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Yoshitani K, Kawaguchi M, Kawamata M, Kakinohana M, Kato S, Hasuwa K, Yamakage M, Yoshikawa Y, Nishiwaki K, Hasegawa K, Inagaki Y, Funaki K, Matsumoto M, Ishida K, Yamashita A, Seo K, Kakumoto S, Tsubaki K, Tanaka S, Ishida T, Uchino H, Kakinuma T, Yamada Y, Mori Y, Izumi S, Shimizu J, Furuichi Y, Kin N, Uezono S, Kida K, Nishimura K, Nakai M, Ohnishi Y. Cerebrospinal fluid drainage to prevent postoperative spinal cord injury in thoracic aortic repair. J Anesth 2020; 35:43-50. [PMID: 32980925 DOI: 10.1007/s00540-020-02857-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cerebrospinal fluid drainage (CSFD) is recommended as a spinal cord protective strategy in open and endovascular thoracic aortic repair. Although small studies support the use of CSFD, systematic reviews have not suggested definite conclusion and a large-scale study is needed. Therefore, we reviewed medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open and endovascular repair) at multiple institutions to assess the association between CSFD and postoperative motor deficits. METHODS Patients included in this study underwent descending or thoracoabdominal aortic repair between 2000 and 2013 at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery. We conducted a retrospective study to investigate whether motor-evoked potential monitoring is effective in reducing motor deficits in thoracic aortic aneurysm repair. We use the same dataset to examine whether CSFD reduces motor deficits after propensity score matching. RESULTS We reviewed data from 1214 patients [open surgery, 601 (49.5%); endovascular repair, 613 (50.5%)]. CSFD was performed in 417 patients and not performed in the remaining 797 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. After propensity score matching (n = 700), mixed-effects logistic regression performed revealed that CSFD is associated with postoperative motor deficits at discharge [adjusted odds ratio (OR), 3.87; 95% confidence interval (CI), 2.30-6.51]. CONCLUSION CSFD may not be effective for postoperative motor deficits at discharge.
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Affiliation(s)
- Kenji Yoshitani
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan.
| | | | - Mikito Kawamata
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Manabu Kakinohana
- Department of Anesthesiology, Faculty of Medicine, University of Ryukyu, Naha, Japan
| | - Shinya Kato
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan
| | - Kyoko Hasuwa
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yusuke Yoshikawa
- Department of Anesthesiology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kimitoshi Nishiwaki
- Department of Anesthesiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kazuko Hasegawa
- Department of Anesthesiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoshimi Inagaki
- Department of Anesthesiology and Critical Care, Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Kazumi Funaki
- Department of Anesthesiology and Critical Care, Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Mishiya Matsumoto
- Department of Anesthesiology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuyoshi Ishida
- Department of Anesthesiology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Atsuo Yamashita
- Department of Anesthesiology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Katsuhiro Seo
- Department of Anesthesiology and Intensive Care Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Kakumoto
- Department of Anesthesiology and Intensive Care Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kosuke Tsubaki
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Satoshi Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Ishida
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Uchino
- Department of Anesthesiology, Tokyo Medical University, Shinjuku Ku, Japan
| | - Takayasu Kakinuma
- Department of Anesthesiology, Tokyo Medical University, Shinjuku Ku, Japan
| | - Yoshitsugu Yamada
- Department of Anesthesiology, Faculty of Vital Care Medicine, The Graduate School of Medicine, The University of Tokyo, Bunkyo Ku, Japan
| | - Yoshiteru Mori
- Department of Anesthesiology, Faculty of Vital Care Medicine, The Graduate School of Medicine, The University of Tokyo, Bunkyo Ku, Japan
| | - Shunsuke Izumi
- Department of Anesthesiology, Faculty of Medicine, University of Ryukyu, Naha, Japan
| | - Jun Shimizu
- Department of Anesthesiology, Sakakibara Heart Institute, Fuchu, Japan
| | - Yuko Furuichi
- Department of Anesthesiology, Sakakibara Heart Institute, Fuchu, Japan
| | - Nobuhide Kin
- Department of Anesthesiology, New Tokyo Hospital, Matsudo, Japan
| | - Shoichi Uezono
- Department of Anesthesiology, School of Medicine, The Jikei University, Minato Ku, Japan
| | - Kotaro Kida
- Department of Anesthesiology, School of Medicine, The Jikei University, Minato Ku, Japan
| | - Kunihiko Nishimura
- Department of Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michikazu Nakai
- Department of Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan
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Yoshitani K, Masui K, Kawaguchi M, Kawamata M, Kakinohana M, Kato S, Hasuwa K, Yamakage M, Yoshikawa Y, Nishiwaki K, Aoyama T, Inagaki Y, Yamasaki K, Matsumoto M, Ishida K, Yamashita A, Seo K, Kakumoto S, Hayashi H, Tanaka Y, Tanaka S, Ishida T, Uchino H, Kakinuma T, Yamada Y, Mori Y, Izumi S, Nishimura K, Nakai M, Ohnishi Y. Clinical Utility of Intraoperative Motor-Evoked Potential Monitoring to Prevent Postoperative Spinal Cord Injury in Thoracic and Thoracoabdominal Aneurysm Repair: An Audit of the Japanese Association of Spinal Cord Protection in Aortic Surgery Database. Anesth Analg 2018; 126:763-768. [PMID: 29283918 DOI: 10.1213/ane.0000000000002749] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Spinal cord ischemic injury is the most devastating sequela of descending and thoracoabdominal aortic surgery. Motor-evoked potentials (MEPs) have been used to intraoperatively assess motor tract function, but it remains unclear whether MEP monitoring can decrease the incidence of postoperative motor deficits. Therefore, we reviewed multicenter medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open surgery