Version June 2024
The algorithm summarizes the anesthetic approach to managing evidence of spinal cord ischemia noted during continuous neuromonitoring and with an intrathecal catheter in place during descending thoracic aortic surgery. Managing intraoperative spinal cord ischemia involves close collaboration among the anesthesia, surgery, and neuromonitoring teams.
This algorithm is intended for use in conjunction with UpToDate content discussing anesthesia and surgery for descending thoracic aortic pathology.CSF: cerebrospinal fluid; CVP: central venous pressure; Hgb: hemoglobin; MAP: mean arterial pressure; MEPs: motor evoked potentials; O2: oxygen; PaO2: partial pressure of arterial oxygen; SCPP: spinal cord perfusion pressure; SEPs: somatosensory evoked potentials.
* Refer to UpToDate topics discussing neuromonitoring and effects of anesthesia.
¶ Other potential causes are reviewed in topics discussing anesthesia for thoracic surgery and aortic surgery techniques.
Δ Anesthesia and surgical interventions to reduce spinal cord ischemia are often performed simultaneously.
◊ Limit CSF drainage to <20 mL during the first hour of surgery and to <40 mL during any 4-hour period.
§ In some cases, there are no additional options to eliminate intraoperative spinal cord ischemia.
¥ Refer to UpToDate topics reviewing management of spinal cord ischemia in the postoperative period.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
