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

Six female and 4 male patients (age, 23 to 75 years) underwent operation for difficult intracranial lesions. Preoperative diagnoses included four giant intracranial aneurysms, three base of skull glomus jugulare tumors, two arteriovenous malformations, and one cerebellar hemangioblastoma. All lesions were inoperable or nearly so by standard neurosurgical techniques. All patients were placed on total bypass via groin cannulations. Bypass times ranged from 111 to 269 minutes (mean, 174 minutes) with cooling times of 26 to 83 minutes (mean, 48 minutes) and warming times of 68 to 110 minutes (mean, 83 minutes). Circulatory arrest times ranged from 1.25 to 60 minutes with 1 patient not requiring arrest. The lowest core temperatures recorded varied from 8.4 degrees to 13.7 degrees C. There was one postoperative death and one major complication, both in patients with arteriovenous malformations. Eight patients (80%) have achieved an excellent result. Profound hypothermia with the option of circulatory arrest and exsanguination has been an indispensable adjunct to the safe management of intracranial aneurysm, glomus jugulare tumor, and hemangioblastoma.
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PMID:Cardiopulmonary bypass, profound hypothermia, and circulatory arrest for neurosurgery. 151 May 42

The authors report a case of voluminous cervicofacial angioma with pelvi-lingual extension which had undergone multiple operations and had embolized. The exeresis consisted of cutaneous sacrifice of 10 x 10 cm combined with a longitudinal hemi-pelvi-glossectomy. Two pediculated musculocutaneous strips of greater pectoris and greater dorsal muscle were associated for reconstruction. The operation took place under extracorporeal circulation by femoral cannulation and deep hypothermia. Post-operative recovery was simple, with resumption of normal phonation and eating. No recurrence was observed upon arteriographic control at six months. The use of extracorporeal circulation is exceptional outside cardiac problems (low tracheal stenosis, intracranial aneurysm). The authors suggest the value of this technique for the treatment of angiomas purportedly inoperable because of the risk of major blood loss.
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PMID:[Excision-reconstruction of voluminous facial angioma under extracorporeal circulation and deep hypothermia]. 208 60

Temporary arterial occlusion during intracranial aneurysm surgery is a safe and effective modality. It is not only an emergency measure for controlling aneurysmal bleeding, but also a helpful means for accurate and meticulous dissection and clipping of an intracranial aneurysm with the advantage of minimizing the chance of its premature rupture or causing damage to the vital neurovascular structures. This technique is especially useful for treating large or giant aneurysms, carotid-ophthalmic arterial aneurysms, or thin-walled and complicated aneurysms tightly adherent to their surrounding tissues. A series of 52 patients with temporary clipping of the involved arteries during intracranial aneurysm surgery were reviewed retrospectively, which represented 37.1% of all aneurysms operated on in Huashan Hospital, Shanghai Medical University during the same period (from 1980 to 1990). Of them, one died (1.9%), 10(19.2%) had immediate or early neurological deficits which were mostly resolved later. A follow-up study with an average time of 3.8 years showed that 98% of patients had an excellent and good recovery without significant deficits. Comparing these results with those in 88 patients with aneurysms operated on over the same period in which temporary clips were not used, there is clearly no significant difference. The use of brain protectors, barbiturates, hypothermia and some monitoring systems can increase the safe coefficient to the brain and reduce the occurrence of ischemic complications during the application of temporary arterial occlusion. However, there is so far neither an absolute reliable medication or monitor, nor a well accepted safe time-limits to vascular occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Temporary arterial occlusion during intracranial aneurysm surgery. 814 90

Recent evidence indicates that the relationship between "brain protection" and the degree of hypothermia is not linear, and even mild reduction of body temperature (i.e. 2-5 degrees C) may provide protection against cerebral ischemia. The protective effects of mild hypothermia have been demonstrated in various animal models of cerebral ischemia, and are encouraging in human studies. At the present time, although there is no randomized clinical trial assessing the benefits of mild hypothermia for intracranial aneurysm clipping, some neurosurgical centers are routinely instituting mild hypothermia before vascular occlusion.
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PMID:Mild hypothermia. 980 Jun 1

Intracranial aneurysms are a common complication of sickle cell disease. The management of a patient with multiple intracranial aneurysms and sickle cell disease is described. The English language literature is reviewed. Neuroanesthetic management has traditionally been based on the avoidance of factors said to lead to erythrocyte sickling; however neuropathology typically arises from arterial intimal damage, not from venous sickling. Neuroanesthesia should be based on an appreciation of this pathophysiological model. Consideration of precipitants of vaso-occlusive crises, such as hypothermia, dehydration and possibly altered hemodynamics, should influence management.
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PMID:Management of multiple intracranial aneurysms: neuroanesthetic considerations of sickle cell disease. 1114 87

Extracorporeal circulation (ECC) is not only used for open heart surgery. There are also other surgical and medical applications. ECC can be used for encephalic arteries surgery to induce hypothermia and maximally protect the brain. Femoro-femoral ECC may be needful for urgent traumatologic surgery of the supra-aortic trunci. Intracranial aneurysm repair can occasionally necessitate deep hypothermia and circulatory arrest with ECC. Renal cell carcinomas may metastasize to the right atrium and surgery with ECC is mandatory for complete excision. Some reports in the literature mention use of ECC for hepatic surgery of intra-hepatic aneurysms. With acute peripheral ischemia, metabolites in the affected limb can be washed out with good results. Medical indications for ECC are numerous with pulmonary assistance as one of the foremost when mechanical ventilation failed. Homogeneous and rapid rewarming of hypothermic patients can be achieved with ECC. Finally, some groups have reported the use of ECC to administer chemotherapy in limb melanoma.
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PMID:[Extracorporeal circulation: an extraordinary tool that is not just for cardiac surgeons]. 1241 Jan 43

Interpreting a Bispectral Index (BIS) of "0", corresponding to an isolelectric electroencephalography, can be difficult. After ruling out technical issues, such as leads disconnection, several possible causes for a decrease in the BIS persists, including deep anesthesia, hypothermia, decrease in the cerebral perfusion pressure and cerebral ischemia. We report a sudden transient decrease of the BIS to "0" in a patient that underwent a coil embolization of a ruptured intracranial aneurysm and suggest that the change in BIS values could provide useful information about the cerebral hemodynamic during aneurysm treatment and might provide indications of a serious cerebral event.
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PMID:Bispectral index transiently decreased to "0" during per-embolization rupture of an intracranial aneurysm. 2437 45

Since the first surgery for an intracranial aneurysm in 1931, neurological surgeons have long strived to determine the optimal methods of surgical correction. Significant challenges of aneurysm clipping include intraoperative rupture and complex dome morphology. Hypothermia, cardiopulmonary bypass, pharmacologically induced hypotension, and cardiac standstill are a few of the methodologies historically and currently employed in the management of these issues. In the 1980s, significant advances in pharmacology and anesthesiology led to the use of agents such as adenosine for chemically induced hypotension and eventually complete circulatory arrest. Since the institution of the use of these agents, the traditional methods of circulatory arrest under conditions of hypothermia and cardiopulmonary bypass have fallen out of favor. However, there still exists a subset of technically difficult aneurysms for which cardiac standstill, both chemical and hypothermic, remains a viable therapeutic option. In this paper, the authors describe the history of cardiac standstill by both hypothermic and chemically induced means as well as provide examples in which these techniques are still necessary.
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PMID:Cardiac standstill and circulatory flow arrest in surgical treatment of intracranial aneurysms: a historical review. 2468 23