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

Surgical removal of a cerebral hemisphere may be undertaken in patients with intractable seizure disorders. Anesthetic management of such patients has not been reviewed in detail before. This study retrospectively analyzed hospital records of ten patients undergoing cerebral hemispherectomy at the Johns Hopkins Hospital between July 1983 and February 1988. Patient records were reviewed for diagnosis, physical characteristics, preoperative medications, anesthetic management, and postoperative course in the intensive care unit (ICU). Massive and sudden blood loss was a common finding in these patients, and during the intraoperative and postoperative periods, fluid resuscitation frequently was an ongoing process. In some patients, the blood loss exceeded one blood volume and was associated with coagulopathy, hypokalemia, and hypothermia. Urine output was elevated by a glucose-induced diuresis in some patients, giving misleading information as to intravascular volume status. Seizures and hemorrhage into the hemispherectomy cavity were management problems in the ICU. From this review, the authors conclude that blood loss may be marked and precipitous during surgical removal of a cerebral hemisphere. Monitoring of intra-arterial pressure and central venous pressure (CVP) is necessary for patient management during the intraoperative and postoperative periods. Intravenous (IV) access should allow rapid intravascular volume administration as it becomes necessary. Patients should remain intubated and observed closely during the immediate postoperative period due to difficulties with hemodynamic stability, seizures, and hemorrhage.
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PMID:Management of cerebral hemispherectomy in children. 234 57

The possibility of coagulopathy can be minimized by attending to certain general perioperative details to avoid hypothermia, hypotension-shock, and multiple transfusions. In this paper, we present our protocol for avoiding coagulopathy in vascular surgery. In the past 1 1/2 years, we have used perioperative plasmapheresis in 204 patients undergoing cardiac or aortic peripheral vascular surgery. Autologous platelet-rich plasma is transfused at the completion of the operation after heparin reversal. Our data show an approximate 50% reduction in homologous blood product requirement. Seventy-five percent of patients having aortic surgery received no homologous blood products during their hospital stay. For those undergoing cardiac surgery, there has been about a 45% reduction in the use of homologous blood products. In our experience, autologous platelet-rich plasma not only decreases the risk of transmittable disease, but promotes hemostasis.
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PMID:Avoiding coagulopathy in vascular surgery. 238 76

We have used the Haemonetics Cell-Saver autotransfusion technique in over 6,500 cases since 1979, salvaging more than 11,000 units of packed red blood cells. Major utilization has been in cardiac, vascular, and orthopedic cases. Coagulopathy associated with hypothermia, shock, multiple transfusions, and the autotransfusion technique, which removes clotting factors and platelets, often necessitated use of fresh-frozen plasma and platelet packs postoperatively to control bleeding and clotting problems. However, this defeats the prevention of disease transmission, transfusion reaction, and autoimmunization. Haemonetics has recently developed a plasma collection system which salvages up to 1,000 cc of platelet-rich plasma. Early experience suggests this technique will not only decrease the incidence of postoperative bleeding but further decrease the use of homologous (bank) blood and components. A step-by-step guide to the plasma collection system is discussed. The plasma collection system augments the present autotransfusion technique that conserves red blood cells, thus making complete autologous blood transfusion a reality.
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PMID:The plasma collection system: a new concept in autotransfusion. 259 14

Hemorrhage accounts for 90 per cent of deaths after abdominal injury, and half of these deaths are secondary to a recalcitrant coagulopathy. This review concentrates on our present knowledge of the role of hypothermia in trauma-related coagulopathies and notes that preventing as well as treating these disorders remains the focus and the challenge of many investigators in the field of trauma.
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PMID:Hypothermia-induced coagulopathies in trauma. 304 5

The terms "consumption coagulopathy" and "disseminated intravascular coagulation" are used synonymously, though the former expression refers to the process of consuming the haemostatic potential, whereas the latter is based upon the generalized formation of microthrombi. Both terms apply to an acquired disturbance of blood clotting leading to an increased turnover of coagulation factors and platelets by which the production sites are being exhausted. Such a process is triggered off by generalized activation of the haemostatic system: after a period of hypercoagulability, haemostasis changes into hypocoagulability with subsequent haemorrhagic diathesis. Additionally, the generalized activation of the haemostatic system leads to a formation of microthrombi in the microcirculation. Since consumption coagulopathies are bound to be secondary disorders, any underlying disease prone to lead to disseminated intravascular coagulation, should be treated as early and as intensively as possible. Solely by this and by restoring circulatory functions impaired by the underlying disease, it is possible in the majority of cases to stop the consumptive coagulopathy and to repair its sequelae. The shock frequently going along with a consumption coagulopathy requires immediate therapy: correction of hypothermia, treatment of acid-base and electrolyte disorders as well as fighting against hypovalaemia, anuria, and uraemia. Dextran does not serve only as plasma expander, but also corrects hypercoagulability and improves the rheological qualities of circulating blood. If these measures fail to stop the consumptive reaction of blood coagulation and/or fail to restore microcirculation in vital organs, indication for the use of anticoagulants or fibrinolytic drugs is given.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Therapy of consumption coagulopathies]. 307 Mar 63

