Spinal Cord Protection during Spinal and Major Vascular Surgeries

Abstract

  For anesthesiologists it is important to maintain adequate conditions for spinal cord monitoring and to control spinal cord perfusion pressure in order to maintain microcirculation of the spinal cord, preventing exacerbation of spinal cord damage. In spine surgery, motor evoked potential (MEP) monitoring and a wake-up test will be performed to detect the intra-operative spinal cord dysfunction. MEP is inhibited by anesthetics and muscle relaxants, while the wake-up test is difficult for patients with communication difficulties. We will show here the algorithm of spinal cord monitoring in our hospital. In major vascular surgery, to understand the characteristics of reactivity of the blood vessels in the spinal cord is helpful in maintaining appropriate spinal cord circulation. However, pharmacological spinal cord protection could not adequately overcome the clinical problems of spinal protection. Since internal organ protection, such as pharmacological- and remote-preconditioning, could be useful for preventing fatal damage even in the spinal cord, its clinical introduction is expected, in addition to conventional spinal cord protection strategies.