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Epidurale Kühlung

Neuroprotektive Versorgung thorakoabdominaler Aortenaneurysmen

Epidural cooling

Neuroprotective treatment of thoracoabdominal aortic aneurysms

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Zusammenfassung

Das Risiko von Paraplegie und Paraparese während der operativen Versorgung eines thorakoabdominalen Aortenaneurysmas stellt nach wie vor eine große Bedrohung dar. Cambria et al. haben 1993 erstmals eine Methode der regionalen Hypothermie am Rückenmark, das „epidural cooling”, angewendet und konnten damit die Rate des neurologischen Defizits signifikant reduzieren. Im Folgenden wird die erste klinische Anwendung dieses Verfahrens in Deutschland vorgestellt. Diese neuroprotektive Methode der epiduralen Kühlung wurde an 7 Patienten angewendet, die sich einer elektiven Versorgung eines thorakoabdominalen Aneurysmas (Crawford-Operation) unterzogen. Das Rückenmark wurde während der Operation lokal über einen epiduralen Katheter mit eisgekühlter Infusionslösung gekühlt. Der Druck der zerebrospinalen Flüssigkeit wurde mit einem Spinalkatheter gemessen und durch Anwendung einer aktiven zerebrospinalen Flüssigkeitsdrainage kontrolliert. Von den 7 Patienten zeigten 4 Patienten postoperativ kein neurologisches Defizit und konnten entlassen werden. Die anderen 3 Patienten verstarben intraoperativ bzw. in der postoperativen Phase an Komplikationen, die nicht durch die epidurale Kühlung bedingt waren. Die hier beschriebene Methode der epiduralen Kühlung stellt ein Verfahren dar, mit dem Rückenmarkschädigungen während der operativen Versorgung thorakoabdomineller Aortenaneurysmen sehr wahrscheinlich reduziert werden können.

Abstract

The risk of paraplegia and paraparesis during thoracoabdominal aneurysm surgery still represents a major threat. In 1993, Cambria and coworkers applied for the first time a method of regional spinal cord hypothermia by epidural cooling and significantly diminished the rate of neurological deficits. In this article the first clinical application of this neuroprotective method in Germany will be reported. This neuroprotective method was used in seven patients who underwent elective thoracoabdominal aortic aneurysm repair. The spinal cord was cooled with ice-cold saline via an epidural catheter during surgical repair. Cerebrospinal fluid pressure was measured on-line via a spinal catheter and controlled using active cerebrospinal fluid drainage. Of these seven patients, four showed no postoperative neurological deficit and were released from hospital. The other three patients died in the intra-operative or post-operative phase due to complications other than spinal cord injury arising from pre-existing comorbid conditions. The described method of epidural cooling represents a preliminary experimental method, which might reduce spinal cord injury during surgical repair of thoracoabdominal aneurysms.

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Authors and Affiliations

  1. Abteilung für Anästhesiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München, Deutschland

    J. Tschöp, S. Czerner & M. Thiel

  2. Abteilung für Anästhesiologie, Kreiskrankenhaus Mindelheim, Mindelheim, Deutschland

    M. Nuscheler

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  1. J. Tschöp
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  2. S. Czerner
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Correspondence to J. Tschöp.

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Tschöp, J., Czerner, S., Nuscheler, M. et al. Epidurale Kühlung. Anaesthesist 57, 988–997 (2008). https://doi.org/10.1007/s00101-008-1414-y

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