Cerebrospinal fluid drainage to prevent postoperative spinal cord injury in thoracic aortic repair

Journal of Anesthesia - Tập 35 - Trang 43-50 - 2020
Kenji Yoshitani1, Masahiko Kawaguchi2, Mikito Kawamata3, Manabu Kakinohana4, Shinya Kato1, Kyoko Hasuwa1, Michiaki Yamakage5, Yusuke Yoshikawa5, Kimitoshi Nishiwaki6, Kazuko Hasegawa6, Yoshimi Inagaki7, Kazumi Funaki7, Mishiya Matsumoto8, Kazuyoshi Ishida8, Atsuo Yamashita8, Katsuhiro Seo9, Shinichi Kakumoto9, Kosuke Tsubaki2, Satoshi Tanaka3, Takashi Ishida3, Hiroyuki Uchino10, Takayasu Kakinuma10, Yoshitsugu Yamada11, Yoshiteru Mori11, Shunsuke Izumi4, Jun Shimizu12, Yuko Furuichi12, Nobuhide Kin13, Shoichi Uezono14, Kotaro Kida14, Kunihiko Nishimura15, Michikazu Nakai15, Yoshihiko Ohnishi1
1Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Japan
2Department of Anesthesiology, Nara Medical University, Kashihara, Japan
3Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan
4Department of Anesthesiology, Faculty of Medicine, University of Ryukyu, Naha, Japan
5Department of Anesthesiology, School of Medicine, Sapporo Medical University, Sapporo, Japan
6Department of Anesthesiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
7Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
8Department of Anesthesiology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
9Department of Anesthesiology and Intensive Care Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
10Department of Anesthesiology, Tokyo Medical University, Shinjuku Ku, Japan
11Department of Anesthesiology, Faculty of Vital Care Medicine, The Graduate School of Medicine, The University of Tokyo, Bunkyo Ku, Japan
12Department of Anesthesiology, Sakakibara Heart Institute, Fuchu, Japan
13Department of Anesthesiology, New Tokyo Hospital, Matsudo, Japan
14Department of Anesthesiology, School of Medicine, The Jikei University, Minato Ku, Japan
15Department of Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Suita, Japan

Tóm tắt

Cerebrospinal fluid drainage (CSFD) is recommended as a spinal cord protective strategy in open and endovascular thoracic aortic repair. Although small studies support the use of CSFD, systematic reviews have not suggested definite conclusion and a large-scale study is needed. Therefore, we reviewed medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open and endovascular repair) at multiple institutions to assess the association between CSFD and postoperative motor deficits. Patients included in this study underwent descending or thoracoabdominal aortic repair between 2000 and 2013 at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery. We conducted a retrospective study to investigate whether motor-evoked potential monitoring is effective in reducing motor deficits in thoracic aortic aneurysm repair. We use the same dataset to examine whether CSFD reduces motor deficits after propensity score matching. We reviewed data from 1214 patients [open surgery, 601 (49.5%); endovascular repair, 613 (50.5%)]. CSFD was performed in 417 patients and not performed in the remaining 797 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. After propensity score matching (n = 700), mixed-effects logistic regression performed revealed that CSFD is associated with postoperative motor deficits at discharge [adjusted odds ratio (OR), 3.87; 95% confidence interval (CI), 2.30–6.51]. CSFD may not be effective for postoperative motor deficits at discharge.

Tài liệu tham khảo

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Journal of Anesthesia

Tập 35

43-50

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