Artikel
Spinal cord perfusion during different hemodynamics in a pig model – influence of blood pressure and circulating volume
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Autoren
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Henrik Rieß
- Universitätsklinikum Hamburg-Eppendorf, Klinik- und Poliklinik für Gefäßmedizin, Hamburg, Deutschland
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Anna Duprée
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Allgemein-,Viszeral- und Thoraxchirurgie, Hamburg, Deutschland
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Tilo Kölbel
- Universitätsklinikum Hamburg-Eppendorf, Klinik- und Poliklinik für Gefäßmedizin, Hamburg, Deutschland
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Philipp von Kroge
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Allgemein-,Viszeral- und Thoraxchirurgie, Hamburg, Deutschland
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Nikolaos Tsilimparis
- Universitätsklinikum Hamburg-Eppendorf, Klinik- und Poliklinik für Gefäßmedizin, Hamburg, Deutschland
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Oliver Mann
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Allgemein-,Viszeral- und Thoraxchirurgie, Hamburg, Deutschland
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Sebastian Debus
- Universitätsklinikum Hamburg-Eppendorf, Klinik- und Poliklinik für Gefäßmedizin, Hamburg, Deutschland
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Sabine Wipper
- Universitätsklinikum Hamburg-Eppendorf, Klinik- und Poliklinik für Gefäßmedizin, Hamburg, Deutschland
| Veröffentlicht: | 21. April 2016 |
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Gliederung
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Background: Spinal chord ischemia is one major adverse event after thoracoabdominal aortic surgery. Various strategies to prevent spinal cord ischemia during open and endovascular aortic repair are under evaluation.
Aim of the present experimental-study was to quantitatively assess spinal cord perfusion during increased intravasal volume substitution as compared to volume restrictive vasodilatative therapy during different blood pressure levels by fluorescent microspheres (FM).
Materials and methods: 12 domestic pigs (56,1±2,7 kg) were instrumented and monitored under general anesthesia. Spinal cord perfusion was investigated during three mean arterial pressure (MAP) levels: propofol induced hypotension (MAP <60mmHg, T1), normotension (MAP 60-90mmHg; T2), and norepinephrine induced hypertension (MAP >90mmHg; T3).
In group 1 isotonic saline-solution was continuously infused to maintain central venous pressure (CVP) above 10mmHg (max. 6l/animal). In group 2 additionally low-dose nitro was continuously injected at 10 mg/h. Spinal cord perfusion was assessed by injection of fluorescent microspheres during all measurement points.
Results: Perfusion values during propofol induced hypotension in both groups were higher as compared to normotension (T1: 0,36±0,13 vs. 0,40 ± 0,17ml/min/g; T2: 0,29±0,10 vs. 0,28±0,17ml/min/g, group 1 vs. group 2; p<0,05). This might be due to vasodilatation. In both groups spinal chord perfusion increased significantly during hypertension as compared to T1 and T2 (T3: 0,51±0,23 vs. 0,43 ±0,20ml/min/g; group I vs. group II, p<0,05). Highest values were achieved in group 2 during T3. There were no significances between the treatment groups.
Conclusion: Hypertension seems to improve spinal chord perfusion. There seems also to be a trend to improve spinal cord perfusion by additional low-dose nitro infusion as compared to solely increased blood volume. Increased spinal chord perfusion during hypotension might be caused by vasodilatative propofol effect.
