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CARDIOVASCULAR ANESTHESIA

Somatosensory Evoked Potential Monitoring Used to Compare the Effect of Three Asymmetric Sternal Retractors on Brachial Plexus Function

W. Scott Jellish, MD, PhD^*, Bradford Blakeman, MD, Patricia Warf, RN^*, and Stephen Slogoff, MD^*

Departments of *Anesthesiology and Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois

Address correspondence and reprint requests to W. Scott Jellish, MD, PhD, Loyola University Medical Center, Department of Anesthesiology, 2160 South First Ave., Maywood, IL 60153.

We compared the effect of three different asymmetric sternal retractors on brachial plexus dysfunction using intraoperative somatosensory evoked potentials (SSEPs). We studied 60 patients undergoing coronary bypass and internal mammary harvest. Assessment of brachial plexus function was performed pre- and postoperatively. Patients were assigned the use of a Pittman^TM (MN Scientific Instruments Inc., Minneapolis, MN), Rultract^TM (Rultract Inc., Cleveland, OH) , or Delacroix-Chevalier^TM (Delacroix-Chevalier, Paris, France) asymmetric sternal retractor for internal mammary exposure. SSEP changes from baseline during asymmetric retractor use and removal were determined, and average changes were compared among the retractor groups. Patient demographics and baseline SSEP values were similar. Fewer patients in the Delacroix-Chevalier^TM group had decreases in SSEP amplitudes after retractor placement. Of the patients in the Rultract^TM and Pittman^TM groups, 45% and 25%, respectively, had amplitude decreases of >50%, compared with only 5% of the Delacroix-Chevalier^TM patients. Three patients in both the Pittman^TM and Rultract^TM groups and one patient in the Delacroix-Chevalier^TM group suffered brachial plexus symptoms postoperatively. We conclude that the Delacroix-Chevalier^TM retractor is associated with less neurophysiologic evidence of brachial plexus dysfunction during asymmetric sternal retraction compared with either the Pittman^TM or Rultract^TM sternal retractors.

Implications: We used somatosensory evoked potentials to assess the effect of several different asymmetric sternal retractors on brachial plexus dysfunction and to determine which produced the least evidence of nerve damage during surgical exposure of the internal mammary artery.

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