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Durdag E, Yildirim Z, Unlu NL, Kale A, Ceviker N. Neuroprotective Effects of Vigabatrin on Spinal Cord Ischemia-Reperfusion Injury. World Neurosurg 2018; 120:e33-e41. [PMID: 30031958 DOI: 10.1016/j.wneu.2018.07.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Spinal cord ischemia is a serious and catastrophic clinicopathologic condition. Despite studies reported over the last 20 years, alternative and efficient treatment options remain unclear. We examined the neuroprotective effects of vigabatrin on a spinal ischemia-reperfusion model. METHODS We divided 24 New Zealand rabbits into 4 groups (control, ischemia reperfusion, and low-dose and high-dose vigabatrin). The control group underwent only abdominal surgery, whereas an abdominal aortic cross-clamp model of spinal ischemia was performed in the other groups. Clips were removed after 30 minutes and 50 and 150 mg/kg vigabatrin was administered intraperitoneally to the low-dose and high-dose groups, respectively. Neurologic examination was performed for 48 hours, after which the rabbits were sacrificed and a blood sample obtained. Biochemical examination of malondialdehyde, advanced oxidation protein products, total nitric oxide, and glutathione levels and superoxide dismutase activities in plasma and tissue sample, and histopathologic examination of the spinal cord were performed and statistical results compared between the groups. RESULTS Low-dose vigabatrin had statistically significant effects of neuroprotection on spinal ischemia. Although high-dose vigabatrin had similar effects, the results were not statistically significant for all parameters of biochemical analysis. In addition, histopathologic examination showed some toxic effects of high-dose vigabatrin. CONCLUSIONS Neuroprotective effects of vigabatrin are shown. For clinical use, further studies are needed.
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Affiliation(s)
- Emre Durdag
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Besevler, Ankara, Turkey
| | - Zuhal Yildirim
- Etimesgut Public Health Laboratory, Etimesgut, Ankara, Turkey.
| | - Nese Lortlar Unlu
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Aydemir Kale
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Besevler, Ankara, Turkey
| | - Necdet Ceviker
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Besevler, Ankara, Turkey
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Abstract
The conduct of partial left heart bypass or partial car diopulmonary bypass (CPB) during surgery involving the descending thoracic aorta or thoracoabdominal aorta is one of the most unappreciated and misunder stood extracorporeal circulation procedures in cardio vascular surgery. It is different from conventional CPB, and although some uninitiated practitioners consider it simpler, it is in fact more complicated than conven tional CPB and involves different concepts. It requires expertise and skill in regulating the flow, pressure, and oxygenation of blood going to both the proximal and distal parts of the body and management of the special bypass or shunt procedures used, specialized monitor ing, and knowledge about the protection and preserva tion of organs both proximal and distal to the aortic clamping. It demands exquisite communication and un derstanding of the unique problems faced by the sur geon, anesthesiologist, and perfusionist.
