A Case of Postoperative Paraplegia in the Descending Thoracic Aortic Aneurysm

Abstract

Dissecting aneurysm involves development of a hematoma in the media of aorta, which is usually contagious with the lumen of the aorta via a tear in the media. The high percentage of co-existing diseases such as other cardiovascular diseases in these patients accounts for much of the surgical morbidity and mortality. Complications in Dacron patch graft surgery for repair of descending thoracic aortic aneurysm include massive hemorrhage, myocardial ischemia, myocardial infarction, heart failure, paraplegia and renal failure. A 60 year-old, 59kg woman underwent Dacron patch graft surgery for descending thoracic aortic aneurysm, under the high thoracic epidural block supplemented with light general anesthesia(N2O-O2). During operation, systolic blood pressure of upper extremities ranging from 120 mmHg to 100 mmHg was maintained, while diastolic pressure was maintained from 60 mmHg to 4) mmHg. Mean arterial pressure of 15-20 mmHg was maintained in lower extremities. When aorta was declamped, hypotension and bradycardia continued for 10 minutes. After administration of epinephrine and CaCl2, vital signs were stable. Total aorta cross-clamping time was 47 minutes, and total urine output was 200 ml. Although mannitol and steroid were administered for prevention, paraplegia occured postoperatively because of prolonged aorta cross clamping time.