Cold blood spinal cord plegia for prediction of spinal cord ischemia during thoracoabdominal aneurysm repair Taijiro Sueda, MD, Kenji Okada, MD, Kazumasa.

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Cold blood spinal cord plegia for prediction of spinal cord ischemia during thoracoabdominal aneurysm repair Taijiro Sueda, MD, Kenji Okada, MD, Kazumasa Orihashi, MD, Yuji Sugawara, MD, Kazuhiro Kouchi, MD, Katsuhiko Imai, MD The Annals of Thoracic Surgery Volume 73, Issue 4, Pages 1155-1159 (April 2002) DOI: 10.1016/S0003-4975(02)03405-7

Fig 1 Spinal cord monitoring. Descending evoked spinal cord potentials (ESCP) after cervical spinal cord stimulation and segmental ESCP elicited by left peroneal nerve stimulation were recorded at the lumbar enlargement. Two bipolar electrodes were inserted into the subcranial space and placed on the dura mater for direct transcranial electrical stimulation of the cerebral motor cortex, and motor evoked potentials (MEP) were recorded at the lumbar enlargement. (C = cervical; L = lumbar; S-ESCP = segmental evoked spinal cord potentials; Th = thoracic.) The Annals of Thoracic Surgery 2002 73, 1155-1159DOI: (10.1016/S0003-4975(02)03405-7)

Fig 2 Cold blood infusion and selective intercostal arterial perfusion. Cold blood was infused into the aneurysm before aneurysmectomy. If the amplitude of motor evoked potentials decreased, the critical intercostal arteries were reconstructed. Reconstruction of the intercostal artery was initiated from the 9th to 11th intercostal artery. These arteries were reconstructed using a small piece of Dacron prosthesis, then reperfused immediately with warm blood (blood flow, 40 to 50 mL/min) for each artery pair. The Annals of Thoracic Surgery 2002 73, 1155-1159DOI: (10.1016/S0003-4975(02)03405-7)

Fig 3 Changes in evoked spinal cord potentials (ESCP) during cold blood infusion into aneurysm. Amplitude of motor evoked potentials (MEPs) decreased significantly during infusion of cold blood into the aneurysm. Once intercostal arteries were reconstructed and reperfused, the amplitude of the MEP recovered quickly. (ICA = intercostal artery; min = minute(s); Th = thoracic; S-ESCP = segmental evoked spinal cord potentials.) The Annals of Thoracic Surgery 2002 73, 1155-1159DOI: (10.1016/S0003-4975(02)03405-7)