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

Right atrial procedures require snaring the venous cannulas to prevent air entrapment in the venous line. In particular situations with complex congenital morphology and/or presence of severe pericardial adhesions the right atrial opening without the inferior vena cava cannula in the surgical field and without dissecting and snaring the inferior vena cava itself, might substantially facilitate the surgical technique, provided an adequate venous drainage is assured to avoid flow reduction or circulatory arrest. In several patients with congenital or acquired heart disease with potentially complicated venous drainage, like extracardiac Fontan procedure and tricuspid valve replacement, cardiopulmonary bypass was conducted either on normothermia (congenital lesions) or with mild hypothermia (acquired disease), with 3 l/min per m(2) flow index and venous drainage through femoral vein cannulation. The right atrium was opened without snaring the inferior vena cava, never provoking reduction of the venous drainage nor air locks in the venous line. This approach substantially enhanced the surgical exposure and therefore facilitated the operative technique without any negative consequence to the patients. Right atrial surgery on cardiopulmonary bypass without direct cannulation and snaring of both superior and inferior vena cava is feasible without flow reduction for surgeons taking care of both congenital and acquired cardiac lesions.
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PMID:Right atrial surgery with unsnared inferior vena cava. 1520 Oct 9

Suboptimal neurodevelopmental outcome is common in children who have congenital heart disease. Its aetiology is often multifactorial. This review focuses on the role of cardiopulmonary bypass. Hypothermia is the mainstay of cerebral protection. Low flow and regional low flow are preferred to deep hypothermic circulatory arrest in many situations. Cooling and rewarming, aortopulmonary collaterals, pH, air emboli, the systemic inflammatory response, haematocrit, oxygenation, glucose and ultrafiltration can influence neurodevelopmental outcome. Although no pharmacological agents have been shown to have a beneficial effect on neurodevelopmental outcome in clinical practice in children, animal work on the use of steroids several hours before surgery is encouraging.
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PMID:Cerebral injury during paediatric heart surgery: perfusion issues. 1537 66

We report a protracted hypoxic event during Soave's endorectal pull-through for Hirschsprung's disease in a 2-month-old male infant with tetralogy of Fallot. After the bowel loops were delivered out of the abdominal cavity, profound hypoxemia occurred which persisted for about 120 min. The hypoxemia was completely resolved after the intestine was reduced back into the peritoneal cavity. The immediate cause was postulated to have been decreased systemic vascular resistance. Associated factors included hypothermia and acidosis leading to high pulmonary vascular resistance which further aggravated the right-to-left blood-shunting situation in this patient. Postoperative follow-up showed no neurological complications. Small infants with complex heart disease should be carefully evaluated before major abdominal surgery.
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PMID:Profound hypoxemia during major abdominal surgery in a small infant with tetralogy of Fallot. 1623 34

Microvessels of the right atrium endothelium were investigated with electron microscope for patients with congenital heart disease receiving surgical treatment under deep perfusionless hypothermia and various methods of pharmaco-cold cardioplegia. In group 1, pharmaco-cold cardioplegia was performed, with hyperosmolar normopotash solution cooled down to 2-4 degrees C. In group 2, the same solution combined with isoptin, a potash-ion blocker, was applied. It has been shown that during global ischemia, stability of ion gradients on plasmalemma of endothelial cells is impaired, irrespective of the composition of cardioplegia solution. Alongside with this, ultrastructural reactions in group 1 proceed towards hyperosmia of endothelium accompanied by building up a large group of cells following coagulation necrosis. In group 2, by contrast, an intracellular edema progresses. The cardioprotective effect of isoptin, which is able to block Ca2+, manifests itself most vividly at reperfusion, when the blocking of cell potash overload prevents the development of dystrophic and destructive changes in endothelium of coronary microvessels, which present one of the most severe consequences in the process of blood flow recovery in ischemic tissues.
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PMID:[Endothelium of myocardium microvessel under conditions of hypothermia, ischemia, reperfusion and pharmaco-cold cardioplegia with calcium antagonist]. 1660 37

