Paraplegia after thoracoabdominal aortic surgery: Not just assisted circulation, hypothermic arrest, clamp and sew, or TEVAR

Departments of Surgery and Anesthesiology, University of Wisconsin, Madison, Wisconsin, USA.
Annals of cardiothoracic surgery 09/2012; 1(3):365-72. DOI: 10.3978/j.issn.2225-319X.2012.08.06
Source: PubMed
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    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 09/2013; 58(3):858-9. DOI:10.1016/j.jvs.2013.05.003 · 3.02 Impact Factor
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    ABSTRACT: Critical care management of vascular surgical patients poses significant challenges owing to patients' comorbidities and the magnitude of the surgical procedures. The primary goals of the anesthesiologist and intensivist are reestablishing preoperative homeostasis, optimizing hemodynamics until return of normal organ function, and managing postoperative complications promptly and effectively. Postoperative critical care management demands a detailed knowledge of the various vascular surgical procedures and the potential postoperative complications. In this review, the authors describe the postoperative complications related to the major specific vascular surgical procedures and their perioperative management.
    Anesthesiology Clinics 09/2014; 32(3). DOI:10.1016/j.anclin.2014.05.001
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    ABSTRACT: Objective We evaluated the role of memantine (N-Methyl-D-Aspartate receptor antagonist) pretreatment for prevention of spinal cord ischemia following infrarenal aortic clamping in a rabbit model. Methods Thirty New Zealand White rabbits were divided into 5 different groups of 6 each. Groups 60-7 and 60-5 received oral memantine 60mg OD for 7 and 5 days, respectively, and groups 30-5 and 30-3 received oral memantine 30mg OD for 5 and 3 days, respectively, all prior to surgery. Group C (control) received normal feeds without memantine. Paraplegic model was created by clamping both aorta and IVC at infrarenal and just proximal to their bifurcations for 45 minutes. Modified Tarlov score, motor evoked potentials (MEP), serum memantine concentration, and histopathology of spinal cord were evaluated. Results Mean modified Tarlov scores were 4.2±1.3, 4.3±1.0, 4.2±1.3, 4.3±1.2, and 0.8±1.6 in group 60-7, 60-5, 30-5, 30-3, and C, respectively at 6, 24, 48, and 72h (p<0.009 for individual groups vs control). Percentage amplitude loss of MEP by the end of surgery was 29.5±46.3, 11.9±28.0, 30.0±46.8, 16.7±40.8, and 81.8±40.3% in 5 groups, respectively (p=0.049). After declamping, MEP reappeared in 83, 100, 83, 83, and 33% cases in 5 groups, respectively (p=0.073). Serum memantine level was similar in all memantine groups. Spinal cords were normal in majority of group 60-7, 60-5, 30-5, and 30-3; but severely ischemic in majority of group C (p=0.041). Conclusions Oral memantine pretreatment is protective against spinal cord ischemia, and can be an additional strategy for prevention of paraplegia during thoracoabdominal aortic surgeries.
    Journal of Thoracic and Cardiovascular Surgery 10/2014; 148(4). DOI:10.1016/j.jtcvs.2014.04.043 · 4.17 Impact Factor
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