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Moderate hypothermia for 359 operations to clip cerebral aneurysms.
P Kimme1, S Fridrikssen, O Engdahl
1Department of Anaesthesiology and Intensive Care, Faculty of Health Sciences, University Hospital, S-581 85 Linköping, Sweden. Peter.Kimme@lio.se
British Journal of Anaesthesia
|June 29, 2004
Summary
Moderate hypothermia is a safe method for patients undergoing surgery for subarachnoid aneurysms. This study found no significant correlation between hypothermia and complications, suggesting its feasibility in neurosurgery.
Area of Science:
- Neurosurgery
- Anesthesiology
- Critical Care Medicine
Background:
- Experimental data suggest hypothermia (32-34°C) may improve outcomes after cerebral ischemia.
- Human efficacy of deliberate moderate perioperative hypothermia remains inconclusive.
- This study investigated the feasibility and safety of moderate hypothermia during subarachnoid aneurysm surgery.
Purpose of the Study:
- To assess the safety and feasibility of deliberate moderate perioperative hypothermia.
- To evaluate the impact of hypothermia on postoperative complications in patients undergoing subarachnoid aneurysm surgery.
Main Methods:
- Prospective study of 359 intracranial cerebral aneurysm operations.
- Core temperature reduced to >34°C within 1 hour using cold IV infusions and convective cooling.
- Assessed postoperative complications: infections, prolonged ventilation, pulmonary issues, coagulopathies.
Main Results:
- Mean intraoperative core temperature was 32.5°C; patients normothermic within 5 hours postoperatively.
- Complications included circulatory instability (10%), arrhythmias (5%), coagulation abnormalities (47%), infections (8%), and pulmonary complications (27%).
- No significant correlation between hypothermia extent and complications; severity of neurological disease (Hunt and Hess score) correlated with complications.
Conclusions:
- Moderate hypothermia, induced within 1 hour of anesthesia and maintained during surgery, appears safe for subarachnoid aneurysm operations.
- Risks of peri/postoperative complications like circulatory instability, coagulation abnormalities, and infections were manageable.
- The severity of the underlying neurological condition is a key factor influencing patient outcomes.