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Spinal cord ischemia after descending thoracic aortic surgery

Spinal cord ischemia after descending thoracic aortic surgery
This algorithm summarizes our suggested approach to managing evidence of spinal cord ischemia manifesting as paraparesis/paraplegia in the postoperative period after descending thoracic aortic surgery. It is intended for use in conjunction with additional UpToDate content discussing management after descending thoracic aortic surgery.

CSF: cerebrospinal fluid; CVP: central venous pressure; Hgb: hemoglobin; MAP: mean arterial pressure; O2: oxygen; PaO2: partial pressure of arterial oxygen; SCPP: spinal cord perfusion pressure.

* Interventions to improve spinal cord perfusion are often performed simultaneously.

¶ Placement/replacement of an intrathecal catheter is desirable but may not possible due to coagulopathy or suspicion for epidural hematoma.

Δ Limit CSF drainage to <20 mL during the first hour of surgery and <40 mL during any four-hour period.

◊ In some cases, there are no additional options to eliminate postoperative spinal cord ischemia.
Graphic 143544 Version 1.0

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