Naloxone infusion combined with cerebrospinal fluid monitoring and drainage during thoracic aorta exploration: a case report.

A 95-kg, 34-year-old male presented for exploration of the thoracic aorta to resect an apparent sarcoma. A significant complication for this surgery is that of paraplegia and/or paraparesis. Continuous monitoring of cerebrospinal fluid pressure and drainage to maintain the pressure at 10 mmHg or less has been advocated to preserve nominal spinal cord perfusion pressure. However, this intervention alone has not demonstrated any greater efficacy in the prevention of paraplegia or paraparesis than no such intervention at all. Naloxone, the narcotic antagonist, has been studied extensively in relation to human paralysis and endogenous opioid actions. More recently, investigators have proposed combining a naloxone infusion with cerebrospinal fluid monitoring and drainage to attempt to prevent the occurrence of paraplegia and/or paraparesis in patients undergoing thoracic or thoracoabdominal aortic surgery. These interventions would seem at least theoretically appropriate to maximize spinal cord perfusion pressure and preserve spinal cord function. However, the extent of investigations is currently limited and the results somewhat controversial.