Fiber-optic Monitoring of Spinal Cord Hemodynamics in Experimental Aortic Occlusion. (December 2015)

• Record Type: Journal Article
• Authors: Kogler, Angela S.; Bilfinger, Thomas V.; Galler, Robert M.; Mesquita, Rickson C.; Cutrone, Michael; Schenkel, Steven S.; Yodh, Arjun G.; Floyd, Thomas F.
• Is Part Of: Anesthesiology. Volume 123:Number 6(2015)
• Publication Date: 2015-12
• Subjects: Anesthesiology -- Periodicals; Anesthetics -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1097/ALN.0000000000000883
• Languages: English
• ISSNs: 0003-3022

Abstract

Abstract : Background: Spinal cord ischemia occurs frequently during thoracic aneurysm repair. Current methods based on electrophysiology techniques to detect ischemia are indirect, non-specific, and temporally slow. In this article, the authors report the testing of a spinal cord blood flow and oxygenation monitor, based on diffuse correlation and optical spectroscopies, during aortic occlusion in a sheep model. Methods: Testing was carried out in 16 Dorset sheep. Sensitivity in detecting spinal cord blood flow and oxygenation changes during aortic occlusion, pharmacologically induced hypotension and hypertension, and physiologically induced hypoxia/hypercarbia was assessed. Accuracy of the diffuse correlation spectroscopy measurements was determined via comparison with microsphere blood flow measurements. Precision was assessed through repeated measurements in response to pharmacologic interventions. Results: The fiber-optic probe can be placed percutaneously and is capable of continuously measuring spinal cord blood flow and oxygenation preoperatively, intraoperatively, and postoperatively. The device is sensitive to spinal cord blood flow and oxygenation changes associated with aortic occlusion, immediately detecting a decrease in blood flow (−65 ± 32%; n = 32) and blood oxygenation (−17 ± 13%, n = 11) in 100% of trials. Comparison of spinal cord blood flow measurements by the device with microsphere measurements led to a correlation of R 2 = 0.49, P < 0.01, and the within-sheep coefficient of variation was 9.69%. Finally, diffuse correlation spectroscopy is temporally more sensitive to ischemic interventions than motor-evoked potentials. Conclusion: The first-generation spinal fiber-optic monitoring device offers a novel and potentially important step forward in the monitoring of spinal cord ischemia. Abstract : The fiber-optic probe can be placed percutaneously into the epidural space of anesthetized sheep. Changes in blood flow detected by the probe correlated with microsphere-detected changes in spinal cord blood flow during occlusion and deocclusion of the thoracic aorta. Changes in spinal cord blood flow detected by the fiber-optic probe were markedly more rapid in onset than functional changes detected by motor-evoked responses.Supplemental Digital Content is available in the text.