Can Recognition of Spinal Ischemia Be Improved? Application of Motor-Evoked Potentials, Serum Markers, and Breath Gas Analysis in an Acutely Instrumented Pig Model.
Ann Vasc Surg
; 49: 191-205, 2018 May.
Article
en En
| MEDLINE
| ID: mdl-29518504
ABSTRACT
BACKGROUND:
Paraplegia due to spinal cord ischemia (SCI) is a serious complication after repair of thoracoabdominal aortic aneurysms. For prevention and early treatment of spinal ischemia, intraoperative monitoring of spinal cord integrity is essential. This study was intended to improve recognition of SCI through a combination of transcranial motor-evoked potentials (tc-MEPs), serum markers, and innovative breath analysis.METHODS:
In 9 female German Landrace pigs, tc-MEPs were captured, markers of neuronal damage were determined in blood, and volatile organic compounds (VOCs) were analyzed in exhaled air. After thoraco-phrenico-laparotomy, SCI was initiated through sequential clamping (n = 4) or permanently ligating (n = 5) SAs of the abdominal and thoracic aorta in caudocranial orientation until a drop in the tc-MEPs to at least 25% of the baseline was recorded. VOCs in breath were determined by means of solid-phase microextraction coupled with gas chromatography-mass spectrometry. After waking up, clinical and neurological status was evaluated (Tarlov score). Spinal cord histology was obtained in postmortem.RESULTS:
Permanent vessel ligature induced a worse neurological outcome and a higher number of necrotic motor neurons compared to clamping. Changes of serum markers remained unspecific. After laparotomy, exhaled acetone and isopropanol showed highest concentrations, and pentane and hexane increased during ischemia-reperfusion injury.CONCLUSIONS:
To mimic spinal ischemia occurring in humans during aortic aneurysm repair, animal models have to be meticulously evaluated concerning vascular anatomy and function. Volatiles from breath indicated metabolic stress during surgery and oxidative damage through ischemia reperfusion. Breath VOCs may provide complimentary information to conventional monitoring methods.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Aorta Abdominal
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Aorta Torácica
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Pruebas Respiratorias
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Biomarcadores
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Potenciales Evocados Motores
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Isquemia de la Médula Espinal
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Compuestos Orgánicos Volátiles
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Monitorización Neurofisiológica Intraoperatoria
Tipo de estudio:
Etiology_studies
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Prognostic_studies
Límite:
Animals
Idioma:
En
Año:
2018
Tipo del documento:
Article