Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management

Author(s):Show less -

Tedde, Miguel L. ^[1] ; Vasconcelos Filho, Paulo ^[2] ; Hajjar, Ludhmila Abrahao ^[2] ; de Almeida, Juliano Pinheiro ^[2] ; Flora, Gustavo Fagundes ^[1] ; Okumura, Erica Mie ^[1] ; Osawa, Eduardo A. ^[2] ; Fukushima, Julia Tizue ^[2] ; Teixeira, Manoel Jacobsen ^{[3, 4]} ; Barbosa Gomes Galas, Filomena Regina ^[2] ; Jatene, Fabio Biscegli ^[1] ; Costa Auler, Jr., Jose Otavio ^[2]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Hosp Clin, Heart Inst InCor, Thorac Surg Dept, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Hosp Clin, Heart Inst InCor, Anaesthesia & Surg Intens Care U, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Fac Med, Hosp Clin, Dept Neurosurg, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Fac Med, Hosp Clin, Lab Expt Surg LIM26, Sao Paulo - Brazil

• Document type: Journal article
• Source: Clinics; v. 67, n. 11, p. 1265-1269, 2012.
• Web of Science Citations: 7

Abstract

OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov:NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results. (AU)