Unintentional Hypothermia Is Associated with Postoperative Myocardial Ischemia

Frank, Steven M.; Beattie, Charles; Christopherson, Rose; Norris, Edward J.; Perler, Bruce A.; Williams, Gerald D.; Gottlieb, Sidney O.

doi:10.1097/00000542-199303000-00010

Cited by 466 publications

(106 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…10 We excluded patients who used nitroglycerine at least once daily for cardiac angina; patients with signs of cardial ischemia present, either on ECG obtained on admission or with precordial pain; patients with signs of cardial incompensation; and patients with severe intermittent claudication, because severe atherosclerotic disease may contraindicate hypothermic therapy due to the increased cardiovascular demands from such treatment. 13 Stroke was defined according to the World Health Organization criteria 14 : rapidly developed clinical signs of focal disturbance of cerebral function, lasting Ͼ24 hours or leading to death, with no apparent cause other than vascular origin. Subarachnoid hemorrhage was not included.…”

Section: Methodsmentioning

confidence: 99%

Feasibility and Safety of Inducing Modest Hypothermia in Awake Patients With Acute Stroke Through Surface Cooling: A Case-Control Study

Kammersgaard

Rasmussen

Jørgensen

et al. 2000

Stroke

252

141

View full text Add to dashboard Cite

Background and Purpose-Hypothermia reduces neuronal damage in animal stroke models. Whether hypothermia is neuroprotective in patients with acute stroke remains to be clarified. In this case-control study, we evaluated the feasibility and safety of inducing modest hypothermia by a surface cooling method in awake patients with acute stroke. Methods-We prospectively included 17 patients (cases) with stroke admitted within 12 hours from stoke onset (mean 3.25 hours). They were given hypothermic treatment for 6 hours by the "forced air" method, a surface cooling method that uses a cooling blanket with a flow of cool air (10°C). Pethidine was given to treat compensatory shivering. Cases were compared with 56 patients (controls) from the Copenhagen Stroke Study matched for age, gender, initial stroke severity, body temperature on admission, and time from stroke onset to admission. Blood cytology, biochemistry, ECGs, and body temperature were monitored during hypothermic treatment. Multiple regression analyses on outcome were performed to examine the safety of hypothermic therapy. Results-Body temperature decreased from t 0 ϭ36.8°C to t 6 ϭ35.5°C (PϽ0.001), and hypothermia was present until 4 hours after therapy (t 0 ϭ36.8°C versus t 10 ϭ36.5°C; Pϭ0.01). Mortality at 6 months after stroke was 12% in cases versus 23% in controls (Pϭ0.50). Final neurological impairment (Scandinavian Stroke Scale score at 6 months) was mean 42.4 points in cases versus 47.9 in controls (Pϭ0.21). Hypothermic therapy was not a predictor of poor outcome in the multivariate analyses. Conclusions-Modest hypothermia can be achieved in awake patients with acute stroke by surface cooling with the "forced air" method, in combination with pethidine to treat shivering. It was not associated with a poor outcome. We suggest a large, randomized clinical trial to test the possible beneficial effect of induced modest hypothermia in unselected patients with stroke. (Stroke. 2000;31:2251-2256.)

show abstract

Section: Methodsmentioning

confidence: 99%

Feasibility and Safety of Inducing Modest Hypothermia in Awake Patients With Acute Stroke Through Surface Cooling: A Case-Control Study

Kammersgaard

Rasmussen

Jørgensen

et al. 2000

Stroke

252

141

View full text Add to dashboard Cite

show abstract

“…13,52,53 Factors that can initiate a hypoxic state include anemia, hypothermia (through shivering), and anesthesia and analgesia (through suppression of breathing). [54][55][56] Perioperative hypoxia can result in myocardial ischemia in the setting of a hemodynamically significant coronary artery stenosis.…”

