Prevention of spinal cord injury after cross-clamping of the descending thoracic aorta
Oka, Y.
Nihon Kyobu Geka Gakkai 33(10): 1956-1962
1985
ISSN/ISBN: 0369-4739 PMID: 4086890 Document Number: 245426
In this study, the effect of the pressure gradient between the aortic pressure distal to the occulsion and cerebrospinal fluid pressure (SCFP), defined as "Relative spinal cord perfusion pressure" (RSPP) on the development of spinal cord injury was investigated. In 32 mongrel dogs, the thoracic aorta just distal to the left subclavian artery was cross-clamped. After the complete loss of somatosensory evoked potentials (SEP) was confirmed, these dogs were divided into six groups by the clamping time and RSPP as follows: Group A (6 dogs), 10 minutes, 0 mmHg; Group B (8 dogs), 20 minutes, 0 mmHg; Group C (3 dogs), 20 minutes, 7.5 mmHg; Group D (3 dogs), 40 minutes 7.5 mmHg; Group E (6 dogs), 40 minutes, 15 mmHg and Group F (6 dogs), 60 minutes, 15 mmHg. RSPP was controlled by withdrawal of cerebrospinal fluid or injection of normal saline into the subarachnoid space. SEP were generated by the stimulation of bilateral peroneal nerves. The incidence of postoperative paraplegia was 0% in Group A, 100% in Group B, 33% in Group C, 100% in Group D, 0% in Group E and 50% in Group F, respectively. These results reveal that RSPP plays an important role in the development of spinal cord injury during cross-clamping of the thoracic aorta. Therefore, RSPP should be maintained as high as possible in order to prevent spinal cord injury during aortic occlusion.