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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have studied core temperature changes occurring during induction of general anaesthesia and surgery in 18 patients undergoing elective aortic aneurysm repair. In the operating theatre, all patients were warmed with a forced-air warmer and a warming mattress, and received warmed (37 degrees C) intravenous fluids. Despite this, mean (SD) [range] core temperatures in the anaesthetic room decreased by 1.5 (0.3)[1.1-2.2] degrees C, while intravascular lines, epidural and urinary catheters were inserted before the introduction of warming methods in theatre. In one-third of patients, the core temperature was still below 36 degrees C at the end of surgery. The overall temperature decrease correlated significantly with the duration of time between induction of general anaesthesia and surgical incision (R2 = 0.6912), when the patients were not being warmed. Hypothermia may thus be prevented by minimising the period that the patient is anaesthetised without being warmed. Vascular lines, urinary and epidural catheters should be inserted before the induction of general anaesthesia or, alternatively, warming methods should be introduced in the anaesthetic room.
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PMID:Heat loss during induction of anaesthesia for elective aortic surgery. 1059 36

A 21-year-old male patient had suffered from palpitation and exertional dyspnea since October, 1997. He was admitted to our hospital, and a series of examinations were performed. Chest computed tomography (CT) revealed marked dilatation of the ascending aorta (about 7.5 cm at the proximal portion) and aortic annulus, an intimal flap in the ascending aorta and aortic arch was also noted. Cardiac catheterization revealed the pulmonary capillary wedge pressure was 33 mmHg, pulmonary artery pressure was 47/38 mmHg with a mean of 35.4. The cardiac index was 1.01 l/min/m2. Poor left ventricular contractility was shown by a left ventricular ejection fraction (LVEF) of 13.8% and a right ventricular ejection fraction (RVEF) of 5.13% by a radionuclide angiogram (RNA) study. Under the diagnosis of dilated cardiomyopathy and dissecting aortic aneurysm of the ascending aorta and aortic arch, he was put on a waiting list for heart transplantation. On November 11, 1997 he received heart transplantation. Resection of the dissecting aneurysm of the ascending aorta and the aortic arch and replacement with a 26 mm Vascutek graft were performed first under deep hypothermia and retrograde cerebral perfusion. Then while he was rewarming up, heart implantation was performed. He was discharged 30 days after surgery and has been doing well since then. As far as we know, no literature regarding combined heart transplantation and resection of a dissecting aneurysm of the ascending aorta and aortic arch has been reported.
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PMID:Combined heart transplantation and resection of dissecting aneurysm of ascending aorta and aortic arch: a case report. 1074 63

Ischemic cerebrovascular diseases are commonly induced by atherosclerosis and cardiogenic embolization but rarely they occur in association with Takayasu's arteritis and aortic lesion such as aortic dissection and aneurysm. Here we experienced two cases of acute aortic disease complicated by ischemic cerebrovascular disease (CVD). Patient 1 was a 77-year-old male. He complained of dyspnea and left hemiparesis. He was brought to our hospital by ambulance. Left hemiparesis and dyspnea improved soon. The patient only complained of left lower extremity pain and physical examination revealed hypotension. Brain CT showed no abnormality but chest CT revealed aortic dissection. The resection of the intimal tear and replacement of ascending aorta and aortic arch with 28 mm Hemashield graft were performed under hypothermia and selective cerebral perfusion. The postoperative course was uneventful and he has been doing well. Patient 2 was a 67-year-old female. She was found lying unconscious and brought to our hospital by ambulance. Physical examination revealed right hemiparesis and hypotension. Brain CT demonstrated low density area in the left corona radiata and ruptured aortic aneurysm was seen in abdominal CT. Just after the examination, the patient suddenly complained of severe back pain and died despite cardiopulmonary resuscitation. Aortic lesions can manifest ischemic symptom involving multiple organs following their vascular disorder. Aortic dissection rarely occurs in association with ischemic CVD and in that case it is likely to be seen by neurologists. Aortic dissection and aneurysm deteriorate so suddenly that immediate diagnosis and proper treatment are needed.
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PMID:[Two cases of acute aortic disease complicated by ischemic cerebrovascular disease]. 1076 48

