• Kenji Yoshitani, Soshiro Ogata, Shinya Kato, Akito Tsukinaga, Tsunenori Takatani, Nobuhide Kin, Mariko Ezaka, Jun Shimizu, Yuko Furuichi, Shoichi Uezono, Kotaro Kida, Katsuhiro Seo, Shinichi Kakumoto, Hiroshi Miyawaki, Mikito Kawamata, Satoshi Tanaka, Manabu Kakinohana, Shunsuke Izumi, Hiroyuki Uchino, Takayasu Kakinuma, Kimitoshi Nishiwaki, Kazuko Hasegawa, Mishiya Matsumoto, Kazuyoshi Ishida, Atsuo Yamashita, Michiaki Yamakage, Yusuke Yoshikawa, Yuji Morimoto, Hitoshi Saito, Takahisa Goto, Tetsuhito Masubuchi, Masahiko Kawaguchi, Kosuke Tsubaki, Satoshi Mizobuchi, Norihiko Obata, Yoshimi Inagaki, Kazumi Funaki, Yoshiki Ishiguro, Masamitsu Sanui, Kazutaka Taniguchi, Kunihiro Nishimura, and Yoshihiko Ohnishi.
• Department of Transfusion, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Osaka, 564-8565, Japan. ykenji@ncvc.go.jp.
• J Anesth. 2023 Jun 1; 37 (3): 408415408-415.

PurposeCerebrospinal fluid drainage (CSFD) is recommended during open or endovascular thoracic aortic repair. However, the incidence of CSFD complications is still high. Recently, CSF pressure has been kept high to avoid complications, but the efficacy of CSFD at higher pressures has not been confirmed. We hypothesize that CSFD at higher pressures is effective for preventing motor deficits.MethodsThis prospective observational study included 14 hospitals that are members of the Japanese Society of Cardiovascular Anesthesiologists. Patients who underwent thoracic and thoracoabdominal aortic repair were divided into four groups: Group 1, CSF pressure around 10 mmHg; Group 2, CSF pressure around 15 mmHg; Group 3, CSFD initiated when motor evoked potential amplitudes decreased; and Group 4, no CSFD. We assessed the association between the CSFD group and motor deficits using mixed-effects logistic regression with a random intercept for the institution.ResultsOf 1072 patients in the study, 84 patients (open surgery, 51; thoracic endovascular aortic repair, 33) had motor deficits at discharge. Groups 1 and 2 were not associated with motor deficits (Group 1, odds ratio (OR): 1.53, 95% confidence interval (95% CI): 0.71-3.29, p = 0.276; Group 2, OR: 1.73, 95% CI: 0.62-4.82) when compared with Group 4. Group 3 was significantly more prone to motor deficits than Group 4 (OR: 2.56, 95% CI: 1.27-5.17, p = 0.009).ConclusionCSFD is not associated with motor deficits in thoracic and thoracoabdominal aortic repair with CSF pressure around 10 or 15 mmHg.© 2023. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.

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