Abstract
Twenty-four patients requiring spinal fusion with Harrington rod instrumentation were studied prospectively to determine the effects of moderate hypotension on blood loss, operating conditions, operating time and spinal cord function. Hypotension reduced blood loss and improved operating conditions but did not shorten operating time. Five patients had alterations in somatosensory cortical evoked potentials after straightening of the spine that prompted us to reverse hypotension (when present) and haemodilution, and then to do wake-up tests. All wake-up tests were normal and all evoked potential alterations resolved during operation. Hypotension seems unlikely to increase the risk of neurological damage if spinal cord function is monitored. Our findings suggest that patients subjected to spinal fusion need not be awakened during operation for testing of cord function provided somatosensory evoked potentials are monitored and remain stable.
Résumé
L’emploi d’une hypotension contrôlée modérée (maintien de la pression systolique entre 80 et 90 torr) au cours de fusions vertébrales par tige de Harrington a été étudié de façon prospective. Les paramètres étudiés étant le volume des pertes sanguines opératoires, la qualité du champ opératoire, la durée de l’intervention et le maintien de la fonction médullaire. Les vingt quatre patients inclus dans cette étude étaient assignés au hasard au groupe témoin ou au groupe opéré sous hypotension contrôlée. Nous avons observé des pertes sanguines moindres ainsi qu’une qualité supérieure du champ opératoire chez les patients opérés sous hypotension contrôlée. La durée de l’ intervention n’était cependant pas raccourcie. Cinq des patients ont présenté des modifications des potentiels corticaux induits par stimulation somato-sensorielle; dans ces cas la pression était ramenée à la normale lorsque l’hypotension contrôlée était utilisée, l’hémodilution était corrigée et le malade était éveillé en cours de chirurgie pour vérifier si la motricité volontaire des membres inférieurs était conservé. Tous les tests d’éveil se sont avérés normaux et les potentiels corticaux évoqués se sont corrigés en cours d’intervention. L’emploi d’hypotension contrôlée ne semble pas susceptible d’augmenter le risque de dommages neurologiques si le maintien de la fonction de la moelle épinière est surveillé en cours de chirurgie.
Nos résultats suggèrent que les malades soumis à une fusion vertébrale n’ont pas à être éveillés en cours d’intervention pour vérification du maintien de leur fonction médullaire en autant que l’on effectue le monitoring per-opératoire des potentiels corticaux induits par Stimuli corticaux sensoriels et que cette fonction est maintenue stable.
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This work was done at Case Western Reserve University and University Hospitals of Cleveland. It was supported by Grants Number GM 26264, GM 27942 and GM 19599 from the National Institute of General Medical Sciences and by Grant 267 from the Orthopedic Research and Education Foundation. This work was presented in part to the American Society of Anesthesiologists in 1979.
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Grundy, B.L., Nash, C.L. & Brown, R.H. Deliberate hypotension for spinal fusion: Prospective randomized study with evoked potential monitoring. Canad. Anaesth. Soc. J. 29, 452–462 (1982). https://doi.org/10.1007/BF03009408
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DOI: https://doi.org/10.1007/BF03009408