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Affiliation(s)
- Eugene A. Hessel
- Department of Anesthesiology, College of Medicine, Chandler Medical Center, University of Kentucky, Louisville, KY
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Iida H, Iida M, Takenaka M. Anesthesia and cerebrospinal microcirculation: assessment using cranial- and spinal-window techniques. J Anesth 2011; 26:143-6. [PMID: 22101772 DOI: 10.1007/s00540-011-1284-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Indexed: 11/26/2022]
Affiliation(s)
- Hiroki Iida
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
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Lee CH, Choi KY, Kim YJ, Kim WG. Neuroprotective Effect of KR-31378, a Novel Potassium Channel Activator, on Spinal Cord Ischemic Injury in Rabbits. J INVEST SURG 2009; 18:297-304. [PMID: 16319050 DOI: 10.1080/08941930500328219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Neurologic deficits after the surgical repair of thoracic and thoracoabdominal aortic disease are devastating complications. Recently, pharmacologic preconditioning with potassium channel openers was reported to protect the spinal cord against neurologic injury in a model of spinal cord ischemia. A novel benzopyran derivative with an N-cyanoguanidine group, KR-31378, has been synthesized as a new therapeutic agent against ischemic injury. In the present study, we evaluated the protective effects of KR-31378 on spinal cord ischemic injury and compared its neuroprotective activities and hemodynamic stabilities with those of diazoxide. Thirty-four New Zealand white rabbits were randomly divided into four groups: ischemia group (n = 10, 25 min of aortic cross-clamping without any intervention), diazoxide group (n = 8, diazoxide [5 mg/kg] intravenously 15 min before the 25-min cross-clamping), KR20 group (n = 8, KR-31378 [20 mg/kg] intravenously 30 min before the 25-min cross-clamping), and the KR50 group (n = 8, KR-31378 [50 mg/kg] intravenously 30 min before the 25-min cross-clamping). Neurologic functions were evaluated for 72 h postoperatively using modified Tarlov's scores. All rabbits were sacrificed for histopathologic observations after finally scoring neurologic function. All rabbits but three survived. The rest were completely evaluated 72 h postoperatively. Unlike diazoxide-treated rabbits, KR-31378-treated rabbits showed relatively stable hemodynamics. Tarlov's score outcomes showed a marked improvement in the diazoxide group, in the KR20 group, and in the KR50 group compared to the ischemia group (p = .005, .002, and .001, respectively). However, Tarlov's scores in the KR50 group were not significantly different from those of the diazoxide group. Histopathologic data were not significantly different between the groups, but the degree of degenerative change in motor neurons showed a significant correlation with Tarlov's scores 3 days postoperatively (gamma = -.378, p = .036). Thus, the administration of KR-31378 before the aortic cross-clamping resulted in a significant improvement in neurologic outcome with stable hemodynamics in this rabbit model.
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Affiliation(s)
- Chang-Ha Lee
- Department of Cardiac Surgery, Sejong General Hospital, Bucheon, Korea
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Abstract
Anesthesia for surgery of the aorta poses some of the most difficult challenges for anesthesiologists. Major hemodynamic and physiologic stresses and sophisticated techniques of extracorporeal support are superimposed on patients with complex medical disease states. In this review, etiologies, natural history, and surgical techniques of thoracic aortic aneurysm are presented. Anesthetic considerations are discussed in detail, including the management of distal perfusion using partial cardiopulmonary bypass. Considerations of spinal cord protection, including management of proximal hypertension, cerebral spinal fluid drainage, and pharmacological therapies, are presented.
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Affiliation(s)
- Ronald A Kahn
- Department of Anesthesiology, the Mount Sinai School of Medicine, New York, New York 10029-6547, USA.
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Savas S, Savas C, Altuntas I, Adiloglu A. The correlation between nitric oxide and vascular endothelial growth factor in spinal cord injury. Spinal Cord 2007; 46:113-7. [PMID: 17420770 DOI: 10.1038/sj.sc.3102066] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective, randomized, placebo-controlled, experimental study. OBJECTIVES The issue of whether nitric oxide (NO) production is beneficial or deleterious on ischemic injuries of the central nervous system still remains doubtful. Vascular endothelial growth factor (VEGF) is known to induce the release of NO from endothelial cells. However, the effect of NO on VEGF synthesis is not clear. We aimed to determine the effects of L-arginine and NG-nitro-L-arginine methyl ester (L-NAME) on VEGF synthesis and free radicals in a rat model of spinal cord ischemia-reperfusion (IR) injury. SETTING Surgical Research Laboratory of a Medical School. MATERIAL AND METHODS Twenty-eight Wistar rats were divided into four groups as follows (n=7): Sham, IR injury, L-arginine, and L-NAME. Infrarenal abdominal aorta was occluded to induce spinal cord ischemia. L-Arginine (100 mg/kg) and L-NAME (10 mg/kg) were given before aortic occlusion. Biochemical assays of malondialdehyde (MDA), NO and VEGF were carried out in spinal cord specimens. RESULTS L-Arginine treatment significantly increased MDA and NO, but decreased VEGF levels in spinal cord. However, nonselective inhibition of NOS with L-NAME significantly decreased MDA and NO, but increased VEGF levels. Besides, the positive linear correlation between MDA and NO, and negative linear correlations between MDA, NO and VEGF levels have also been demonstrated. CONCLUSION Nonselective inhibition of NO synthase activity with L-NAME attenuated free radical formation and increased VEGF level when compared with NO precursor L-arginine in a rat model of spinal cord ischemia. We suggest that inhibition of NO synthase, as well as induction of VEGF, may be a therapeutic option in spinal cord IR injury.
