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Title: Epidural regional hypothermia for prevention of paraplegia after aortic occlusion : experimental evaluation in a rabbit model
Authors: González Fajardo, José Antonio
Aguirre, Beatriz
Pérez Bushardt, José Luis
Álvarez, Tomás
Fernández, Leopoldo
Ramos, Guillermo
Vaquero Puerta, Carlos
Issue Date: 1996
Publisher: Society of Vascular Surgery
Description: Producción Científica
Citation: Journal of Vascular Surgery, July 1996, vol. 23, num. 3 p. 446-451
Abstract: The efficacy of epidural regional hypothermia in the prevention of acute and delayed-onset paraplegia, as well as possible complications and limitations of this technique to a clinically acceptable form, were evaluated in 49 New Zealand white rabbits. Methods: A modified rabbit spinal cord ischemia model of infrarenal aortic occlusion for 30 minutes was employed. The study was performed in two phases. In phase I (n = 20), regional hypothermia induced by epidural perfusion of iced normal saline solution (4 ~ C) was tested versus control in 10 rabbits each (groups A and B). In phase II (n = 29) the animals were subdivided into three groups to study the kinetics of absorption and distribution of methylene blue (group C; n = 10), radiographic contrast material (group D; n = 9), and measurement ofcerebrospinal pressure while an epidural iced solution was or was not infused (group E; n = 10). Results: At 24 and 48 hours, all of the normothermic animals showed irreversible paraplegia (Tarlov score 0). In contrast, at 24 hours none of the rabbits undergoing epidural cold infusion were paraplegic, although at 48 hours one animal had weakness of a hindiimb (Tarlov score 3). Plasma concentration-time profiles of a continuous epidural perfusion with methylene blue showed that the spinal canal is a highly compliant space. Epidurographs showed that epidural perfusion tends to spread more in a cephalic than caudal direction and the main uptake is by the vascular compartiiient. Despite the large volumes infused (78.75 ml/hr; range, 50 to 100 ml), we observed only a modest transient increase in cerebrospinal fluid pressure (from 2.5 -+ 0.3 mm Hg to 5.4 -+ 0.1 mm Hg), although some animals had intracranial hypertension. Conclusions: Regional hypothermia induced by epidural cold perfusion has a highly protective effect against the ischemic spinal cord damage. However, this method probably does not avoid the risk of delayed-onset paraplegia. An important limitation of this technique is the difficulty of controlling the intrathecal pressures.
Keywords: Paraplegia
Cardiováscular, Aparato
ISSN: 0741-5214
Peer Review: SI
DOI: 101016/j.jvs.2008.05.033
Language: eng
Rights: info:eu-repo/semantics/openAccess
Appears in Collections:DEP11 - Artículos de revista

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