| Budget Amount *help |
¥3,300,000 (Direct Cost: ¥3,300,000)
Fiscal Year 2006: ¥1,600,000 (Direct Cost: ¥1,600,000)
Fiscal Year 2005: ¥1,700,000 (Direct Cost: ¥1,700,000)
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| Research Abstract |
Background : Using swine, we investigated whether epidural placement of a cooling catheter rather than infusing iced saline could protect the spinal cord from ischemia during aortic surgery, thus avoiding paraplegia.
Materials and Methods : We divided 14 domestic pigs into two groups of 7. Each underwent thoracic epidural catheter placement preceding 30 min of thoracic aortic crossclamping distal to the origin of the left subclavian artery. In group I, cold water was circulated continuously through the lumen of the catheter connected to an external unit. Spinal cord somatosensory evoked potentials were recorded in both groups. Neurologic status involving hindlimbs was graded sequentially after surgery.
Results : The epidural cooling catheter lowered spinal and epidural temperature significantly in group I, from 38.3±0.6℃ and 38.3±0.5℃ respectively at initiation of cooling to 31.7±0.6℃ and 29.4±0.7℃ at initiation of aortic crossclamping(mean±SEM ; p<0.0001). During crossclamping, spinal temperature in group I (31.7±0.6℃) was significantly lower than in group II (37.8±0.4℃;p<0.0001). No significant elevation of intrathecal pressure accompanied cooling with the catheter,( group I,8.4±3.3mmHg ; group II,8.1±1.8mmHg). Mean time from aortic cross-damping to onset of evoked potential loss was significantly longer in group I (25.7±4.5min) than group II (16.1±6.0minutes:p=0.0053). Mean duration of total loss of potentials was significantly shorter in group I (7.4±3.8min) than group II (19.7±7.3min:p=0.0002). Pigs in group I exhibited better hindlimb function recovery (mean modified Tarlov score, 4.71±0.49) than group II (0.57±0.79;p=0.0017).
Conclusion ; Epidural cooling catheter without iced saline infusion can cool the spinal cord selectively without elevating intrathecal pressure, protecting the cord against ischemia. This measure could help to prevent paraplegia complicating thoracic and thoracoabdominal aortic surgery.
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