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Affiliation(s)
- S Savas
- Department of Physical Medicine and Rehabilitation, Süleyman Demirel University Medical School, Isparta, Turkey.
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Elbers PWG, de Haan P, Vanicky I, Legemate D, Dzoljic M. Effect of Temporary Visceral Ischemia on Spinal Cord Ischemic Damage in the Rabbit. Ann Thorac Surg 2006; 81:910-7. [PMID: 16488694 DOI: 10.1016/j.athoracsur.2005.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2005] [Revised: 09/06/2005] [Accepted: 09/09/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Spinal cord ischemia and visceral ischemia may occur simultaneously during thoracoabdominal aortic aneurysm repair. The present rabbit study investigated the effect of a temporary interruption of the visceral perfusion on the development of ischemia-reperfusion injury of the spinal cord. METHODS Spinal cord ischemia was induced by occlusion of the infrarenal aorta for variable durations (6 to 20 minutes) in 32 rabbits. In the visceral ischemia group, 20-minute concurrent clamping of the celiac trunk and mesenteric arteries was performed. At 24, 48, and 72 hours after ischemia, neurologic outcome was assessed in the control and visceral ischemia group. The PD50 (the duration of ischemia that produces lower limb neurologic deficits in 50% of the animals) was determined by quantal bioassay analysis. At 72 hours, histologic evaluation of spinal cord infarct size was performed. RESULTS Compared with control animals, PD50 was significantly longer in the visceral ischemia group at 48 hours and 72 hours after ischemia. Neurologic and histologic outcomes correlated well (r = -0.90). CONCLUSIONS The results of the present rabbit study suggest that concurrent temporary visceral ischemia does not aggravate spinal cord ischemic injury in the rabbit. Moreover, the results suggest that concurrent visceral ischemia may increase the tolerance of the spinal cord to ischemic damage.
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Affiliation(s)
- Paul W G Elbers
- Department of Anesthesiology, St. Antonius Ziekenhuis Nieuwegein, Nieuwegein, The Netherlands
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Savaş S, Delibaş N, Savaş C, Sütçü R, Cindaş A. Pentoxifylline reduces biochemical markers of ischemia-reperfusion induced spinal cord injury in rabbits. Spinal Cord 2002; 40:224-9. [PMID: 11987004 DOI: 10.1038/sj.sc.3101281] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
STUDY DESIGN Occlusion of the infrarenal abdominal aorta with administration of pentoxifylline was applied to adult rabbits, followed by removal of aortic clamp and reperfusion. Tissue levels of cytokines, lipid peroxides, and antioxidant enzymes were assayed and compared within groups. OBJECTIVES To examine the effect of pentoxifylline (PTX) on cytokine levels, lipid peroxidation, and antioxidant enzymes in a rabbit model of spinal cord ischemia-reperfusion injury induced by aortic occlusion. SETTING Isparta, Turkey. METHODS Rabbits were randomly allocated into four groups of sham laparotomy (SHAM), sham laparotomy with PTX administration (SHAM+PTX), aortic occlusion and reperfusion (AOR), aortic occlusion and reperfusion with PTX administration (AOR+PTX). An intravenous bolus of 50 mg/kg PTX was given just before