Differential diagnosis of neonatal respiratory distress includes pulmonary and systemic disorders and anatomic problems compromising respiratory system. We report on a 2770-g female born to a 29-year-old gravida 3, para 2 woman after 34 weeks of gestation. Antenatal ultrasound performed in week 8 and 21 was normal. The infant was delivered by cesarean section after amniotic membranes had been ruptured for less than 12 hours due to signs of fetal distress. The Apgar score was 3 and 3 at 1 and 5 minutes, respectively. The infant was intubated and resuscitated, and transferred immediately to the neonatal intensive care unit. She had an extremely protuberant and cyanotic abdomen. Dilated cutaneous collateral vessels were apparent in the periumbilical region. Abdominal sonography showed cystic multiloculated tumorous mass filled with dense, flocculent content at the level of hepatic portal. The tumorous mass occupied the majority of the abdomen with caudal extension toward the pelvis and dorsally toward the spine. The liver was displaced high under the diaphragm with the left liver lobe in the left hemiabdomen. On x-ray the lung were collapsed due to a large abdominal mass in the right hemiabdomen that displaced the right diaphragm and intestines contralaterally. She soon developed bilateral pneumothoraces. Drainage and continuous suction were started. The infant failed to improve despite all attempts and died. On autopsy, an extremely large, mobile, multichambered, solitary cyst was found. It was attached to the mesenteric side of the ileum by its own thin peduncular stalk and had no communication with the remainder of the gut. It occupied the majority of the abdomen. Histologic section revealed a well-developed smooth muscle wall and inner mucosa of small bowel type. Respiratory distress is a common problem in premature infants. The majority of cases are due to pulmonary disorders (e. g., hyaline membrane disease, meconium aspiration syndrome, pneumonia), hypothermia, metabolic acidosis, anemia, and congenital heart disease. Anatomic problems including space occupying lesions are less common. Duplications of the alimentary tract in infants and children are rare congenital anomalies. Although symptoms can occur at any age, they usually present during the first year. In our patient, intraabdominal mass caused severe respiratory distress and respiratory failure in the first hours of postnatal life. This had been seen before only as a complication of intrathoracic lesions extending into the abdominal cavity. Pathology revealed spherical intestinal duplication that was completely separated from the alimentary tract. Embryologically, it was a localized duplication. Respiratory distress in our patient was refractory to all means of mechanical ventilation. Poor lung compliance was the consequence of prenatal lung hypoplasia and inadequate postnatal lung expansion due to the duplication cyst space occupying character and its compressive effect. Prenatal diagnosis was the child's only chance for survival but it was not made. Duplications of the alimentary tract can present a diagnostic challenge even in the first hours of life. They should be included in the differential diagnosis of severe respiratory distress, especially in premature infants in which timely prenatal diagnosis cannot be always made. We propose their inclusion among other space occupying lesions that might be the cause of severe respiratory distress even in the earliest neonatal period.
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PMID:[Severe respiratory distress due to ileal duplication cyst in the newborn]. 1680 74

Therapeutic hypothermia, introduced more than 5 decades ago, remains an important neuroprotective factor in the surgery for the correction of congenital heart disease, in particular when intraoperative circulatory arrest is required. Hypothermia decreases cerebral metabolism and energy consumption and reduces the extent of degenerative processes such as the excitotoxic cascade, apoptotic and necrotic cell death, microglial activation, oxidative stress, and inflammation. Neurological outcome has become the focus of several studies in the recent years, and deep hypothermic circulatory arrest durations of more than 40 minutes are associated with increased mid- and long-term disability. Physiologic cerebral flow-metabolism coupling seems to be preserved with moderate and mild hypothermia, but cerebral blood flow autoregulation is probably altered after deep hypothermic circulatory arrest, suggesting disordered cerebral metabolism and oxygen use. Although evidence from animal studies suggests potential benefit from very low temperatures, postoperative development of choreoathetosis has been found to correlate with the degree of intraoperative hypothermia, recommending the use of central temperatures greater than 15 degrees C in the clinical practice. Cooling times longer than 20 minutes are needed to obtain homogeneous brain cooling and effective neuroprotection. Finally, there is evidence that the sites of temperature monitoring used in the clinical practice may underestimate brain temperature after cardiopulmonary bypass, with the risk of postoperative hyperthermic brain damage.
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PMID:Therapeutic hypothermia. 1748 69

