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Somatosensory-evoked potentials during aortic coarctation repair
L W Faberowski1, S Black, M F Trankina
1Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA.
Insights
Somatosensory-evoked potential (SSEP) changes occurred in 40% of aortic coarctation repairs, often prompting interventions like blood pressure adjustments. Importantly, no neurologic deficits were observed in these patients.
Area of Science:
- Neurophysiology
- Pediatric Cardiac Surgery
- Intraoperative Monitoring
Background:
- Aortic coarctation repair is a complex procedure.
- Intraoperative monitoring is crucial for patient safety.
- Somatosensory-evoked potentials (SSEPs) can detect neural compromise.
Purpose of the Study:
- To determine the incidence of SSEP changes during aortic coarctation repair.
- To identify interventions based on SSEP changes.
- To assess the neurological outcomes associated with SSEP monitoring.
Main Methods:
- Retrospective review of 84 children undergoing aortic coarctation repair (1984-1996).
- Continuous SSEP monitoring throughout surgical procedures.
- Definition of significant SSEP change: >50% amplitude decrease from baseline.
Main Results:
- SSEP changes occurred in 40% of 87 procedures.
- Interventions based on SSEP changes (e.g., clamp repositioning, BP elevation) were performed in 26.4% of procedures.
- No patient experienced a neurologic deficit.
Conclusions:
- SSEP monitoring is valuable during aortic coarctation repair.
- SSEP changes are frequently observed and often reversible with timely interventions.
- This study represents a significant series on SSEP use in this surgical context.
Objective:
To determine the incidence of somatosensory-evoked potential (SSEP) changes and the interventions based on these changes during aortic coarctation repair.
Design:
Retrospective review.
Setting:
Single-institution, university hospital.
Participants:
Eighty-four children who had undergone surgical repair of aortic coarctation from January 1984 to May 1996.
Interventions:
SSEPs were monitored in all patients throughout the procedure. A persistent decrease in amplitude greater than 50% from baseline was considered significant. Duration of SSEP changes in relation to the time course of surgical repair and whether a surgical or anesthetic intervention resulted from a change in SSEPs were documented.
Measurements And Main Results:
Eighty-four patients underwent 87 surgical procedures. SSEP changes occurred in 40% of the procedures: 38.5% with repair and 15% with test clamp, with 9% occurring during both test clamp and repair. Interventions, which included repositioning the aortic cross-clamp, elevating blood pressure, and aborting surgery, occurred in 26.4% of all procedures based on SSEP changes. No patient sustained a neurologic deficit.
Conclusion:
This is the largest series to date describing the use of SSEPs in aortic coarctation repair. These SSEP changes were often immediately amenable to changes in surgical and anesthetic management. SSEP changes and interventions based on these changes occurred with a considerable frequency.
