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Título
Epidural regional hypothermia for prevention of paraplegia after aortic occlusion : experimental evaluation in a rabbit model
Autor
Año del Documento
1996
Editorial
Society of Vascular Surgery
Descripción
Producción Científica
Documento Fuente
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.
Materias (normalizadas)
Paraplegia
Cardiovascular, Aparato
ISSN
0741-5214
Revisión por pares
SI
Idioma
eng
Derechos
openAccess
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