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[The spinal catheter in aortic surgery : Implications for anesthesia].

P Lüke1,2, J Abicht3, M Rehm3

  • 1Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland. philipp.lueke@med.uni-muenchen.de.

Der Anaesthesist
|September 25, 2020
PubMed
Summary

Spinal catheters can prevent and treat spinal cord ischemia during aortic surgery. However, careful risk-benefit analysis is crucial due to potential serious complications like bleeding and infection.

Keywords:
Aortic aneurysmAortic dissectionAortic surgeryCerebrospinal fluid drainageSpinal cord injury

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Area of Science:

  • Neurosurgery
  • Cardiovascular Surgery
  • Neurology

Background:

  • Aortic surgeries carry a risk of spinal cord ischemia, potentially leading to paraplegia.
  • Spinal cord ischemia can result from aortic cross-clamping or overstenting of critical arteries.
  • Current prophylactic and treatment methods for spinal cord ischemia include spinal catheter use.

Purpose of the Study:

  • To evaluate the efficacy and risks associated with spinal catheter use in preventing and treating spinal cord ischemia during aortic surgery.
  • To highlight the importance of a thorough risk-benefit assessment for spinal catheter procedures.
  • To emphasize the need for adequate training and adherence to parameters for safe perioperative handling.

Main Methods:

  • Review of existing literature on spinal catheter use in aortic surgery.
  • Analysis of complication rates and types associated with spinal catheters.
  • Discussion of clinical presentation differences between catheter-associated complications and ischemic spinal cord injury.

Main Results:

  • Spinal catheters are effective in regulating cerebrospinal fluid pressure for spinal cord ischemia prophylaxis and treatment.
  • Spinal catheters have a high complication rate, including cerebrospinal fluid leakage, headaches, infections, intracranial bleeding, meningitis, and neuraxial hematomas.
  • Complications can manifest with a significant latent period post-procedure.

Conclusions:

  • Detailed risk-benefit assessment is mandatory before spinal catheter use.
  • Adequate personnel training and strict adherence to drainage parameters are critical for enhancing procedural safety.
  • Clinical vigilance is necessary as catheter-associated complications can mimic ischemic spinal cord injury.