Somatosensory-evoked potentials during aortic coarctation repair

Objective: To determine the incidence of somatosensoryevoked 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 su...

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Published in:	Journal of cardiothoracic and vascular anesthesia Vol. 13; no. 5; pp. 538 - 543
Main Authors:	Faberowski, Lisa W., Black, Susan, Trankina, Mark F., Pollard, Richard J., Clark, Rhonda K., Mahla, Michael E.
Format:	Journal Article
Language:	English
Published:	Philadelphia, PA Elsevier Inc 01-10-1999 Elsevier
Subjects:	Adolescent Aortic Coarctation - physiopathology Aortic Coarctation - surgery Biological and medical sciences Child Child, Preschool Evoked Potentials, Somatosensory Female Humans Infant Infant, Newborn Intraoperative Complications - diagnosis Male Medical sciences Monitoring, Intraoperative neurologic deficit paraplegia Retrospective Studies spinal cord ischemia Spinal Cord Ischemia - diagnosis Spinal Cord Ischemia - etiology Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart paraplegia spinal cord ischemia neurologic deficit Human Aortic coarctation Cardiovascular disease Exploration Intraoperative Congenital disease Vascular disease Electrodiagnosis Treatment Malformation Surgery Anesthesia Evolution Somatosensory evoked potential Child Aortic disease Monitoring
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Summary:	Objective: To determine the incidence of somatosensoryevoked 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 crossclamp, 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1053-0770 1532-8422
DOI:	10.1016/S1053-0770(99)90004-6