Thoracoabdominal aortic aneurysm repairs present many challenges, and the complication of paraplegia remains a concern for both the surgeon and the nurse caring for the patient in the postoperative period. Paraplegia can occur secondary to spinal cord ischemia from prolonged aortic clamping during the repair of the descending thoracic aorta. Paraplegia is a devastating complication for the patient and family. Multiple adjunct techniques have been instituted to prevent reduced spinal cord perfusion during and after the operation, including the use of shunts and cardiopulmonary bypass, femoral artery-femoral vein bypass, left atrial-femoral artery bypass, and selective revascularization of the dominant intercostal artery. Other methods, such as somatosensory evoked potential monitoring during the operation and regional spinal hypothermia techniques, have not reduced the incidence of paraplegia. Improved outcomes have been seen with the use of methods to reduce cerebrospinal fluid (CSF) pressure. One such method is the use of external CSF drainage during the operation, followed by use of a lumbar drain system for as long as 72 hours after the operation. This system setup uses a transducer to monitor CSF pressure and a drip chamber to drain CSF to maintain a normal pressure. This article describes thoracoabdominal aneurysms, surgical techniques to repair the aneurysm, and the use of external CSF drainage and related nursing care measures.
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PMID:Use of lumbar cerebrospinal fluid drainage in thoracoabdominal aortic aneurysm repairs. 1081 81

Right-sided aortic arch is a rare variant of the thoracic vascular anatomy that may be accompanied by an aberrant origin of the left subclavian artery. We report a true aneurysm of the distal arch and descending thoracic aorta in a patient with right-sided arch and review previous descriptions of aneurysms of anomalous right-sided aortas. In our patient, the left subclavian artery originated at the junction between the distal arch and the descending thoracic aorta located in the right chest and was aneurysmal (Kommerell's diverticulum); the thoracic aorta was also aneurysmal. Extra-anatomic left subclavian-to-carotid transposition was performed before the intrathoracic procedure. Subsequently, a right thoracotomy provided adequate exposure for repairing the aortic aneurysm and oversewing the aneurysmal origin of the subclavian artery. Because the distal aortic arch was involved, deep hypothermia and circulatory arrest were used. Only five previous instances of true aneurysms of a right-sided aortic arch have been reported; four of these patients underwent operative repair (via bilateral thoracotomy, median sternotomy, or right thoracotomy). We believe that a right thoracotomy provides good exposure and avoids the morbidity associated with bilateral thoracotomy. The reconstruction of the subclavian artery has not previously been reported in this setting. Performing subclavian reconstruction as an extrathoracic procedure before the intrathoracic repair would be expected to reduce the subsequent risk of distal ischemia or subclavian steal without increasing the overall morbidity associated with the procedure.
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PMID:Kommerell's diverticulum and aneurysmal right-sided aortic arch: a case report and review of the literature. 1520 14

Despite numerous strategies that aim to maintain and restore adequate spinal cord perfusion during thoracoabdominal aortic aneurysm repair, a lower limb neurologic deficit remains a distinct possibility. When critical intercostal arteries originate either at or below the level of repair, transient spinal cord ischemia might occur. Pending on the severity and duration of ischemia, irreversible damage evolves. Therefore, it would be advantageous if adjuncts were available that could enhance neuronal tolerance and improve neuronal survival after episodes of spinal cord ischemia. The beneficial effect of permissive or induced hypothermia is well established. This review focuses on pharmacologic adjuncts. The cascade that leads to neuronal death after ischemia consists of several pathways that act both parallel and sequential. The ischemic cascade provides logical pathogenetic determinants for pharmacologic interventions. Indeed, neuroprotection was attributed to numerous agents in experimental spinal cord ischemia. The clinical use of most of these agents is hampered by their toxicity and side effects. The current status of pharmacologic protection against spinal cord ischemia is summarized, and future directions are provided.
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PMID:Pharmacologic adjuncts to protect the spinal cord during transient ischemia. 1115 54

