Mild Hypothermia as a Protective Therapy during Intracranial Aneurysm Surgery: A Randomized Prospective Pilot Trial

Mild Hypothermia as a Protective Therapy during Intracranial Aneurysm Surgery: A Randomized... AbstractOBJECTIVETo conduct a pilot trial of mild intraoperative hypothermia during cerebral aneurysm surgery.METHODSOne hundred fourteen patients undergoing cerebral aneurysm clipping with (n = 52) (World Federation of Neurological Surgeons score ≤lll) and without (n = 62) acute aneurysmal subarachnoid hemorrhage (SAH) were randomized to normothermic (target esophageal temperature at clip application of 36.5°C) and hypothermic (target temperature of 33.5°C) groups. Neurological status was prospectively evaluated before surgery, 24 and 72 hours postoperatively (National Institutes of Health Stroke Scale), and 3 to 6 months after surgery (Glasgow Outcome Scale). Secondary outcomes included postoperative critical care requirements, respiratory and cardiovascular complications, duration of hospitalization, and discharge disposition.RESULTSSeven hypothermic patients (12%) could not be cooled to within 1°C of target temperature; three of the seven were obese. Patients randomized to the hypothermic group more frequently required intubation and rewarming for the first 2 hours after surgery. Although not achieving statistical significance, patients with SAH randomized to the hypothermic group, when compared with patients in the normothermic group, had the following: 1) a lower frequency of neurological deterioration at 24 and 72 hours after surgery (21 versus 37-41 %), 2) a greater frequency of discharge to home (75 versus 57%), and 3) a greater incidence of good long-term outcomes (71 versus 57%). For patients without acute SAH, there were no outcome differences between the temperature groups. There was no suggestion that hypothermia was associated with excess morbidity or mortality.CONCLUSIONMild hypothermia during cerebral aneurysm surgery is feasible in nonobese patients and is well tolerated. Our results indicate that a multicenter trial enrolling 300 to 900 patients with acute aneurysmal SAH will be required to demonstrate a statistically significant benefit with mild intraoperative hypothermia. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Mild Hypothermia as a Protective Therapy during Intracranial Aneurysm Surgery: A Randomized Prospective Pilot Trial

Mild Hypothermia as a Protective Therapy during Intracranial Aneurysm Surgery: A Randomized Prospective Pilot Trial

Mild Hypothermia as a Protective Therapy during Intracranial Aneurysm Surgery: A Randomized Prospective Pilot Trial Bradley J. Hindman, M .D ., Michael M. Todd, M .D ., Adrian W. Gelb, M.B., Ch.B., Christopher M. Loftus, M.D., Rosemary A. Craen, M.B., B.S., Armin Schubert, M.D., Michael E. Mahla, M.D., James C. Tomer, Ph.D. Departments of Anesthesia (BJH, M M T), Surgery (Neurosurgery) (CM L), and Preventive M edicine (JCT), University of Iowa, Iowa City, Iowa; Department of Anaesthesia (A W G , RA C), U niversity of Western Ontario, London, C anada; Department of General Anesthesiology (AS), Cleveland C lin ic , C leveland , O h io ; and Department of Anesthesiology (MEM), University of Florida, G a in e sville , Florida OBJECTIVE; To conduct a pilot trial of mild intraoperative hypothermia during cerebral aneurysm surgery. METHODS: O n e hundred fourteen patients undergoing cerebral aneurysm clipping with (n = 52) (World Federation of Neurological Surgeons score < l l l ) and without (n = 62) acute aneurysmal subarachnoid hemorrhage (SAH) were randomized to normothermic (target esophageal temperature at clip application of 36.5°C) and hypother­ mic (target temperature of 33.5°C) groups. Neurological status was prospectively evaluated before surgery, 24 and 72 hours postoperatively (National Institutes of Health Stroke Scale), and 3 to 6 months after surgery (Glasgow O utcom e Scale). Secondary outcomes included postoperative critical care requirements, respiratory and cardiovascular complications, duration of hospitalization, and discharge disposition. RESULTS: Seven hypothermic patients (1 2 % ) could not be cooled to within 1°C of target temperature; three of the seven were obese. Patients randomized to the hypothermic group more frequently required intubation and rewarming for the first 2 hours after surgery. Although not achieving statistical significance, patients with SAH randomized to the hypothermic group, when compared with patients...
Loading next page...
 
/lp/ou_press/mild-hypothermia-as-a-protective-therapy-during-intracranial-aneurysm-fNEM0VnmCC
Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199901000-00009
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVETo conduct a pilot trial of mild intraoperative hypothermia during cerebral aneurysm surgery.METHODSOne hundred fourteen patients undergoing cerebral aneurysm clipping with (n = 52) (World Federation of Neurological Surgeons score ≤lll) and without (n = 62) acute aneurysmal subarachnoid hemorrhage (SAH) were randomized to normothermic (target esophageal temperature at clip application of 36.5°C) and hypothermic (target temperature of 33.5°C) groups. Neurological status was prospectively evaluated before surgery, 24 and 72 hours postoperatively (National Institutes of Health Stroke Scale), and 3 to 6 months after surgery (Glasgow Outcome Scale). Secondary outcomes included postoperative critical care requirements, respiratory and cardiovascular complications, duration of hospitalization, and discharge disposition.RESULTSSeven hypothermic patients (12%) could not be cooled to within 1°C of target temperature; three of the seven were obese. Patients randomized to the hypothermic group more frequently required intubation and rewarming for the first 2 hours after surgery. Although not achieving statistical significance, patients with SAH randomized to the hypothermic group, when compared with patients in the normothermic group, had the following: 1) a lower frequency of neurological deterioration at 24 and 72 hours after surgery (21 versus 37-41 %), 2) a greater frequency of discharge to home (75 versus 57%), and 3) a greater incidence of good long-term outcomes (71 versus 57%). For patients without acute SAH, there were no outcome differences between the temperature groups. There was no suggestion that hypothermia was associated with excess morbidity or mortality.CONCLUSIONMild hypothermia during cerebral aneurysm surgery is feasible in nonobese patients and is well tolerated. Our results indicate that a multicenter trial enrolling 300 to 900 patients with acute aneurysmal SAH will be required to demonstrate a statistically significant benefit with mild intraoperative hypothermia.

Journal

NeurosurgeryOxford University Press

Published: Jan 1, 1999

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off