Journal of vascular surgery
-
Remote ischemic preconditioning is a physiologic mechanism in mammalian species whereby brief exposure to nonlethal ischemia in one tissue confers protection against a prolonged ischemic insult in a distant tissue. First described almost 15 years ago, it has been slow to translate into clinical practice. ⋯ In addition, a randomized trial in patients undergoing open abdominal aortic aneurysm repair reported a significant reduction in perioperative myocardial infarctions. Remote ischemic preconditioning is easily performed and likely to prove highly cost-effective. large-scale trials of the technique are warranted in patients undergoing major vascular surgery.
-
Comparative Study
Analysis of motor and somatosensory evoked potentials during thoracic and thoracoabdominal aortic aneurysm repair.
Use of motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP) monitoring during thoracic and thoracoabdominal aortic surgery is controversial. This study evaluated the intraoperative use of SSEP and MEP during thoracoabdominal repair and assessed their role in decreasing the risk of spinal cord ischemia and paralysis. ⋯ SSEP and MEP monitoring were highly correlated only when intraoperative changes were irreversible. Reversible changes were not significantly associated with immediate neurologic deficit. Irreversible changes were significantly associated with immediate neurologic deficit, and the findings were identical for SSEP and MEP in this variable, indicating that the more complex MEP measures do not add further information to that obtained from SSEP. Normal SSEP and MEP findings had a strong negative predictive value, indicating that patients without signal loss are unlikely to awake with neurologic deficit.