Patients with acute alcohol intoxication often present with pathological electrocardiographic (ECG) changes. The changes are more frequent and prognostically more significant in chronic alcoholics, in patients with ischaemic heart disease (IHD), in alcohol cardiomyopathy or another organic heart disease, but they can also occur in young and healthy individuals. The typical ECG changes in inebriety are disturbances of heart rate having the nature of electric impulse generation disorder or of impulse conduction pathology. In persons without clinical evidence of heart disease, they are classified as 'holiday heart syndrome'. The most frequent tachyarrhythmia is atrial fibrillation; less frequent but prognostically much more significant is torsades de pointes (TdP) polymorphous ventricular tachycardia. Among bradyarrhythmias, the most significant is alcohol-induced sinus bradycardia which may be manifested by recurrent syncope. The higher the blood alcohol concentration, the higher the occurrence of a significant extension of ECG intervals with possible manifestation of latent conduction disturbance or even sudden cardiac death. Apart from heart rate disturbances, ECG picture very often shows non-specific repolarisation changes. Ischaemia, which is mostly asymptomatic in the form of silent myocardial ischaemia, is worsened in alcohol-intoxicated IHD patients. The resulting ECG may be to a large extent influenced by states which often associate with inebriety, such as hypothermia, hypoglycaemia or electrolyte imbalance. ECG changes similar to those due to acute alcohol intoxication are also present in acute abstinence syndrome, especially in delirium tremens. There is convincing evidence that not only chronic alcoholism, but also single episodes of excessive alcohol consumption are associated with increased cardiovascular mortality.
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PMID:[ECG changes in alcoholic intoxication]. 1863 Jun 9

We have analysed the published literature on eptacog alfa (recombinant factor VIIa; rFVIIa) for nonhaemophiliac conditions with the aim of determining its current place in therapy. Initial surgical and/or medical management is required for any patient with life-threatening bleeding. In those with continued life-threatening bleeding (i.e. despite maximal surgical and/or medical therapy), eptacog alfa may be considered as additional therapy, in exceptional circumstances. There is good evidence from systematic reviews and randomized controlled trials (RCTs) that eptacog alfa stops bleeding in adults with intracerebral haemorrhage (ICH) if it is given within 4 hours of symptom onset. However, a recent phase III RCT suggests that it does not improve clinically relevant long-term outcomes (death and disability). There is also good evidence against prophylactic use of eptacog alfa during orthotopic liver transplantation or liver resection, and in treating variceal and nonvariceal haemorrhage in patients with cirrhosis. The evidence for the use of eptacog alfa for unexpected life-threatening bleeding in liver, cardiac or other surgery, or in blunt trauma, is not robust. In these circumstances, it should only be given as part of a clinical trial or in exceptional cases when other therapies have failed. The evidence for use of eptacog alfa in penetrating trauma is lacking. Conflicting RCT results exist for the prophylactic use of eptacog alfa in elective surgery; therefore, it cannot be recommended in this situation. There is insufficient evidence for a primary role of eptacog alfa in reversal of anticoagulation with heparin-like molecules and novel anticoagulant agents. There are effective therapies that correct all warfarin-induced factor deficiencies; thus, off-label use of eptacog alfa for reversal of warfarin should only be considered in the context of ICH. The evidence for eptacog alfa use in children is limited. The only RCT is in cardiac surgery for congenital heart disease, where eptacog alfa prophylaxis was actually associated with increased time to chest closure. It may be of potential benefit in some children with life-threatening bleeding in the context of trauma, surgery or liver disease (as additional therapy when surgical and/or medical control of bleeding has failed), but the overall benefit-risk ratio may be unfavourable if there is an underlying risk of thromboembolism (e.g. trauma, congenital heart disease, other hyperviscous or hypercoagulable states, presence of arterial or central venous catheters). Thromboembolism may be associated with eptacog alfa use. Although the magnitude of this risk and possible predisposing factors are not clearly delineated, some data suggest increased risk at higher doses. Variable effects of eptacog alfa use on mortality have been shown in a pooled analysis of RCTs. Data from some observational studies and postmarketing surveillance suggest an increased risk of thromboembolism associated with off-label uses. Further well designed studies are required to more definitively assess the risk of thromboembolism with eptacog alfa and to better determine its effects on mortality. Optimum dosages for nonhaemophiliac conditions are not defined and nor is the optimum timing of administration. Moreover, it is not clear which patients will be most likely to benefit in terms of haemostatic efficacy and mortality. In addition to conventional measures to stop bleeding (i.e. surgery and blood transfusion), correction of hypothermia and acidosis, and reversal of anticoagulation are all recommended. The outcomes (effectiveness and safety) of all off-label uses should be systematically evaluated and reported. Adequate data to assess cost effectiveness for eptacog alfa does not exist for most off-label indications.
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PMID:An evaluation of eptacog alfa in nonhaemophiliac conditions. 1868 90