Several techniques have been developed and clinically applied to reduce the spinal cord ischemia complications that follow thoracoabdominal aortic aneurysm (TAA) repair. Hypothermia as a protective adjunct is a concept that has been used throughout the evolution of cardiac and central aortic surgery. Because experimental regional hypothermic perfusion delivered directly to the epidural or intrathecal space showed protective effects against cord injury, we developed and applied a method for providing regional cord hypothermia with epidural cooling during TAA repair. This review describes the technical considerations with epidural cooling and the clinical results obtained in our experience.
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PMID:Regional hypothermia with epidural cooling for spinal cord protection during thoracoabdominal aneurysm repair. 1115 60

This study was undertaken to evaluate the role of cerebrospinal fluid (CSF) drainage and left atrial to femoral artery (LAFA) bypass in preventing postoperative neurologic complications for patients who had undergone descending and thoracoabdominal aortic aneurysm (TAAA) repair. LAFA bypass and CSF drainage were used as adjuncts in the treatment of 8 patients with descending and 13 patients with TAAAs (December 1999 to March 2000). LAFA bypass was established with the use of a centrifugal Biomedicus pump. Distal flows were maintained between 1.5 and 2.5 L/min during the procedures. Mean LAFA bypass time was 40 (range, 21 to 60 min). The CSF pressure was kept below 10-12 mmHg during the operations and for the first 72 hr postoperatively. All patients received heparin (1 mg/kg), which was reversed at the completion of the procedure. Passive hypothermia (rectal temperature: 32 degrees-34 degrees C) was used in all cases. All patent T8-L1 intercostal arteries were reattached to the graft. There were 13 men and 8 women. The median age was 56 years (range, 49 to 78). Chronic aortic dissection was the cause of the aneurysm in 9 patients (43%), trauma in 1 patient (5%), and medial degeneration in 11 patients (52%). There were four type I (19%), four type II (19%), and five type III (24%) TAAA. In eight patients (38%) the entire descending thoracic aorta was aneurysmal. Our results showed that the use of CSF drainage and LAFA bypass prevents paraplegia/paraparesis after repair of thoracoabdominal and descending thoracic aneurysms.
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PMID:Left atrial femoral bypass and cerebrospinal fluid drainage decreases neurologic complications in repair of descending and thoracoabdominal aortic aneurysms. 1122 44

A 53-yearold man with a dissecting aneurysm of Stanford's type-B or Crawford's type I measuring 8.5 cm in diameter underwent replacement of the distal descending aorta and the thoracic aorta using techniques for spinal cord protection involving deep hypothermia at 17 degrees C and lasting 38 minutes with total absence of circulation. A subarachnoid catheter was inserted at the lumbar level to monitor spinal fluid pressure as well as to provide drainage if pressure exceeded 10 mm Hg. During surgery 60 ml was drained, followed by 95 ml after surgery on the same day and 325, 262 and 169 ml on the following three days. No signs of neurological deficit were observed during the postoperative period. Clinical course was good until hypovolemic shock developed 27 days after the operation due to upper digestive tract bleeding caused by two duodenal ulcers that perforated the gastroduodenal artery. Emergency antrectomy and vagotomy were performed. The patient died from multiple organ failure. Spinal cord injury continues to be one of the most feared complications after excision of thoracic and thoracoabdominal aorta aneurysm. Currently, various ways of protecting the spinal cord are practiced, including drainage of cerebrospinal fluid, partial bypass of the femoral artery, intercostal artery reimplantation, drug therapy and local spinal and/or systemic hypothermia. These methods, together with shorter clamping time have achieved a reduction in the incidence of spinal cord injuries.
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PMID:[Cerebrospinal fluid drainage and deep systemic hypothermia with total absence of circulation for spinal cord protection during surgery on the thoracic aorta]. 1133 11

Mild hypothermia induced by abdominal cavity cooling together with a selective visceral shunting technique can be a useful adjunct for thoracoabdominal aortic aneurysm repair. The authors adopted this combined technique for repair of selected Crawford type III and type IV aneurysms to reduce visceral ischemic damage and minimize the incidence of postoperative complications.
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PMID:Thoracoabdominal aortic aneurysms repair under abdominal cavity cooling with visceral shunting technique--a case report. 1145 51


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