aortic cross clamping. An atraumatic microvascular clamp was then placed on the abdominal aorta immediately distal to the left renal artery for 30 min. PTX was infused at a rate of 0.5 mg/kg/min during the aortic occlusion. Animals were subjected to 120 min of reperfusion after removal of the aortic clamp. All animals were sacrificed at the end of reperfusion. The lumbosacral segments of spinal cords were quickly harvested and stored at -78 degrees C for biochemical assays of IL-6, TNF-alpha, MDA, SOD, and CAT levels. Differences among groups were analyzed by one-way analysis of variance followed by a post hoc Tukey's honestly significant difference test. RESULTS No differences in mean levels of IL-6, TNF-alpha, MDA, SOD, and CAT were noted between SHAM and SHAM+PTX groups (P>0.05). There was a significant increase in all biochemical parameters in the AOR group (P<0.05). Administration of PTX significantly attenuated the levels of all biochemical parameters in the AOR+PTX group (P<0.05). CONCLUSION PTX pretreatment attenuated ischemia-reperfusion induced spinal cord injury in a rabbit model, in terms of biochemical parameters of ischemia and reperfusion.
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Affiliation(s)
- S Savaş
- Department of Physical Medicine and Rehabilitation, Suleyman Demirel University Medical School, Isparta, Turkey
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Wakamatsu Y, Shiiya N, Kunihara T, Watanabe S, Yasuda K. The adenosine triphosphate-sensitive potassium channel opener nicorandil protects the ischemic rabbit spinal cord. J Thorac Cardiovasc Surg 2001; 122:728-33. [PMID: 11581605 DOI: 10.1067/mtc.2001.115703] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We investigated the protective effects of an adenosine triphosphate-sensitive potassium channel opener nicorandil in the rabbit model of spinal cord ischemia. METHODS Rabbits were randomized into 4 groups (each n = 6): the nicorandil group (100 microg/kg intravenous nicorandil 10 minutes before ischemia); the glibenclamide plus nicorandil group (3 mg/kg intravenous glibenclamide, an antagonist of adenosine triphosphate-sensitive potassium channels, 10 minutes before nicorandil administration); the vehicle group (vehicle alone); and the sham operation group (without spinal cord ischemia). Spinal cord ischemia was induced by balloon occlusion of the infrarenal abdominal aorta for 15 minutes at 39 degrees C. Neurologic function was graded into Johnson's score at 8 hours, 1 day, and 2 days. Histopathologic examination was performed at 2 days, and the number of intact motor neuron cells was compared. RESULTS Johnson scores of the glibenclamide plus nicorandil and vehicle groups were significantly lower than those of the sham operation and nicorandil groups at each time point, and no statistically significant difference was observed between the glibenclamide plus nicorandil and vehicle groups. Histopathologic examination revealed that motor neurons were almost normal in the nicorandil group, whereas about 55% of motor neurons were lost in the vehicle and glibenclamide plus nicorandil groups. CONCLUSIONS Nicorandil has a protective effect on the ischemic rabbit spinal cord, and the beneficial effect seems mediated through the activation of adenosine triphosphate-sensitive potassium channels.
