Lowering body temperature in acute ischemic stroke without artificial ventilation and heavy sedation: a feasibility...

We assessed the feasibility of inducing very mild hypothermia in 8 patients with acute ischemic anterior circulation stroke, without artificial ventilation and heavy sedation, until 24 hours after onset of symptoms.

Four regimes (A, B, C, and D) with increasing monitoring and treatment intensity were studied. Two patients in in regime A were monitored only. In regime B, 2 patients were treated with acetaminophen suppositoria of 1 g at 4-hour intervals. Additionally, the patients in regime C were cooled with a cooling blanket until 24 hours after the onset of symptoms. The target body temperature was 35 degrees C to 36 degrees C. During the cooling procedure, slight sedation was induced by continuous intravenous administration of low-dose midazolam. In regime D, sponging with 70% alcohol could be applied.

In these 4 patients, the mean reduction in body temperature after 8 hours of treatment amounted to 1.25 degrees C. No clinically important changes in vital parameters occurred.

The present study suggests that mild hypothermia in noncomatose stroke patients during a period of 24 hours after the ictus may be accomplished with a cooling blanket and light sedation with midazolam in a well-equipped stroke unit.