Anaes · Vascular anaesthesia
Thoracoabdominal aortic surgery and spinal cord protection
Also known as Thoracoabdominal aortic surgery and spinal cord protection
Exam-exhaustive spinal cord protection in TAAA/TEVAR for ANZCA Final.
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Target exams
ANZCAFRCAABAEDAICFCAI
Red flags
- Cord perfusion pressure ≈ MAP − CSF pressure (or CVP).
- CSF drain often target CSF pressure about 10 mmHg.
- Delayed paraplegia is a ward emergency — raise MAP, drain CSF.
- Adamkiewicz is critical segmental supply concept.
- TEVAR still risks cord ischaemia.
Meet the patient
A 71-year-old vasculopath is postoperative day 2 after an extent II thoracoabdominal aneurysm repair with a CSF drain in situ. The night nurse pages you: "He says his legs feel heavy."[3]
The examiner's question: "What do you do in the next five minutes?" The answer is not a scan in the morning — it is MAP up and CSF drain check now.[2][3]
References9ShowHide
- [1]Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery Circulation, 1999.PMID 10477528
- [2]Wong CS, Healy D, Canning C, et al. A systematic review of spinal cord injury and cerebrospinal fluid drainage after thoracic aortic endografting J Vasc Surg, 2012.PMID 22884456
- [3]Coselli JS, Green SY, Price MD, et al. Spinal cord deficit after 1114 extent II open thoracoabdominal aortic aneurysm repairs J Thorac Cardiovasc Surg, 2020.PMID 30904252
- [4]Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial Lancet, 2008.PMID 18479744
- [5]Miller LK, Patel VI, Wagener G Spinal Cord Protection for Thoracoabdominal Aortic Surgery J Cardiothorac Vasc Anesth, 2022.PMID 34366215
- [6]Shine T, Nugent M Sodium nitroprusside decreases spinal cord perfusion pressure during descending thoracic aortic cross-clamping in the dog J Cardiothorac Anesth, 1990.PMID 2131865
- [7]Joyce JA Naloxone infusion combined with cerebrospinal fluid monitoring and drainage during thoracic aorta exploration: a case report AANA J, 1996.PMID 9124031
- [8]Piola FPF, Nogueira-Barbosa MH, Maranho DAC, et al. Identification of the Artery of Adamkiewicz Using Multidetector Computed Tomography Angiography (MCTA) Rev Bras Ortop, 2020.PMID 32123448
- [9]Imamura Y, Kin H, Yoshioka K, et al. Thoracoabdominal aortic aneurysm repair based on pre- and postoperative evaluation of the artery of Adamkiewicz Eur J Cardiothorac Surg, 2022.PMID 36305679