and endovascular repair) to assess the association of MEP monitoring with postoperative motor deficits. METHODS Patients included in the study underwent descending or thoracoabdominal aortic repair at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery between 2000 and 2013. Using multivariable mixed-effects logistic regression analysis, we investigated whether intraoperative MEP monitoring was associated with postoperative motor deficits at discharge after open and endovascular aortic repair. RESULTS We reviewed data from 1214 patients (open surgery, 601 [49.5%]; endovascular repair, 613 [50.5%]). MEP monitoring was performed in 631 patients and not performed in the remaining 583 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. Multivariable logistic regression analysis revealed that postoperative motor deficits at discharge did not have a significant association with MEP monitoring (adjusted odds ratio [OR], 1.13; 95% confidence interval [CI], 0.69-1.88; P = .624), but with other factors: history of neural deficits (adjusted OR, 6.08; 95% CI, 3.10-11.91; P < .001), spinal drainage (adjusted OR, 2.14; 95% CI, 1.32-3.47; P = .002), and endovascular procedure (adjusted OR, 0.45; 95% CI, 0.27-0.76; P = .003). The sensitivity and specificity of MEP <25% of control value for motor deficits at discharge were 37.8% (95% CI, 26.5%-49.5%) and 95.5% (95% CI, 94.7%-96.4%), respectively. CONCLUSIONS MEP monitoring was not significantly associated with motor deficits at discharge.
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Affiliation(s)
- Kenji Yoshitani
- From the Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichi Masui
- Department of Anesthesiology, National Defense Medical College, Tokorozawa, Japan.,Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan
| | | | - Mikito Kawamata
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Manabu Kakinohana
- Department of Anesthesiology, University of Ryukyu, Faculty of Medicine, Nishihara, Japan
| | - Shinya Kato
- From the Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kyoko Hasuwa
- From the Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Yusuke Yoshikawa
- Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Kimitoshi Nishiwaki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Chikusa-ku, Nagoya
| | - Tadashi Aoyama
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Chikusa-ku, Nagoya
| | - Yoshimi Inagaki
- Department of Anesthesiology and Critical Care and Medicine, Tottori University, Faculty of Medicine, Tottori, Japan
| | - Kazumasa Yamasaki
- Department of Anesthesiology and Critical Care and Medicine, Tottori University, Faculty of Medicine, Tottori, Japan
| | - Mishiya Matsumoto
- Department of Anesthesiology, Yamaguchi University, Graduate School of Medicine, Ube, Japan
| | - Kazuyoshi Ishida
- Department of Anesthesiology, Yamaguchi University, Graduate School of Medicine, Ube, Japan
| | - Atsuo Yamashita
- Department of Anesthesiology, Yamaguchi University, Graduate School of Medicine, Ube, Japan
| | - Katsuhiro Seo
- Department of Anesthesiology and Intensive Care Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Kakumoto
- Department of Anesthesiology and Intensive Care Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hironobu Hayashi
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Yuu Tanaka
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Satoshi Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Ishida
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Uchino
- Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan
| | - Takayasu Kakinuma
- Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan
| | - Yoshitsugu Yamada
- Department of Anesthesiology, Faculty of Vital Care Medicine, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiteru Mori
- Department of Anesthesiology, Faculty of Vital Care Medicine, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shunsuke Izumi
- Department of Anesthesiology, University of Ryukyu, Faculty of Medicine, Nishihara, Japan
| | - Kunihiro Nishimura
- Department of Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michikazu Nakai
- Department of Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiko Ohnishi
- From the Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Japan
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Aguilar Lloret C, Sernano Hernando FJ, Baquero MC, Fernández Francos S, López-Timoneda F. [Anesthesia in the surgical repair of thoracoabdominal aneurysms: 17 years experience]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:16-22. [PMID: 23062570 DOI: 10.1016/j.redar.2012.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 07/10/2012] [Accepted: 07/13/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To review the results after thoracoabdominal aortic aneurysms repair performed by the same team of surgeons and anesthesiologists over a 17 year period. MATERIAL AND METHODS A prospective and observational study carried out on 65 patients (97% male) who were operated on from 1995 until July 2011 for thoracoabdominal aneurysm, Crawford type i 5 (7.6%), ii 22 (33.8%), iii 17 (26.11%) and iv 21 (32.31%). RESULTS The 30-day mortality was 9.2% (6/65 patients), which was the same as the incidence of paraplegia. This complication only occurred in the Crawford types ii and iii aneurysms. Paraplegia was present in 4.5% (1/22) of patients in whom "left bypass" was used, compared with 29% (5/17) in which the intervention was performed by cross-clamping without distal aortic perfusion (P=.068). The most frequent complication was respiratory, with prolonged mechanical ventilation (>48h) in 20% (13 patients) of cases. The mean hospital stay was 28 days (7-92). DISCUSSION The average mortality in referral centers is 9.7%, ranging between 5% and 16%. In other centres the mortality at 30 days is between 19% and 31% per year. Our group had a 9.2% of mortality rate at 30 days. The incidence of paraplegia in hospitals with greater experience ranges between 2.7% and 16%. Nowadays, an incidence of less than 10% is accepted as good. We had 9.2%. The use of CSF drainage in these patients, as well as the use of left bypass and moderate hypothermia in the Crawford types i, ii and iii appear to be acceptable for prophylaxis of paraplegia.