During a 1-year period, three patients presented with acute traumatic thrombosis of the common or external iliac artery concomitant with a massive crush injury to the pelvis. All had vascular compromise of the involved extremity on initial physical examination, but in two patients with open pelvic trauma, exsanguination, major visceral injury, hypothermia, and a coagulopathy precluded emergency vascular reconstruction. Both required hindquarter amputation for adequate debridement. The third patient presented without exsanguination or visceral trauma. Angiography and vascular reconstruction were undertaken, but myonecrosis compounded the initial vascular compromise, and eventually required a hip disarticulation for debridement. It was concluded that: exsanguination and/or major visceral injury takes priority over emergency vascular reconstruction; soft-tissue injury may preclude limb salvage despite vascular reconstruction. If a cadaveric limb exists, early radical amputation, including hindquarter amputation, should be undertaken.
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PMID:Pelvic crush injuries with occlusion of the iliac artery. 317 9

Six elderly patients with accidental hypothermia were prospectively evaluated for impaired coagulation. All patients had abnormal coagulation profiles. Three patients with severe coagulopathies and serious underlying conditions died while hypothermic. Despite investigation, no cause for disordered coagulation was found in four patients. We conclude that hypothermia per se contributes to disordered coagulation in the elderly.
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PMID:Impaired coagulation in accidental hypothermia of the elderly. 323 89

Injuries missed at initial operation have the potential to cause the most disastrous complications in trauma patients. Over the past 5 years, 12 patients have required re-operation for 14 injuries missed at initial laparotomy and/or thoracotomy. Six missed injuries were vascular, two each in the thorax, pelvis, and retroperitoneum. The other eight were visceral: three small bowel (one patient), two pancreatic, and one each of the heart, ureter, and diaphragm. Five patients (42%) died, three with missed vascular and two with missed visceral injuries. Three died due to complications directly related to their missed injuries, while the unrecognized injury did not play a significant role in the other two. Indications for re-operation in patients with vascular injuries were hypotension in two patients, persistent output from drains in three, and refractory acidosis in one. Re-exploration in visceral injuries was for clinical sepsis in three patients, DIC in one, cardiac tamponade in one, and persistent chest tube drainage in one. Eleven of the 12 patients presented to the E.D. in shock. All patients had multiple injuries with a mean of 3.25 organ systems injured. Hypotension, coagulopathy, and/or hypothermia (T less than 92 degrees) were felt to have contributed to missing the injury in five of the patients with vascular, and three of the patients with visceral injuries. In the four other patients, injuries were missed due to inadequate exploration or a low index of suspicion in the presence of multiple injuries.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Injuries missed at operation: nemesis of the trauma surgeon. 339 94

Aortic arch resection remains a challenging problem. At present, the most reliable technique appears to be profound hypothermia and circulatory arrest, although long cardiopulmonary bypass times and coagulopathy remain significant problems. Interest in alternative procedures continues. Herein, we report our experience of aortic arch replacement in eight patients using profound hypothermia (12 to 17 degrees C) and circulatory arrest in six patients (Group I) and moderate (20 degrees C) hypothermia with low flow (200 ml/min), pressure-monitored (100 mm Hg) innominate artery perfusion by way of a 14 Ga. cannula in 2 (Group II). Arch repair was by patch graft in two, and tube graft in six. Concomitant ascending aortic replacement was performed in five, aortic valve replacement in four, and coronary bypass in two. Circulatory arrest times ranged from 15 to 71 minutes in Group I and were 15 minutes and 35 minutes in Group II. All patients survived. One patient in Group I had a neurologic injury of moderate severity, probably due to a hypoxic postoperative cardiac arrest. We have found low flow pressure-monitored innominate artery perfusion and moderate hypothermia to be simple and expedient, and we will continue use of this technique.
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PMID:Techniques of aortic arch replacement: profound hypothermia versus moderate hypothermia with innominate artery perfusion. 355 44

No useful purpose is served by developing therapeutic interventions that are applicable only in nonexistent patient populations. The history of laboratory hemorrhagic shock research may be a case in point because although many interventions have been proposed on the basis of animal experimentation, few if any have found a place in the treatment of human beings. For a laboratory shock model to have clinical relevance, it must replicate important aspects of shock as seen in human beings during or following massive blood loss. The difficulty in developing an animal model that incorporates these human aspects--hypothermia, hypoxia, hypotension, acidosis, coagulopathy, etc--must not be underestimated. Four methodological factors to consider are animal species, anesthesia, tissue trauma, and nociceptive effects. The development of an animal shock model will require several compromises and the results, whether dealing with mechanisms or therapeutic outcomes, must be considered suspect until confirmatory data are obtained from human studies.
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PMID:Current shock models and clinical correlations. 377 11


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