Hypothermia during Carotid Endarterectomy: A Safety Study

Abstract

BackgroundCEA is associated with peri-operative risk of brain ischemia, due both to emboli production caused by manipulation of the plaque and to potentially noxious reduction of cerebral blood flow by carotid clamping. Mild hypothermia (34–35°C) is probably the most effective approach to protect brain from ischemic insult. It is therefore a substantial hypothesis that hypothermia lowers the risk of ischemic brain damage potentially associated with CEA. Purpose of the study is to test whether systemic endovascular cooling to a target of 34.5–35°C, initiated before and maintained during CEA, is feasible and safe.MethodsThe study was carried out in 7 consecutive patients referred to the Vascular Surgery Unit and judged eligible for CEA. Cooling was initiated 60–90 min before CEA, by endovascular approach (Zoll system). The target temperature was maintained during CEA, followed by passive, controlled rewarming (0.4°C/h). The whole procedure was carried out under anesthesia.ResultsAll the patients enrolled had no adverse events. Two patients exhibited a transient bradycardia (heart rate 30 beats/min). There were no significant differences in the clinical status, laboratory and physiological data measured before and after CEA.ConclusionsSystemic cooling to 34.5–35.0°C, initiated before and maintained during carotid clamping, is feasible and safe.Trial RegistrationClinicalTrials.gov NCT02629653

Effect of Forced-Air Warming Blanket on Perioperative Hypothermia in Elderly Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer

“…In this study, there were no significant differences in the perioperative blood loss and blood transfusion ratio between the two groups. This is inconsistent with the conclusions by Candela et al (2016). The possible reason was that routine warming measures were taken by both groups of patients, there was no severe hypothermia in the two groups, and all patients underwent laparoscopic minimally invasive surgery.…”

A pilot protocol and review of triple neuroprotection with targeted hypothermia, controlled induced hypertension, and barbiturate infusion during emergency carotid endarterectomy for acute stroke after failed tPA or beyond 24-hour window of opportunity

“…A lower metabolic rate will progressively improve global neurological outcomes and reperfusion injury (34). Early cooling has been used in a phase II trial with stroke patients to establish its safety and feasibility (35). Induced therapeutic hypothermia for 1 to 3 days has shown to be effective in dense stroke patients treated without neuro-vascular intervention (15,30,31).…”

Clinically induced hypothermia with cardiopulmonary support in a high-risk patient undergoing carotid endarterectomy

“…Animal studies have previously shown reduced brain oxidative stress when regulated hypothermia is applied during hypoxic ischemia (6).It seems reasonable to assume the same protective effect during carotid clamping. Moderate hypothermia has been suggested to be feasible and safe during CEA in a small previous study (7).…”

“…Moderate hypothermia has been suggested to be feasible and safe during CEA in a small previous study. 7 …”