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Observational Study
. 2023 Jun;37(3):408-415.
doi: 10.1007/s00540-023-03179-3. Epub 2023 Mar 21.

Effect of cerebrospinal fluid drainage pressure in descending and thoracoabdominal aortic repair: a prospective multicenter observational study

Kenji Yoshitani  1   2 , Soshiro Ogata  3 , Shinya Kato  4 , Akito Tsukinaga  4   5 , Tsunenori Takatani  6 , Nobuhide Kin  7 , Mariko Ezaka  7 , Jun Shimizu  8 , Yuko Furuichi  8 , Shoichi Uezono  9 , Kotaro Kida  9 , Katsuhiro Seo  10 , Shinichi Kakumoto  11 , Hiroshi Miyawaki  11 , Mikito Kawamata  12 , Satoshi Tanaka  12 , Manabu Kakinohana  13 , Shunsuke Izumi  13 , Hiroyuki Uchino  14 , Takayasu Kakinuma  14 , Kimitoshi Nishiwaki  15 , Kazuko Hasegawa  15 , Mishiya Matsumoto  16 , Kazuyoshi Ishida  16 , Atsuo Yamashita  16 , Michiaki Yamakage  17 , Yusuke Yoshikawa  17 , Yuji Morimoto  18 , Hitoshi Saito  18 , Takahisa Goto  5   19 , Tetsuhito Masubuchi  19 , Masahiko Kawaguchi  20 , Kosuke Tsubaki  20 , Satoshi Mizobuchi  21 , Norihiko Obata  21 , Yoshimi Inagaki  22 , Kazumi Funaki  22 , Yoshiki Ishiguro  9   23 , Masamitsu Sanui  23 , Kazutaka Taniguchi  24 , Kunihiro Nishimura  3 , Yoshihiko Ohnishi  4
Affiliations
Observational Study

Effect of cerebrospinal fluid drainage pressure in descending and thoracoabdominal aortic repair: a prospective multicenter observational study

Kenji Yoshitani et al. J Anesth. 2023 Jun.

Abstract

Purpose: Cerebrospinal fluid drainage (CSFD) is recommended during open or endovascular thoracic aortic repair. However, the incidence of CSFD complications is still high. Recently, CSF pressure has been kept high to avoid complications, but the efficacy of CSFD at higher pressures has not been confirmed. We hypothesize that CSFD at higher pressures is effective for preventing motor deficits.

Methods: This prospective observational study included 14 hospitals that are members of the Japanese Society of Cardiovascular Anesthesiologists. Patients who underwent thoracic and thoracoabdominal aortic repair were divided into four groups: Group 1, CSF pressure around 10 mmHg; Group 2, CSF pressure around 15 mmHg; Group 3, CSFD initiated when motor evoked potential amplitudes decreased; and Group 4, no CSFD. We assessed the association between the CSFD group and motor deficits using mixed-effects logistic regression with a random intercept for the institution.

Results: Of 1072 patients in the study, 84 patients (open surgery, 51; thoracic endovascular aortic repair, 33) had motor deficits at discharge. Groups 1 and 2 were not associated with motor deficits (Group 1, odds ratio (OR): 1.53, 95% confidence interval (95% CI): 0.71-3.29, p = 0.276; Group 2, OR: 1.73, 95% CI: 0.62-4.82) when compared with Group 4. Group 3 was significantly more prone to motor deficits than Group 4 (OR: 2.56, 95% CI: 1.27-5.17, p = 0.009).

Conclusion: CSFD is not associated with motor deficits in thoracic and thoracoabdominal aortic repair with CSF pressure around 10 or 15 mmHg.

Keywords: Cerebrospinal fluid drainage; Postoperative motor deficits; Thoracic and thoracoabdominal aortic aneurysm.

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