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Clinical Utility of Intraoperative Motor-Evoked Potential Monitoring to Prevent Postoperative Spinal Cord Injury in Thoracic and Thoracoabdominal Aneurysm Repair: An Audit of the Japanese Association of Spinal Cord Protection in Aortic Surgery Database

Yoshitani, Kenji, MD*; Masui, Kenichi, MD†,‡; Kawaguchi, Masahiko, MD§; Kawamata, Mikito, MD; Kakinohana, Manabu, MD; Kato, Shinya, MD*; Hasuwa, Kyoko, MD*; Yamakage, Michiaki, MD#; Yoshikawa, Yusuke, MD#; Nishiwaki, Kimitoshi, MD**; Aoyama, Tadashi, MD**; Inagaki, Yoshimi, MD††; Yamasaki, Kazumasa, MD††; Matsumoto, Mishiya, MD‡‡; Ishida, Kazuyoshi, MD‡‡; Yamashita, Atsuo, MD‡‡; Seo, Katsuhiro, MD§§; Kakumoto, Shinichi, MD§§; Hayashi, Hironobu, MD§; Tanaka, Yuu, MD§; Tanaka, Satoshi, MD; Ishida, Takashi, MD; Uchino, Hiroyuki, MD∥∥; Kakinuma, Takayasu, MD∥∥; Yamada, Yoshitsugu, MD¶¶; Mori, Yoshiteru, MD¶¶; Izumi, Shunsuke, MD; Nishimura, Kunihiro, MD, PhD##; Nakai, Michikazu, PhD##; Ohnishi, Yoshihiko, MD*

doi: 10.1213/ANE.0000000000002749
Cardiovascular Anesthesiology: Original Clinical Research Report

BACKGROUND: Spinal cord ischemic injury is the most devastating sequela of descending and thoracoabdominal aortic surgery. Motor-evoked potentials (MEPs) have been used to intraoperatively assess motor tract function, but it remains unclear whether MEP monitoring can decrease the incidence of postoperative motor deficits. Therefore, we reviewed multicenter medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open surgery and endovascular repair) to assess the association of MEP monitoring with postoperative motor deficits.

METHODS: Patients included in the study underwent descending or thoracoabdominal aortic repair at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery between 2000 and 2013. Using multivariable mixed-effects logistic regression analysis, we investigated whether intraoperative MEP monitoring was associated with postoperative motor deficits at discharge after open and endovascular aortic repair.

RESULTS: We reviewed data from 1214 patients (open surgery, 601 [49.5%]; endovascular repair, 613 [50.5%]). MEP monitoring was performed in 631 patients and not performed in the remaining 583 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. Multivariable logistic regression analysis revealed that postoperative motor deficits at discharge did not have a significant association with MEP monitoring (adjusted odds ratio [OR], 1.13; 95% confidence interval [CI], 0.69–1.88; P = .624), but with other factors: history of neural deficits (adjusted OR, 6.08; 95% CI, 3.10–11.91; P < .001), spinal drainage (adjusted OR, 2.14; 95% CI, 1.32–3.47; P = .002), and endovascular procedure (adjusted OR, 0.45; 95% CI, 0.27–0.76; P = .003). The sensitivity and specificity of MEP <25% of control value for motor deficits at discharge were 37.8% (95% CI, 26.5%–49.5%) and 95.5% (95% CI, 94.7%–96.4%), respectively.

CONCLUSIONS: MEP monitoring was not significantly associated with motor deficits at discharge.

From the *Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Japan

Department of Anesthesiology, National Defense Medical College, Tokorozawa, Japan

Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan

§Department of Anesthesiology, Nara Medical University, Kashihara, Japan

Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan

Department of Anesthesiology, University of Ryukyu, Faculty of Medicine, Nishihara, Japan

#Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo, Japan

**Department of Anesthesiology, Nagoya University Graduate School of Medicine, Chikusa-ku, Nagoya

††Department of Anesthesiology and Critical Care and Medicine, Tottori University, Faculty of Medicine, Tottori, Japan

‡‡Department of Anesthesiology, Yamaguchi University, Graduate School of Medicine, Ube, Japan

§§Department of Anesthesiology and Intensive Care Medicine, Kokura Memorial Hospital, Kitakyushu, Japan

∥∥Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan

¶¶Department of Anesthesiology, Faculty of Vital Care Medicine, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

##Department of Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Suita, Japan.

Published ahead of print December 26, 2017.

Accepted for publication November 2, 2017.

Funding: Departmental.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Kenji Yoshitani, MD, Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan. Address e-mail to ykenji@kfz.biglobe.ne.jp.

© 2018 International Anesthesia Research Society
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