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Gerard Stansby – One of the best experts on this subject based on the ideXlab platform.
cerebrospinal fluid drainage for thoracic and thoracoabdominal aortic Aneurysm SurgeryCochrane Database of Systematic Reviews, 2012Co-Authors: S N Khan, Gerard StansbyAbstract:
During aortic Aneurysm Surgery, cross-clamping can lead to inadequate blood supply to the spinal cord resulting in neurological deficit. Cerebrospinal fluid drainage (CSFD) may increase the perfusion pressure to the spinal cord and hence reduce the risk of ischaemic spinal cord injury.
To determine the effect of CSFD during thoracic and thoracoabdominal aortic Aneurysm (TAAA) Surgery on the risk of developing spinal cord injury.
For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched May 31 2012) and CENTRAL (2012, Issue 5) for publications describing randomised controlled trials of cerebrospinal fluid drainage for thoracic and thoracoabdominal aortic Aneurysm Surgery. Reference lists of relevant articles were checked.
Randomised trials involving CSFD during thoracic and TAAA Surgery.
Data collection and analysis
Both authors assessed the quality of trials independently. SNK extracted data and GS verified the data.
Three trials with a total of 287 participants operated on for Type I or II TAAA were included.
In the first trial of 98 participants, neurological deficits in the lower extremities occurred in 14 (30%) of CSFD group and 17 (33%) controls. The deficit was observed within 24 hours of the operation in 21 (68%), and from three to 22 days in 10 (32%) participants. CSFD did not have a significant benefit in preventing ischaemic injury to the spinal cord.
The second trial of 33 participants used a combination of CSFD and intrathecal papaverine. It showed a statistically significant reduction in the rate of postoperative neurological deficit (P = 0.039), compared to controls. Analysis was undertaken after only one third of the estimated sample size had entered the trial.
In the third trial TAAA repair was performed on 145 participants. CSFD was initiated during the operation and continued for 48 hours after Surgery. Paraplegia or paraparesis occurred in 9 of 74 participants (12.2%) in the control group versus 2 of 82 participants (2.7%) receiving CSFD (P = 0.03). Overall, CSFD resulted in an 80% reduction in the relative risk of postoperative deficits. Meta-analysis showed an odds ratio (OR) of 0.48 (95 % confidence interval (CI) 0.25 to 0.92). For CSFD-only trials, OR was 0.57 (95% CI 0.28 to 1.17) and for intention-to-treat analysis in CSFD-only studies, the OR remained unchanged.
There are limited data supporting the role of CSFD in thoracic and thoracoabdominal Aneurysm Surgery for prevention of neurological injury. Further clinical and experimental studies are indicated.
Spinal cord complications of thoracoabdominal Aneurysm SurgeryThe British journal of surgery, 1998Co-Authors: P. Lintott, H. M. Hafez, Gerard StansbyAbstract:
Background Although rare, paralysis secondary to spinal cord ischaemia after aortic Aneurysm Surgery is a devastating complication. Many papers have been published on this topic but without a clear consensus on the best way of minimizing the problem. Recent articles have included advanced pharmacolo
E. Stanley Crawford – One of the best experts on this subject based on the ideXlab platform.
Cefamandole levels during thoracoabdominal aortic Aneurysm SurgeryJournal of vascular surgery, 1991Co-Authors: Richard L. Harris, Jae H. Yuk, Chris Cribari, Dan Jernigan, Joseph S. Coselli, Hazim J. Safi, E. Stanley CrawfordAbstract:
Abstract The pharmacokinetics of prophylactic antibodies may differ in cardiac and aortic Aneurysm Surgery for at least two reasons: aortic Aneurysm Surgery generally entails a greater blood volume loss and replacement, and aortic Aneurysm Surgery usually does not require extracorporeal cardiopulmonary bypass. We prospectively studied two different cefamandole dosing regimens in patients undergoing aortic Aneurysm Surgery (phase 1, 1 gm intravenously at the induction of anesthesia; phase 2, 2 gm intravenously at the induction of anesthesia followed by 1 gm intravenously every 2 hours during Surgery). In phase 1 and 2 plasma levels were measured at the time of skin incision, aortic cross-clamping, aortic unclamping, and skin closure. In phase 2 cefamandole elimination in urine and cell-saver effluent was also determined. An adequate plasma level of 10 μg/ml was maintained in only 4 of 14 patients in phase 1, but in 10 of 10 patients in phase 2. Cefamandole loss in cell-saver effluent was 136 ± 100 mg, which was 13% of the measured renally excreted amount. As has been previously shown in cardiac Surgery, a cefamandole prophylactic antibiotic regimen of 2 gm intravenously at the induction of anesthesia followed by 1 gm every 2 hours during Surgery provides a dependable and practical dosing regimen in patients undergoing aortic Aneurysm Surgery.
Hans-ekkehart Vitzthum – One of the best experts on this subject based on the ideXlab platform.
Effects of temporary clips on somatosensory evoked potentials in Aneurysm Surgery.Neurocritical care, 2005Co-Authors: Uta Schick, Jörg Döhnert, Jan-jakob Meyer, Hans-ekkehart VitzthumAbstract:
Introduction: Changes in somatosensory evoked potentials (SEPs) were used to identify cerebral ischemia and to predict neurological outcome during the application of temporary clips in Aneurysm Surgery.