THERAPEUTICAL NOTES  CARDIAC PAPERS 

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

Copyright © 2000 EDIZIONI MINERVA MEDICA

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

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.