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Affiliation(s)
- C Aguilar Lloret
- Servicio de Anestesiología y Reanimación, [corrected] Hospital Clínico San Carlos, Madrid, España.
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Cinà CS, Abouzahr L, Arena GO, Laganà A, Devereaux PJ, Farrokhyar F. Cerebrospinal fluid drainage to prevent paraplegia during thoracic and thoracoabdominal aortic aneurysm surgery: a systematic review and meta-analysis. J Vasc Surg 2004; 40:36-44. [PMID: 15218460 DOI: 10.1016/j.jvs.2004.03.017] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We undertook a quantitative systematic review of randomized controlled trials (RCTs) and observational studies to determine the effectiveness of cerebrospinal fluid (CSF) drainage to prevent paraplegia in thoracic aneurysm (TA) and thoracoabdominal aortic aneurysm (TAAA) surgery. METHODS We included RCTs and cohort studies that met the following criteria: elective or emergent aneurysm surgery involving the thoracic or thoracoabdominal aorta, documentation of postoperative neurologic deficits, and patient age older than 18 years. We excluded studies that reported results in 10 or fewer patients and duplicate publications. We identified eligible studies by searching computerized databases, our own files, and the reference lists of relevant articles and review articles. Database searching, eligibility decisions, relevance and method quality assessments, and data extraction were performed in duplicate with prespecified criteria. RESULTS Of 372 publications identified in our search, 14 met our eligibility criteria. Three RCTs reported 289 patients with type I or type II TAAA. Lower limb neurologic deficits occurred in 12% of patients who underwent CSF drainage and 33% of control subjects (number needed to treat, 9; 95% confidence interval [CI], 5-50). The pooled odds ratio (OR) for development of paraplegia in patients in the CSF drainage group was 0.35 (P =.05; 95% CI, 0.12-0.99). Similar results were found in five cohort studies with a control group (pooled OR, 0.26; P =.0002; 95% CI, 0.13-0.53). When all studies were considered together the pooled OR of TA and TAAA was 0.3 (95% CI, 0.17-0.54). There was no statistical heterogeneity among studies included in the meta-analysis. In six cohort studies without a control group, the incidence of paraplegia in high-risk TA and TAAA was 7.6%. CONCLUSIONS Evidence from randomized and nonrandomized trials and from cohort studies support the use of CSF drainage as an adjunct to prevent paraplegia when this adjunct is used in centers with large experience in the management of TAAA.
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Affiliation(s)
- Claudio S Cinà
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada.
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Garutti I, Fernández C, Bardina A, Martínez E, Ferrando A, Fernández-Quero L. Reversal of paraplegia via cerebrospinal fluid drainage after abdominal aortic surgery. J Cardiothorac Vasc Anesth 2002; 16:471-2. [PMID: 12154429 DOI: 10.1053/jcan.2002.125139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- I Garutti
- Department de Anestesiología, Reanimación y Terapia del dolor, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Tsusaki B, Grigore A, Cooley DA, Collard CD. Reversal of delayed paraplegia with cerebrospinal fluid drainage after thoracoabdominal aneurysm repair. Anesth Analg 2002; 94:1674. [PMID: 12032060 DOI: 10.1097/00000539-200206000-00073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tsusaki B, Grigore A, Cooley DA, Collard CD. Reversal of Delayed Paraplegia with Cerebrospinal Fluid Drainage after Thoracoabdominal Aneurysm Repair. Anesth Analg 2002. [DOI: 10.1213/00000539-200206000-00073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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