ORIGINAL ARTICLES   

Panminerva Medica 2001 March;43(1):39-44

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Perfusion of the subarachnoid space in cadavers. A technique applicable for prevention of paraplegia in surgery of the thoracic aorta

Cinà C. S., Bruin G., Dath D.

From the Division of Vascular Surgery Department of Surgery *Department of Anaesthesiology McMaster University, Hamilton, Ontario, Canada

Background. No ­safe tech­nique of sub­arach­noid per­fu­sion dur­ing thor­a­coab­dom­i­nal aneu­rysm sur­gery has ­been ­described. We test­ed the hypoth­e­sis ­that in ­cold cadav­ers, per­fu­sion of the sub­arach­noid ­space at the lum­bar lev­el ­with ­warm solu­tion is fea­sible and increas­es the tem­per­a­ture at the tho­rac­ic lev­el with­out an ­increase in cere­bro­spi­nal ­fluid (CSF) pres­sure.
Methods. Six cadav­ers ­were ­used. A 5 Fr silas­tic cath­e­ter in the sub­arach­noid ­space ­between the sec­ond and ­third lum­bar ver­te­bra (L2-3) was ­used as an ­inflow and a 16-­gauge cath­e­ter at L4-5 as an out­flow. Normal ­saline at 38°C was ­infused at 999 mL/h. Temperatures of ­inflow and out­flow, of the tho­rac­ic sub­arach­noid ­space (T8), and of the cis­ter­na mag­na, ­were record­ed. CSF pres­sures ­were meas­ured ­from the out­flow cath­e­ter.
Results. Outflow tem­per­a­ture was 9±1°C at 10 min­utes. At 15 min­utes it was 27±4°C, and tho­rac­ic sub­arach­noid tem­per­a­tures was 22±5°C. There was no sta­tis­ti­cal dif­fer­ence ­between the tem­per­a­tures record­ed at 10 and 15 min­utes. The tem­per­a­ture of the cis­ter­na mag­na was 8.5±1.2°C at 15 min­utes, sig­nif­i­cant­ly high­er ­than the base­line (p=0.01), but low­er ­than ­that at the T8 lev­el (p=0.0001). CSF pres­sures dur­ing the experi­ment did not ­changed sig­nif­i­cant­ly ­from base­line and ­remained ­below 10 cm H20.
Conclusions. The tech­nique ­described is sim­ple to imple­ment, and effec­tive in chang­ing the tem­per­a­ture of the sub­arach­noid ­space at the tho­rac­ic lev­el. Whether spi­nal ­cord cool­ing by ­this tech­nique safe­ly reduc­es the ­risk of par­a­ple­gia ­remains to be estab­lished in an ani­mal mod­el.