RT info:eu-repo/semantics/article
T1 Epidural regional hypothermia for prevention of paraplegia after aortic occlusion : experimental evaluation in a rabbit model
A1 González Fajardo, José Antonio
A1 Aguirre Cervás, Beatriz
A1 Pérez Bushardt, José Luis
A1 Álvarez, Tomás
A1 Fernández, Leopoldo
A1 Ramos Seisdedos, Guillermo
A1 Vaquero Puerta, Carlos
K1 Paraplegia
K1 Cardiovascular, Aparato
AB The efficacy of epidural regional hypothermia in the prevention of acute anddelayed-onset paraplegia, as well as possible complications and limitations of thistechnique 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 for30 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) theanimals were subdivided into three groups to study the kinetics of absorption anddistribution of methylene blue (group C; n = 10), radiographic contrast material (groupD; n = 9), and measurement ofcerebrospinal pressure while an epidural iced solution wasor was not infused (group E; n = 10).Results: At 24 and 48 hours, all of the normothermic animals showed irreversibleparaplegia (Tarlov score 0). In contrast, at 24 hours none of the rabbits undergoingepidural cold infusion were paraplegic, although at 48 hours one animal had weakness ofa hindiimb (Tarlov score 3). Plasma concentration-time profiles of a continuous epiduralperfusion 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 thancaudal direction and the main uptake is by the vascular compartiiient. Despite the largevolumes infused (78.75 ml/hr; range, 50 to 100 ml), we observed only a modest transientincrease 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 highlyprotective effect against the ischemic spinal cord damage. However, this method probablydoes not avoid the risk of delayed-onset paraplegia. An important limitation of thistechnique is the difficulty of controlling the intrathecal pressures.
PB Society of Vascular Surgery
SN 0741-5214
YR 1996
FD 1996
LK http://uvadoc.uva.es/handle/10324/3422
UL http://uvadoc.uva.es/handle/10324/3422
LA eng
NO Journal of Vascular Surgery, July 1996, vol. 23, num. 3 p. 446-451
NO Producción Científica
DS UVaDOC
RD 22-dic-2024