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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1998 December;39(6):839-42

lingua: Inglese

Spinal ­cord pro­tec­tion by papav­e­rine and intra­thecal ­cooling ­during ­aortic cross­clamping

Sun J., Hirsch D., Svensson G.

From the Depart­ment of Tho­racic and Car­di­ovascular Sur­gery Center for ­Aortic Sur­gery Lahey ­Clinic, Bur­lington, MA, USA


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Aim. To ­extend the ­safe ­period of ­aortic cross­clamping in the por­cine ­model by intra­the­cally ­dilating the ­spinal ­arteries, ­with ­cooling of the ­spinal ­cord, or ­using self­otel.
­Methods. Experi­mental ­design and set­ting: pros­pec­tive ­domestic labor­a­tory pig ­study. Inter­ven­tions: fif­teen ani­mals ­were ­assigned to a con­trol ­group (C, N=5), intra­thecal papav­e­rine ­plus ­spinal ­cord ­cooling ­group (IP+C, N=5), or self­otel ­group (S, N=5). In the IP+C ­group, a ­lumbar lam­i­nec­tomy was per­formed and an intra­thecal cath­eter ­placed for intra­thecal injec­tion of papav­e­rine and per­fu­sion ­with ­cold ­Ringer’s solu­tion (4°C) ­prior to ­aortic cross­clamping. In the self­otel ­group, 20 mg/kg of self­otel was admin­is­tered 30 min­utes ­before ­aortic cross­clamping. In all 15 ani­mals, the ­aorta was cross­clamped for 60 min­utes at nor­mo­thermia. Meas­ures: imme­di­ately ­after the oper­a­tion and 24 ­hours ­later, ­lower ­limb func­tion was eval­u­ated.
­Results. All ­five con­trol ani­mals ­were par­a­lyzed; all 5 IP+C ani­mals ­could ­stand or ­walk (p=0.004 ­versus con­trol); and in the self­otel ­group, one had par­a­par­esis, ­three had par­a­plegia and one ­died ­before eval­u­a­tion (p=n.s.)
Con­clu­sions. The com­bi­na­tion of intra­thecal papav­e­rine to ­dilate ­spinal ­arteries and pre­vent ­spasm ­from the ­cold solu­tion ­plus intra­the­cally ­cooling the ­spinal ­cord ­appears to ­extend the ­period of ­safe ­aortic cross­clamping. Self­otel, in ­this ­model of ­extended, ­severe, ­spinal ­cord ­ischemia, was inef­fec­tive.

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