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Ann Vasc Surg

Title:		"Can Recognition of Spinal Ischemia Be Improved? Application of Motor-Evoked Potentials, Serum Markers, and Breath Gas Analysis in an Acutely Instrumented Pig Model"
Author(s):		Puschel A; Ebel R; Fuchs P; Hofmann J; Schubert JK; Roesner JP; Bergt S; Wree A; Vollmar B; Klar E; Bunger CM; Kischkel S;
Address:		"Department of General, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, Rostock, Germany. Clinic for Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany. Clinic for Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany; Clinic for Anesthesiology and Intensive Care Medicine, Sudstadtklinikum Rostock, Germany. Department of Anatomy, Rostock University Medical Center, Rostock, Germany. Institute for Experimental Surgery, Rostock University Medical Center, Rostock, Germany. Department of General, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, Rostock, Germany; Department of Vascular Medicine, Vivantes Humboldt-Klinikum, Berlin, Germany. Department of General, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, Rostock, Germany. Electronic address: sabine.kischkel@uni-rostock.de"
Journal Title:		Ann Vasc Surg
Year:		2018
Volume:		20180305
Issue:
Page Number:		191 - 205
DOI:		10.1016/j.avsg.2018.01.095
ISSN/ISBN:		1615-5947 (Electronic) 0890-5096 (Linking)
Abstract:		"BACKGROUND: Paraplegia due to spinal cord ischemia (SCI) is a serious complication after repair of thoracoabdominal aortic aneurysms. For prevention and early treatment of spinal ischemia, intraoperative monitoring of spinal cord integrity is essential. This study was intended to improve recognition of SCI through a combination of transcranial motor-evoked potentials (tc-MEPs), serum markers, and innovative breath analysis. METHODS: In 9 female German Landrace pigs, tc-MEPs were captured, markers of neuronal damage were determined in blood, and volatile organic compounds (VOCs) were analyzed in exhaled air. After thoraco-phrenico-laparotomy, SCI was initiated through sequential clamping (n = 4) or permanently ligating (n = 5) SAs of the abdominal and thoracic aorta in caudocranial orientation until a drop in the tc-MEPs to at least 25% of the baseline was recorded. VOCs in breath were determined by means of solid-phase microextraction coupled with gas chromatography-mass spectrometry. After waking up, clinical and neurological status was evaluated (Tarlov score). Spinal cord histology was obtained in postmortem. RESULTS: Permanent vessel ligature induced a worse neurological outcome and a higher number of necrotic motor neurons compared to clamping. Changes of serum markers remained unspecific. After laparotomy, exhaled acetone and isopropanol showed highest concentrations, and pentane and hexane increased during ischemia-reperfusion injury. CONCLUSIONS: To mimic spinal ischemia occurring in humans during aortic aneurysm repair, animal models have to be meticulously evaluated concerning vascular anatomy and function. Volatiles from breath indicated metabolic stress during surgery and oxidative damage through ischemia reperfusion. Breath VOCs may provide complimentary information to conventional monitoring methods"
Keywords:		"Animals Aorta, Abdominal/*surgery Aorta, Thoracic/*surgery Biomarkers/*blood Breath Tests/*methods Constriction Disease Models, Animal *Evoked Potentials, Motor Female Gas Chromatography-Mass Spectrometry Intraoperative Neurophysiological Monitoring/*meth;"
Notes:		"MedlinePuschel, Anja Ebel, Rasmus Fuchs, Patricia Hofmann, Janet Schubert, Jochen K Roesner, Jan P Bergt, Stefan Wree, Andreas Vollmar, Brigitte Klar, Ernst Bunger, Carsten M Kischkel, Sabine eng Netherlands 2018/03/09 Ann Vasc Surg. 2018 May; 49:191-205. doi: 10.1016/j.avsg.2018.01.095. Epub 2018 Mar 5"