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      Association between anesthesia duration and outcome in dogs with surgically treated acute severe spinal cord injury caused by thoracolumbar intervertebral disk herniation

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          Abstract

          Background

          Retrospective research recently identified a possible relationship between duration of surgery and outcome in severely affected dogs treated surgically for acute thoracolumbar intervertebral disk herniation (TL‐IVDH).

          Hypothesis

          That increased duration of surgery is associated with poorer outcome in dogs with absent pain perception treated surgically for TL‐IVDH.

          Animals

          Two hundred ninety‐seven paraplegic dogs with absent pain perception surgically treated for acute TL‐IVDH.

          Methods

          Retrospective cohort study. Medical records of 5 institutions were reviewed. Inclusion criteria were paraplegia with absence of pain perception, surgical treatment of TL‐IVDH, and 1‐year postoperative outcome (ambulatory: yes or no). Canine data, outcome, and surgery and total anesthesia duration were retrieved.

          Results

          In this study, 183/297 (61.6%) dogs were ambulatory within 1 year, 114 (38.4%) dogs failed to recover, including 74 dogs (24.9%) euthanized because of progressive myelomalacia. Median anesthesia duration in dogs that regained ambulation within 1 year of surgery (4.0 hours, interquartile range [IQR] 3.2‐5.1) was significantly shorter than those that did not (4.5 hours, IQR 3.7‐5.6, P = .01). Multivariable logistic regression demonstrated a significant negative association between both duration of surgery and total anesthesia time and ambulation at 1 year when controlling for body weight and number of disk spaces operated on.

          Conclusions and Clinical Importance

          Findings support a negative association between increased duration of anesthesia and outcome in this group of dogs. However, the retrospective nature of the data does not imply a causal relationship.

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          Most cited references28

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          Monitoring of spinal cord perfusion pressure in acute spinal cord injury: initial findings of the injured spinal cord pressure evaluation study*.

          To develop a technique for continuously monitoring intraspinal pressure at the injury site (intraspinal pressure) after traumatic spinal cord injury. A pressure probe was placed subdurally at the injury site in 18 patients who had isolated severe traumatic spinal cord injury (American Spinal Injuries Association grades A-C). Intraspinal pressure monitoring started within 72 hours of the injury and continued for up to a week. In four patients, additional probes were inserted to simultaneously monitor subdural pressure below the injury and extradural pressure. Blood pressure was recorded from a radial artery catheter kept at the same horizontal level as the injured segment of the spinal cord. We determined the effect of various maneuvers on spinal cord perfusion pressure and spinal cord function and assessed using a limb motor score and motor-evoked potentials. Neurosurgery and neuro-ICU covering a 3 million population in London. Patients with severe traumatic spinal cord injury. Control subjects without spinal cord injury (to monitor spinal cerebrospinal fluid signal and motor evoked potentials). Insertion of subdural spinal pressure probe. There were no procedure-related complications. Intraspinal pressure at the injury site was higher than subdural pressure below the injury or extradural pressure. Average intraspinal pressure from the 18 patients with traumatic spinal cord injury was significantly higher than average intraspinal pressure from 12 subjects without traumatic spinal cord injury. Change in arterial PCO2, change in sevoflurane dose, and mannitol administration had no significant effect on intraspinal pressure or spinal cord perfusion pressure. Increase in inotrope dose significantly increased spinal cord perfusion pressure. Bony realignment and laminectomy did not effectively lower intraspinal pressure. Laminectomy was potentially detrimental by exposing the swollen spinal cord to compression forces applied to the skin. By intervening to increase spinal cord perfusion pressure, we could increase the amplitude of motor-evoked potentials recorded from below or just above the injury level in nine of nine patients with traumatic spinal cord injury. In two of two patients with American Spinal Injuries Association grade C traumatic spinal cord injury, higher spinal cord perfusion pressure correlated with increased limb motor score. Our findings provide proof-of-principle that subdural intraspinal pressure at the injury site can be measured safely after traumatic spinal cord injury.
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            Spinal cord perfusion pressure predicts neurologic recovery in acute spinal cord injury

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              Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions.

              The authors present a review of spinal cord blood supply, discussing the anatomy of the vascular system and physiological aspects of blood flow regulation in normal and injured spinal cords. Unique anatomical functional properties of vessels and blood supply determine the susceptibility of the spinal cord to damage, especially ischemia. Spinal cord injury (SCI), for example, complicating thoracoabdominal aortic aneurysm repair is associated with ischemic trauma. The rate of this devastating complication has been decreased significantly by instituting physiological methods of protection. Traumatic SCI causes complex changes in spinal cord blood flow, which are closely related to the severity of injury. Manipulating physiological parameters such as mean arterial blood pressure and intrathecal pressure may be beneficial for patients with an SCI. Studying the physiopathological processes of the spinal cord under vascular compromise remains challenging because of its central role in almost all of the body's hemodynamic and neurofunctional processes.
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                Author and article information

                Contributors
                njolby@ncsu.edu
                Journal
                J Vet Intern Med
                J. Vet. Intern. Med
                10.1111/(ISSN)1939-1676
                JVIM
                Journal of Veterinary Internal Medicine
                John Wiley & Sons, Inc. (Hoboken, USA )
                0891-6640
                1939-1676
                17 May 2020
                July 2020
                : 34
                : 4 ( doiID: 10.1111/jvim.v34.4 )
                : 1507-1513
                Affiliations
                [ 1 ] Department of Clinical Science and Services Royal Veterinary College Hertfordshire United Kingdom
                [ 2 ] The Canine Spinal Cord Injury Consortium (CANSORT‐SCI)
                [ 3 ] Department of Statistics North Carolina State University Raleigh North Carolina USA
                [ 4 ] Department of Small Animal Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Texas A&M University College Station Texas USA
                [ 5 ] Department of Veterinary Clinical Sciences The Ohio State University College of Veterinary Medicine Columbus Ohio USA
                [ 6 ] Department of Small Animal Medicine and Surgery University of Veterinary Medicine Hannover Germany
                [ 7 ] Department of Clinical Sciences College of Veterinary Medicine, North Carolina State University Raleigh North Carolina USA
                Author notes
                [*] [* ] Correspondence

                Natasha J. Olby, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

                Email: njolby@ 123456ncsu.edu

                Author information
                https://orcid.org/0000-0001-7851-670X
                https://orcid.org/0000-0002-4311-6199
                https://orcid.org/0000-0003-2991-5696
                https://orcid.org/0000-0003-3228-6536
                https://orcid.org/0000-0003-3399-8500
                https://orcid.org/0000-0001-9592-6276
                https://orcid.org/0000-0003-1349-3484
                Article
                JVIM15796
                10.1111/jvim.15796
                7379036
                32418346
                d185009e-c7e4-4a00-99dd-f1f46600e98f
                © 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 August 2019
                : 19 April 2020
                : 28 April 2020
                Page count
                Figures: 2, Tables: 4, Pages: 7, Words: 5768
                Categories
                Standard Article
                SMALL ANIMAL
                Standard Articles
                Neurology
                Custom metadata
                2.0
                July 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.5 mode:remove_FC converted:24.07.2020

                Veterinary medicine
                canine,extrusion,hemilaminectomy,prognosis,surgery
                Veterinary medicine
                canine, extrusion, hemilaminectomy, prognosis, surgery

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