Efficacy of Intraoperative Cooling Methods

Plattner, Olga; Kurz, Andrea; Sessler, Daniel I.; Ikeda, Takehiko; Christensen, Richard M.; Marder, Danielle; Clough, David

doi:10.1097/00000542-199711000-00013

Cited by 60 publications

(20 citation statements)

References 25 publications

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“…Endovascular cooling may be faster than with surface cooling. 23,24 For the majority of patients, the target temperature was overshot. Because the rewarming process was deliberately slow, the mean duration of hypothermia, defined as the time during which core temperature was Ͻ36°C, was 48.6 hours.…”

Section: Discussionmentioning

confidence: 99%

Cooling for Acute Ischemic Brain Damage (COOL AID)

Krieger

Georgia

Aböu-Chebl

et al. 2001

Stroke

352

105

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Background and Purpose-Hypothermia is effective in improving outcome in experimental models of brain infarction.We studied the feasibility and safety of hypothermia in patients with acute ischemic stroke treated with thrombolysis. Methods-An open study design was used. All patients presented with major ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score Ͼ15) within 6 hours of onset. After informed consent, patients with a persistent NIHSS score of Ͼ8 were treated with hypothermia to 32Ϯ1°C for 12 to 72 hours depending on vessel patency. All patients were monitored in the neurocritical care unit for complications. A modified Rankin Scale was measured at 90 days and compared with concurrent controls. Results-Ten patients with a mean age of 71.1Ϯ14.3 years and an NIHSS score of 19.8Ϯ3.3 were treated with hypothermia. Nine patients served as concurrent controls. The mean time from symptom onset to thrombolysis was 3.1Ϯ1.4 hours and from symptom onset to initiation of hypothermia was 6.2Ϯ1.3 hours. The mean duration of hypothermia was 47.4Ϯ20.4 hours. Target temperature was achieved in 3.5Ϯ1.5 hours. Noncritical complications in hypothermia patients included bradycardia (nϭ5), ventricular ectopy (nϭ3), hypotension (nϭ3), melena (nϭ2), fever after rewarming (nϭ3), and infections (nϭ4). Four patients with chronic atrial fibrillation developed rapid ventricular rate, which was noncritical in 2 and critical in 2 patients. Three patients had myocardial infarctions without sequelae. There were 3 deaths in patients undergoing hypothermia. The mean modified Rankin Scale score at 3 months in hypothermia patients was 3.1Ϯ2.3. Conclusion-Induced hypothermia appears feasible and safe in patients with acute ischemic stroke even after thrombolysis. Refinements of the cooling process, optimal target temperature, duration of therapy, and, most important, clinical efficacy, require further study. (Stroke. 2001;32:1847-1854.)

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Section: Discussionmentioning

confidence: 99%

Cooling for Acute Ischemic Brain Damage (COOL AID)

Krieger

Georgia

Aböu-Chebl

et al. 2001

Stroke

352

105

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“…41 Direct core cooling has distinct advantages when compared with conventional surface cooling: (1) It is much faster, because heat is removed directly from the core, rather than being required to pass through peripheral tissues, which insulate the core. 42 (2) Less heat needs to be removed, and peripheral tissues stay relatively warm. Consequently, redistribution of heat from the periphery to the core or constraint of metabolic heat to the core has the potential to speed the return to normothermia during rewarming, if that is neccessary.…”

Section: Doufas Et Al Inhibition Of Shiveringmentioning

confidence: 99%

Dexmedetomidine and Meperidine Additively Reduce the Shivering Threshold in Humans

Doufas

Lin

Suleman

et al. 2003

Stroke

147

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Background and Purpose-Hypothermia might prove to be therapeutically beneficial in stroke victims; however, even mild hypothermia provokes vigorous shivering. Meperidine and dexmedetomidine each linearly reduce the shivering threshold (triggering core temperature) with minimal sedation. We tested the hypothesis that meperidine and dexmedetomidine synergistically reduce the shivering threshold without producing substantial sedation or respiratory depression. Methods-We studied 10 healthy male volunteers (18 to 40 years) on 4 days: (1) control (no drug); (2) meperidine (target plasma level 0.3 g/mL); (3) dexmedetomidine (target plasma level 0.4 ng/mL); and (4) meperidine plus dexmedetomidine (target plasma levels of 0.3 g/mL and 0.4 ng/mL, respectively). Lactated Ringer's solution (Ϸ4°C) was infused through a central venous catheter to decrease tympanic membrane temperature by Ϸ2.5°C/h; mean skin temperature was maintained at 31°C. An increase in oxygen consumption Ͼ25% of baseline identified the shivering threshold. Sedation was evaluated by using the Observer's Assessment of Sedation/Alertness scale. Two-way repeated-measures ANOVA was used to identify interactions between drugs. Data are presented as meanϮSD; PϽ0.05 was statistically significant. Results-The shivering thresholds on the study days were as follows: control, 36.7Ϯ0.3°C; dexmedetomidine, 36.0Ϯ0.5°C (PϽ0.001 from control); meperidine, 35.5Ϯ0.6°C (PϽ0.001); and meperidine plus dexmedetomidine, 34.7Ϯ0.6°C (PϽ0.001). Although meperidine and dexmedetomidine each reduced the shivering threshold, their interaction was not synergistic but additive (Pϭ0.19). There was trivial sedation with either drug alone or in combination. Respiratory rate and end-tidal PCO 2 were well preserved on all days. Conclusions-Dexmedetomidine and meperidine additively reduce the shivering threshold; in the small doses tested, the combination produced only mild sedation and no respiratory toxicity.

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“…In the other report, the same intraoperative dose was used (1 mg.kg -1 ) and no maintenance dose was used; in this case, no signs of liver graft dysfunction were observed 96 . Therefore, to minimize the risks of graft toxicity by dantrolene, it seems prudent to adopt intraoperative doses of 1 mg. 131 , on the other hand, today, it seems reasonable to use it to antagonize hyperkalemia-induced electrocardiographic changes 132 . 8.…”

Section: Intraoperativelymentioning

confidence: 99%

“…As a result, authors recommend observation in Intensive Care Units for 24-72 hours postoperatively 32 . Samples for blood gases, electrolytes, creatine kinase, coagulation profile and blood and urine myoglobin should be collected every 6-12 hours 76,131 .…”

Section: Postoperativelymentioning

confidence: 99%