• Kenji Yoshitani, Kenichi Masui, Masahiko Kawaguchi, Mikito Kawamata, Manabu Kakinohana, Shinya Kato, Kyoko Hasuwa, Michiaki Yamakage, Yusuke Yoshikawa, Kimitoshi Nishiwaki, Tadashi Aoyama, Yoshimi Inagaki, Kazumasa Yamasaki, Mishiya Matsumoto, Kazuyoshi Ishida, Atsuo Yamashita, Katsuhiro Seo, Shinichi Kakumoto, Hironobu Hayashi, Yuu Tanaka, Satoshi Tanaka, Takashi Ishida, Hiroyuki Uchino, Takayasu Kakinuma, Yoshitsugu Yamada, Yoshiteru Mori, Shunsuke Izumi, Kunihiro Nishimura, Michikazu Nakai, and Yoshihiko Ohnishi.
• From the Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Japan.
• Anesth. Analg. 2018 Mar 1; 126 (3): 763-768.

BackgroundSpinal cord ischemic injury is the most devastating sequela of descending and thoracoabdominal aortic surgery. Motor-evoked potentials (MEPs) have been used to intraoperatively assess motor tract function, but it remains unclear whether MEP monitoring can decrease the incidence of postoperative motor deficits. Therefore, we reviewed multicenter medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open surgery and endovascular repair) to assess the association of MEP monitoring with postoperative motor deficits.MethodsPatients included in the study underwent descending or thoracoabdominal aortic repair at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery between 2000 and 2013. Using multivariable mixed-effects logistic regression analysis, we investigated whether intraoperative MEP monitoring was associated with postoperative motor deficits at discharge after open and endovascular aortic repair.ResultsWe reviewed data from 1214 patients (open surgery, 601 [49.5%]; endovascular repair, 613 [50.5%]). MEP monitoring was performed in 631 patients and not performed in the remaining 583 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. Multivariable logistic regression analysis revealed that postoperative motor deficits at discharge did not have a significant association with MEP monitoring (adjusted odds ratio [OR], 1.13; 95% confidence interval [CI], 0.69-1.88; P = .624), but with other factors: history of neural deficits (adjusted OR, 6.08; 95% CI, 3.10-11.91; P < .001), spinal drainage (adjusted OR, 2.14; 95% CI, 1.32-3.47; P = .002), and endovascular procedure (adjusted OR, 0.45; 95% CI, 0.27-0.76; P = .003). The sensitivity and specificity of MEP <25% of control value for motor deficits at discharge were 37.8% (95% CI, 26.5%-49.5%) and 95.5% (95% CI, 94.7%-96.4%), respectively.ConclusionsMEP monitoring was not significantly associated with motor deficits at discharge.

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