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Mongan Paul D. MD Major Medical Corps; Peterson, Richard E. MD, Major, Medical Corps; Williams, Dan; Prough, Donald S.
Anesthesia & Analgesia: February 1994
Neurosurgical Anesthesia: PDF Only

The limitations of somatosensory evoked potentials during aortic occlusion stimulated us to evaluate the sensitivity and specificity of spinal (T10 and L4) evoked potentials (SpEPs) in predicting neurologic function after aortic occlusion. Thirty-six swine were assigned randomly to three equal groups (Group 1, control; Group 2, cerebrospinal fluid (CSF) drainage; Group 3, CSF drainage with 20-mg intrathecal papaverine). After induction of anesthesia and initiation of physiologic monitoring, a left-sided thoracotomy was performed to provide access to the descending aorta. SpEPs were generated by stimulating the thoracic spinal cord and recording the conducted response at the T10 and L4 level. After baseline measurements were recorded, the descending aorta was occluded 1 cm distal to the left subclavian artery. SpEPs were recorded every 2.5 min and physiologic variables every 5 min. The aorta was unclamped 10, 15, or 20 min after loss of the L4 SpEP. If the L4 SpEP was not lost, the aortic occlusion interval was terminated at 90 min. Attenuation of the SpEPs occurred earlier at the L4 level. Group 1 experienced the earliest loss of the L4 SpEP (18.3 ± 7.8 min, P < 0.005). Loss of the L4 SpEP in Group 2 (49.3 ± 27.8 min) was earlier than in Group 3 (73.7 ± 26.1 min, P < 0.05). Early postoperative motor function (modified Tarlov scale) correlated with time from loss of the L4 SpEP until reperfusion of the distal aorta (r = 0.93). The sensitivity, specificity, and accuracy of the L4 SpEP in predicting neurologic dysfunction was 92.8% (13 abnormal/14 predicted), 90.9% (20/ 22), and 91.7% (33/36). SpEPs provide an assessment of the response to protective measures and are accurate predictors of early postoperative motor function. Further evaluation of SpEPs may discern similar results in clinical practice.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.

© 1994 International Anesthesia Research Society