Abstract The use of surface cooling and brief circulatory arrest in the repair of previously inoperable cardiac anomalies awakened modern scientific interest in hypothermia less than two decades ago. Oxygen consumption in the dog and man is approximately halved by every 8 C decrease in body temperature.1,2 With body temperature lowered to 30 C cardiac arrest can be tolerated for 10 minutes. This allows a brief period of bloodless neurosurgery or cardiovascular surgery but is usually insufficient to deal with difficult problems such as multiple or broad based cerebral arterial aneurysms, rupture of a berry aneurysm during surgery or carotid artery reconstruction. Therefore, some clinics have used deep general hypothermia in the range of 15 C for difficult neurosurgical procedures.3,4 This has required supportive cardiopulmonary bypass. An alternate technique combines moderate surface-induced hypothermia with profound selective cerebral hypothermia. This avoids the use of bypass and the complications of profound References 1. Bigelow, W.G., et al: Oxygen Transport and Utilization in Dogs at Low Body Temperatures , Amer J Physiol 160:125-137 ( (Jan) ) 1950. 2. Rehder, K., et al: Physiologic Studies Following Profound Hypothermia and Circulatory Arrest for Treatment of Intracranial Aneurysm , Ann Surg 156:882-889 ( (Dec) ) 1962.Crossref 3. Patterson, R.H., Jr., and Ray, B.S.: Profound Hypothermia for Intracranial Surgery: Laboratory and Clinical Experiences With Extracorporeal Circulation by Peripheral Cannulation , Ann Surg 156:377-393 ( (Sept) ) 1962.Crossref 4. Uihlein, A., et al: Deep Hypothermia and Surgical Treatment of Intracranial Aneurysms , JAMA 195:639-641 ( (Feb 21) ) 1966.Crossref 5. Wolfson, S.K., Jr., et al: Preferential Cerebral Hypothermia for Circulatory Arrest , Surgery 57:846-855 ( (June) ) 1965. 6. Wolfson, S.K., Jr.; Icoz, M.V.; and Luber, S.: Preservation of Conditioned Responses in Primates After Total Circulatory Arrest With Preferential Cerebral Hypothermia , Surg Forum 16:409-411 ( (Oct) ) 1965. 7. Callaghan, P.B., et al: Effect of Varying Carbon Dioxide Tensions on the Oxyhemoglobin Dissociation Curves Under Hypothermic Conditions , Ann Surg 154: 903-910 ( (Dec) ) 1961. 8. Icoz, M.V., and Wolfson, S.K., Jr.: Tolerance to Total Ischemia in Dogs After Cold Blood or Cold Physiologic Saline Perfusion of the Brain , Surg Forum 17:403-405 ( (Oct) ) 1966. 9. Parkins, W.M.; Jensen, J.M.; and Vars, H.M.: Brain Cooling in the Prevention of Brain Damage During Periods of Circulatory Occlusion in Dogs , Ann Surg 140:284-289 ( (Sept) ) 1954.Crossref 10. Bjork, V.O., and Hultguist, G.: Contraindications to Profound Hypothermia in Open Heart Surgery , J Thorac Cardiovasc Surg 44:1-13 ( (July) ) 1962. 11. Swan, H., et al: Cessation of Circulation in General Hypothermia: I. Physiologic Changes and Their Control , Ann Surg 138:360-376 ( (Sept) ) 1953.Crossref 12. Bacalzo, L.V., Jr., and Wolfson, S.K., Jr.: Intracellular Buffering and Dextran (LMWD) in Cold Brain Perfusion for Circulatory Arrest , Circulation 38:36 ( (Oct) ) 1968.
Archives of Surgery – American Medical Association
Published: Jun 1, 1969