Le suivi par potentiels évoqués somesthésiques des patients adultes subissant un arrêt circulatoire sous hypothermie profonde.

Abstract

The surgical repair of ascending aorta aneurysms can only be carried out under total circulatory arrest, and is consequently to be performed under deep hypothermia, in order to adequately decrease the metabolic requirements of the brain. However, the optimal temperature to be reached is poorly known. SEPs to median nerve stimulation were recorded in 21 operations performed in 20 patients undergoing profound hypothermia. The latencies of all SEP components increase to 21 degrees C. Waves N20 and P14 disappear at mean naso-pharyngeal temperatures of 20 degrees C and 17 degrees C, respectively, although a wide inter-individual variability was observed. We suggest to use the P14 disappearance as the criterion to perform the circulatory arrest: in fact, all surviving patients in whom this criterion was fulfilled recovered without any detectable neurological sequellae, while three patients in whom brain activities disappeared independently on body temperature presented with neurological sequellae. Moreover, particularly if patients presenting with ischemia-induced disappearance of Erb's point activities were excluded, we found a significant correlation between the duration of the circulatory arrest and the delay of N20 and P14 reappearance on rewarming. This confirms the importance of sufficient hypothermia, on the one hand; and on the other hand, our findings imply that, even if SEP monitoring considerably decreases the risk of neurological sequellae associated with these operations, the duration of the circulatory arrest should be reduced as far as possible