Few patients with cyanotic congenital heart disease reach adulthood without a cardiac operation. The prognosis for ''unrepaired'' pulmonary atresia with ventricular septal defect is approximately 8% in the 1st decade of age. Consequently, the number of adults with this particular heart disease (unrepaired) who are expected to need a non-cardiac surgery is extremely low. General anesthesia may aggravate the preexisting right to left shunt and lead to persistent severe hypoxemia. The goal of anesthetic management should be to maintain intravascular volume. Systemic and pulmonary vascular resistance changes, such as might occur due to acidosis, hypothermia, hypercarbia or excessive airway pressures, should be avoided. Maintenance of preload, contractility and sinus rhythm is of major importance. The complex pathophysiology of such heart disease, in addition to the circumstances of emergency operation, exacerbate the total anesthetic risk. We present here a rare case of an acute appendectomy with successful outcome in an adult with pulmonary atresia and ventricular septal defect.
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PMID:Appendectomy for an adult with cyanotic congenital heart disease. 1919 May 64

Perioperative cerebral ischemic insults are common in some surgical procedures. The notion that induced hypothermia can be employed to improve outcome in surgical patients has persisted for six decades. Its principal application has been in the context of cardiothoracic and neurosurgery. Mild (32-35 degrees C) and moderate (26-31 degrees C) hypothermia have been utilized for numerous procedures involving the heart, but intensive research has found little or no benefit to outcome. This may, in part, be attributable to confounding effects associated with rewarming and lack of understanding of the mechanisms of injury. Evidence of efficacy of mild hypothermia is absent for cerebral aneurysm clipping and carotid endarterectomy. Deep hypothermia (18-25 degrees C) during circulatory arrest has been practiced in the repair of congenital heart disease, adult thoracic aortas, and giant intracranial aneurysms. There is little doubt of the protective efficacy of deep hypothermia, but continued efforts to refine its application may serve to enhance its utility. Recent evidence that mild hypothermia is efficacious in out-of-hospital cardiac arrest has implications for patients incurring anoxic or global ischemic brain insults during anesthesia and surgery, or perioperatively. Advances in preclinical models of ischemic/anoxic injury and cardiopulmonary bypass that allow definition of optimal cooling strategies and study of cellular and subcellular events during perioperative ischemia can add to our understanding of mechanisms of hypothermia efficacy and provide a rationale basis for its implementation in humans.
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PMID:Perioperative hypothermia: use and therapeutic implications. 1923 24


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