Prolonged loss of leg myogenic motor evoked potentials during thoracoabdominal aortic aneurysm repair, without postoperative paraplegia |
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Authors: | Sadahei Denda Miki Taneoka Hiroyuki Honda Yukiko Watanabe Hidekazu Imai Yasushi Kitahara |
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Institution: | (1) Department of Anesthesia, Niigata City General Hospital, 2-6-1 Shichikuyama, Niigata 950-8739, Japan |
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Abstract: | No postoperative paraplegia occurred in a patient whose leg myogenic motor evoked potentials (mMEPs) disappeared during thoracoabdominal
aortic aneurysm repair. A 69-year-old man underwent resection and repair of a type III (Crawford classification) thoracoabdominal
aneurysm. An epidural catheter was placed into the epidural space for epidural cooling, and a Swan-Ganz catheter was placed
into the subarachnoid space for cerebrospinal fluid (CSF) drainage. Continuous CSF pressure and temperature measurement was
carried out the day before surgery. The mMEPs gradually disappeared 10 min after proximal double aortic clamping and complete
aortic transection. Selective perfusion of intercostal arteries was started about 20 min after the loss of the mMEPs, but
the mMEPs were not restored. Possibly, spinal cord hyperemia, induced by selective perfusion of the intercostal vessels, narrowed
the subarachnoid space so that CSF could not be satisfactorily drained during surgery. The spinal cord hyperemia may have
decreased spinal function and suppressed the leg mMEPs. The persistence of the loss of mMEPs was undeniably due to the influence
of the anesthetic agent or a perfusion disorder in the lower-extremity muscles. Of note, moderate spinal cord hypothermia
and postoperative CSF drainage probably resulted in improved lower-limb motor function. |
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Keywords: | Thoracoabdominal aneurysm Myogenic motor evoked potential Spinal cord hyperemia Moderate spinal cord hypothermia Cerebral spinal drainage |
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