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Affiliation(s)
- Y Wakamatsu
- Department of Cardiovascular Surgery, Hokkaido University, Sapporo, Japan
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Abstract
BACKGROUND Ischemic spinal cord damage during thoracic aortic operations has not been eliminated despite application of various adjuncts. We experimentally investigated the protective effects of pentobarbital and hypothermia on the spinal cord subjected to ischemia. METHODS Among nine groups of 6 rabbits each, groups AI to AIII underwent 20-minute infrarenal aortic occlusion, and groups BI to BVI underwent 40-minute occlusion. Five milligrams per kilogram of pentobarbital was administered to groups AII and BII; 10 mg/kg in groups AIII, BIII, and BVI; 20 mg/kg in group BIV; and none in groups AI, BI, and BV. In groups BV and BVI, hypothermia was induced. Forty-eight hours postoperatively, the motor function of the lower limbs was evaluated. RESULTS Statistically significant recovery of motor function was observed in animals in groups AII, AIII, BIII, BIV, BV, and BVI. CONCLUSIONS Pentobarbital showed dose-dependent protective effects of the spinal cord. Moderate hypothermia alone also showed protective effects. Combined use of pentobarbital and hypothermia resulted in highly significant recovery of spinal cord function.
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Affiliation(s)
- S Kazama
- Department of Cardiothoracic Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
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Robe J, Carell TP, Neidhart P. Anaesthetic management of patients undergoing surgery on the descending aorta. Best Pract Res Clin Anaesthesiol 2000. [DOI: 10.1053/bean.2000.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hellberg A, Christiansson L, Tulga Ulus A, Bergqvist D, Wiklund L, Karacagil S. A prolonged spinal cord ischaemia model in pigs. Passive shunting offers stable central haemodynamics during aortic occlusion. Eur J Vasc Endovasc Surg 2000; 19:318-23. [PMID: 10753699 DOI: 10.1053/ejvs.1999.1027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to evaluate the effect of a modified aortic shunt on central haemodynamic variables during experimental thoracic aortic occlusion in a prolonged spinal cord ischaemia model. MATERIAL AND METHODS central haemodynamic variables were evaluated during aortic cross-clamping. In the shunt group (n=11), after the placement of proximal and distal aortic clamps, distal aortic perfusion was restored through an aortoiliac shunt via the left subclavian artery. In the no-shunt group (n=11), spinal cord ischaemia was achieved with only proximal aortic cross-clamping. The clamping time was 60 minutes in the shunt group and 30 minutes in the no-shunt group. RESULTS in the no-shunt group, all animals needed inotropic support, vasodilators and buffers during the experiment. None of these drugs were needed in the shunt group. In the no-shunt group, cross-clamping caused a significant increase in mean arterial pressure and heart rate compared to baseline values. These variables were stable in the shunt group during aortic occlusion. In the reperfusion period cardiac output, heart rate and arterial pCO(2)were significantly higher in the no-shunt than in the shunt group. CONCLUSION the present experimental spinal cord ischaemia model, using double aortic cross-clamping with shunt, offers improved central haemodynamics. This enables the study of prolonged selective spinal cord ischaemia without interaction from vasoactive drugs or systemic reperfusion.
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Affiliation(s)
- A Hellberg
- Department of Surgery, University Hospital, Uppsala, Sweden
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Abstract
BACKGROUND Although rare, paralysis secondary to spinal cord ischaemia after aortic aneurysm surgery is a devastating complication. Many papers have been published on this topic but without a clear consensus on the best way of minimizing the problem. Recent articles have included advanced pharmacological approaches and the literature has been reviewed in light of these. METHODS Relevant papers were identified by an extensive text word search of the Medline database and a review of quoted articles. RESULTS Spinal cord complications are commoner after the repair of Crawford type II aneurysms than less extensive aneurysms. The presence of dissection, rupture and prolonged clamp times are associated with an increased incidence. About a quarter of all cord problems develop over 24 h after surgery and this may be due to a reperfusion type injury, although the exact mechanisms are by no means clear. CONCLUSION A combination of rapid surgery, left heart bypass for the repair of more extensive aneurysms, free spinal drainage and the avoidance of postoperative hypoxia and hypotension help to minimize spinal cord ischaemia. No pharmacological agent has yet been shown conclusively to improve outcome in the clinical setting.
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Affiliation(s)
- P Lintott
- Academic Surgical Unit, Imperial College School of Medicine at St Mary's, St Mary's Hospital, London, UK
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