|
KMID : 0377219990240020071
|
|
Medical Journal of Chosun Univercity
1999 Volume.24 No. 2 p.71 ~ p.78
|
|
|
A Study on Protective Effects of the Spinal Cord during Cross-clamping of the Descending Thoracic Aorta
|
|
Choi Hyung-Ho
Kim Bo-Young
Jung Hae-Dong
|
|
|
Abstract
|
|
|
Background and Objective: Paraplegia has been an unpredictable and serious complication following operation upon the thoracoabdominal aorta. The frequency ranges from 0.5% with operation for coarctation to as high as 14% following surgery for thoracoabdominal aneurysms. Controversy exist about the value of different protective methods during aortic clamping. This report was aimed at finding what is the best method of spinal protection during thoracoabdominal aortic surgery.
Materials and Method: The effects of cross-clamping the descending aorta for 90minutes were studied in rats and were divided into 4 groups. In all animals, the central venous, carotid artery, and femoral artery pressures were recorded. During aortic cross-clamping, Group I(n=7) has simple clamping without any treatment and Group II(n=7) were given intravenous methylpredrisolone and Group III(n=7) were given peritoneal nitroprusside continuously and Group W(n=5) were placed external shunt between proximal and distal aorta.
Results: During aortic cross clamping, the following hemodynamic parameters significantly changed. Carotid artery pressure significantly increased in all groups. While the descending aorta was cross-clamped, mean femoral artery pressure decreaed in all groups, but the decreament of pressure between carotid arterial pressure and femoral arterial pressure was significant in Group IV and also changed compared with 45minute and 95minute aortic cross-clamping. Central venous pressure was significantly decreased in Group III, but not changed in other groups. Heart rate was not changed during or after aortic cross-clamping. Paraplegia was present 57% of Group I(4/7), 28% of Group II(2/7), 43% of Group III(3/7) and 40% of Group IV(2/5).
Conclusion: These findings suggest that cross-clamping(90minutes) of thenormal descending aorta should be accompanied by some form of spinal protective methods. If bypass cannot be employed, intravenous nitroprusside or steroid administration may decrease the incidence of paraplegia.
|
|
|
KEYWORD
|
|
|
Paraplegia, Thoracoabdominal Aneurysm
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|