Section: Triggers Of Perioperative Myocardial Infarctionmentioning

confidence: 99%

Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk

Devereaux

Goldman

Cook

et al. 2005

CMAJ

570

350

View full text Add to dashboard Cite

THIS IS THE FIRST OF 2 ARTICLES EVALUATING cardiac events in patients undergoing noncardiac surgery. In this article, we review the magnitude of the problem, the pathophysiology of these events, approaches to risk assessment and communication of risk. The number of patients undergoing noncardiac surgery worldwide is growing, and annually 500 000 to 900 000 of these patients experience perioperative cardiac death, nonfatal myocardial infarction (MI) or nonfatal cardiac arrest. Although the evidence is limited, a substantial proportion of fatal perioperative MIs may not share the same pathophysiology as nonoperative MIs. A clearer understanding of the pathophysiology is needed to direct future research evaluating prophylactic, acute and long-term interventions. Researchers have developed tools to facilitate the estimation of perioperative cardiac risk. Studies suggest that the Lee index is the most accurate generic perioperative cardiac risk index. The limitations of the studies evaluating the ability of noninvasive cardiac tests to predict perioperative cardiac risk reveals considerable uncertainty as to the role of these popular tests. Similarly, there is uncertainty as to the predictive accuracy of the American College of Cardiology / American Heart Association algorithm for cardiac risk assessment. Patients are likely to benefit from improved estimation and communication of cardiac risk because the majority of noncardiac surgeries are elective and accurate risk estimation is important to allow informed patient and physician decision-making

show abstract

“…This hypothermia in patients with extensive burns may have a number of deleterious effects. There have been many reports of the various dysfunctions caused by hypothermia (Roher and Natale 1992; Frank et al 1993;Sessler 1993;Michelon et al 1994;Kurz et al 1996;Schmied et al 1996). Rohrer and Natale (1992) reported that the series of enzymatic reactions of the coagulation cascade were strongly inhibited by hypothermia in an investigation of the isolated effects of alterations of temperature on the integrity of the coagulation cascade.…”

Section: Discussionmentioning

confidence: 99%

“…Under these conditions, patients with extensive burns can suffer hypothermia at ambient temperatures less than 35°C. Hypothermia causes coagulopathy, delays drug metabolism, increases oxygen consumption, and increases morbidity of infection (Roher and Natale 1992;Frank et al 1993;Sessler 1993;Michelon et al 1994;Schmied et al 1996) The present study was performed to evaluate the usefulness of warm fluid for burn injury resuscitation in laboratory animals.…”

confidence: 99%

Usefulness of Warm Fluid in Acute Burn Resuscitation: An Experimental Study in Dogs

Nakazawa

Nozaki

2005

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

NAKAZAWA, H. and NOZAKI, M. Usefulness of Warm Fluid in Acute Burn Resuscitation: An Experimental Study in Dogs. Tohoku J. Exp. Med., 2005, 207 (2), [149][150][151][152][153][154][155] Hypothermia is a common complication in patients with extensive burns, receiving massive volumes of fluid for resuscitation at ambient temperature. It is therefore important to maintain the body temperature of patients with extensive burns. The present study was performed to evaluate the usefulness of warm fluid for burn injury resuscitation. Ten dogs were used in this study. Full-thickness burns, involving 40% of the body surface, were generated in the backs of the animals. In the control group (n = 5), the fluid temperature was maintained at about 23°C, while in other group (n = 5), the temperature of the fluid was maintained at 39°C with a warming device. Cardiac output and urinary output were measured in both groups for up to 24 hours. The cardiac output decreased in all animals during the first two hours following injury. The cardiac dynamics remained depressed in the control group. By contrast, in animals treated with warm fluid, the cardiac output returned to the baseline level within 4 hours of resuscitative measures and then decreased slightly for the subsequent 20 hours. The urinary output was better in animals treated with warm fluid, indicating the improved hemodynamic state in these animals. These results suggested that the hemodynamic state in acute burn shock was ameliorated by the use of warm fluid. Therefore, warmed fluid resuscitation might be useful to perform immediate excision and grafting for the patients with extensive burns in acute burn shock. acute burn shock; fluid resuscitation; warming device; hypothermia; hemodynamics © 2005 Tohoku University Medical PressIt is important to maintain the body temperature of patients with extensive burns. For this purpose, it is usual to raise the ambient temperature and to warm the patient using a heating device. Hypothermia is a common complication in patients with extensive burns, receiving massive volumes of fluid for resuscitation at ambient temperature. In addition, coating of the burn wounds with massive amounts of disinfectant and ointment lowers the body temperature of these patients. Under these conditions, patients with extensive burns can suffer hypothermia at ambient temperatures less than 35°C. Hypothermia causes coagulopathy, delays drug metabolism, increases

show abstract

Unintentional Hypothermia Is Associated with Postoperative Myocardial Ischemia

Cited by 466 publications

References 0 publications

Feasibility and Safety of Inducing Modest Hypothermia in Awake Patients With Acute Stroke Through Surface Cooling: A Case-Control Study

Feasibility and Safety of Inducing Modest Hypothermia in Awake Patients With Acute Stroke Through Surface Cooling: A Case-Control Study

Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk

Usefulness of Warm Fluid in Acute Burn Resuscitation: An Experimental Study in Dogs

Contact Info

Product

Resources

About