Thoracoabdominal aortic surgery and spinal cord protection

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]

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1. [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. [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. [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. [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