[Motor evoked potentials in thoracoabdominal aortic surgery].

Area of Science:

• Neurology
• Cardiovascular Surgery
• Neurophysiology

Context:

• Thoracoabdominal aortic disease, including aneurysms and dissections, is rising.
• Surgical repair carries significant risks, notably paraplegia.
• Existing spinal cord protection strategies are not universally effective.

Purpose:

• To review the scientific evidence on motor evoked potentials (MEP) monitoring for neurological outcomes in thoracoabdominal aortic surgery.
• To assess the efficacy of MEP in preventing spinal cord injury.
• To identify challenges and best practices for MEP implementation.

Summary:

• Intraoperative motor evoked potentials (MEP) monitoring facilitates early detection of spinal cord ischemia during thoracoabdominal aortic surgery.
• Targeted interventions based on MEP alerts can significantly reduce the incidence of postoperative paraplegia.
• Neuromuscular blockade is a key challenge affecting MEP interpretation, necessitating careful anesthetic management.

Impact:

• MEP monitoring improves neurological outcomes by enabling timely interventions to prevent spinal cord damage.
• Effective integration of MEP requires balancing monitoring needs with surgical and anesthetic requirements.
• A multidisciplinary approach incorporating MEP and other protective mechanisms is crucial for optimizing patient safety.