand and leg skin temperature were also recorded simultaneously.

Results

In the cooling phase MEP amplitude decreased lineally in both the hand and leg. The MEP disappeared at ~16°C in both the hand and leg in 10 of 15 patients, but was still elicited in 5 patients. In the rewarming phase MEP in the hand recovered before the temperature reached 20°C for eight patients and 25°C for the other seven patients. In contrast, MEP in the leg recovered below 20°C for two patients and 30°C for three patients. For the other eight patients MEP waves did not recover during the rewarming phase.

Conclusion

In the cooling phase of DHCA, MEP disappeared at ~16°C in some patients but was still elicited in others. MEP recovered below 25°C in the hand. Recovery of MEP in the leg was, however, extremely variable.

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References

  1. Coselli JS, Conklin LD, LeMaire SA. Thoracoabdominal aortic aneurysm repair: review and update of current strategies. Ann Thorac Surg. 2002;74:S1881–4.

    Article  PubMed  Google Scholar 

  2. Cambria RP, Clouse WD, Davison JK, Dunn PF, Corey M, Dorer D. Thoracoabdominal aneurysm repair: results with 337 operations performed over a 15-year interval. Ann Surg. 2002;236:471–9.

    Article  PubMed  Google Scholar 

  3. Coselli JS, Lemaire SA, Koksoy C, Schmittling ZC, Curling PE. Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. J Vasc Surg. 2002;35:631–9.

    Article  PubMed  Google Scholar 

  4. Kouchoukos NT, Rokkas CK. Hypothermic cardiopulmonary bypass for spinal cord protection: rationale and clinical results. Ann Thorac Surg. 1999;67:1940–2.

    Article  PubMed  CAS  Google Scholar 

  5. Safi HJ, Miller CC 3rd, Carr C, Iliopoulos DC, Dorsay DA, Baldwin JC. Importance of intercostal artery reattachment during thoracoabdominal aortic aneurysm repair. J Vasc Surg. 1998;27:58–66.

    Article  PubMed  CAS  Google Scholar 

  6. Nijenhuis RJ, Jacobs MJ, Schurink GW, Kessels AG, van Engelshoven JM, Backes WH. Magnetic resonance angiography and neuromonitoring to assess spinal cord blood supply in thoracic and thoracoabdominal aortic aneurysm surgery. J Vasc Surg. 2007;45:71–7.

    Article  PubMed  Google Scholar 

  7. Kawanishi Y, Munakata H, Matsumori M, Tanaka H, Yamashita T, Nakagiri K, et al. Usefulness of transcranial motor evoked potentials during thoracoabdominal aortic surgery. Ann Thorac Surg. 2007;83:456–61.

    Article  PubMed  Google Scholar 

  8. Koja K, Kuniyoshi Y, Miyagi K, Uezu T, Arakaki K, Yamashiro S, et al. Spinal cord protection during thoracoabdominal aortic aneurysm repair; efficacy of distal aortic perfusion and segmental aortic clamping. Kyobu Geka. 2004;57:268–73.

    PubMed  CAS  Google Scholar 

  9. Sueda T, Morita S, Okada K, Orihashi K, Shikata H, Matsuura Y. Selective intercostal arterial perfusion during thoracoabdominal aortic aneurysm surgery. Ann Thorac Surg. 2000;70:44–7.

    Article  PubMed  CAS  Google Scholar 

  10. Sakamoto T, Kawaguchi M, Kakimoto M, Inoue S, Takahashi M, Furuya H. The effect of hypothermia on myogenic motor-evoked potentials to electrical stimulation with a single pulse and a train of pulses under propofol/ketamine/fentanyl anesthesia in rabbits. Anesth Analg. 2003;96:1692–7.

    Article  PubMed  CAS  Google Scholar 

  11. Kawaguchi M, Furuya H. Intraoperative spinal cord monitoring of motor function with myogenic motor evoked potentials: a consideration in anesthesia. J Anesth. 2004;18:18–28.

    Article  PubMed  Google Scholar 

  12. Lotto ML, Banoub M, Schubert A. Effects of anesthetic agents and physiologic changes on intraoperative motor evoked potentials. J Neurosurg Anesthesiol. 2004;16:32–42.

    Article  PubMed  Google Scholar 

  13. Yamamoto Y, Kawaguchi M, Hayashi H, Horiuchi T, Inoue S, Nakase H, et al. The effects of the neuromuscular blockade levels on amplitudes of posttetanic motor-evoked potentials and movement in response to transcranial stimulation in patients receiving propofol and fentanyl anesthesia. Anesth Analg. 2008;106:930–4.

    Article  PubMed  CAS  Google Scholar 

  14. Browning JL, Heizer ML, Baskin DS. Variations in corticomotor and somatosensory evoked potentials: effects of temperature, halothane anesthesia, and arterial partial pressure of CO2. Anesth Analg. 1992;74:643–8.

    Article  PubMed  CAS  Google Scholar 

  15. Oro J, Haghighi SS. Effects of altering core body temperature on somatosensory and motor evoked potentials in rats. Spine. 1992;17:498–503.

    Article  PubMed  CAS  Google Scholar 

  16. Meylaerts SA, De Haan P, Kalkman CJ, Lips J, De Mol BA, Jacobs MJ. The influence of regional spinal cord hypothermia on transcranial myogenic motor-evoked potential monitoring and the efficacy of spinal cord ischemia detection. J Thorac Cardiovasc Surg. 1999;118:1038–45.

    Article  PubMed  CAS  Google Scholar 

  17. Meylaerts SA, Jacobs MJ, van Iterson V, De Haan P, Kalkman CJ. Comparison of transcranial motor evoked potentials and somatosensory evoked potentials during thoracoabdominal aortic aneurysm repair. Ann Surg. 1999;230:742–9.

    Article  PubMed  CAS  Google Scholar 

  18. Heier T, Caldwell JE, Sessler DI, Miller RD. The effect of local surface and central cooling on adductor pollicis twitch tension during nitrous oxide/isoflurane and nitrous oxide/fentanyl anesthesia in humans. Anesthesiology. 1990;72:807–11.

    Article  PubMed  CAS  Google Scholar 

  19. Kakinohana M, Nakamura S, Fuchigami T, Miyata Y, Sugahara K. Influence of the descending thoracic aortic cross clamping on bispectral index value and plasma propofol concentration in humans. Anesthesiology. 2006;104:939–43.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan

    Masahide Shinzawa, Kenji Yoshitani, Tomoya Irie & Yoshihiko Ohnishi

  2. Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Suita, Japan

    Kenji Minatoya & Hitoshi Ogino

Authors
  1. Masahide Shinzawa
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  2. Kenji Yoshitani
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  3. Kenji Minatoya
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  4. Tomoya Irie
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  5. Hitoshi Ogino
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  6. Yoshihiko Ohnishi
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Corresponding author

Correspondence to Kenji Yoshitani.

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Shinzawa, M., Yoshitani, K., Minatoya, K. et al. Changes of motor evoked potentials during descending thoracic and thoracoabdominal aortic surgery with deep hypothermic circulatory arrest. J Anesth 26, 160–167 (2012). https://doi.org/10.1007/s00540-011-1313-2

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  • DOI: https://doi.org/10.1007/s00540-011-1313-2

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