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

Systemic hypothermia is used almost universally in cardiac surgery. Since 1987, 2383 patients underwent normothermic cardiopulmonary bypass (NCPB, "warm body", bladder temperature 36 degrees C) with cold blood cardioplegic arrest ("cold heart", 8-14 degrees C) during myocardial revascularization. No patients were denied this technique regardless of age, condition or severity of surgery. Clinical characteristics in patients: Age range: 31-92 years, mean 66; male/female ratio 3:1; pump time (min): 23-228, mean 80; cross clamp time (min): 18-152, mean 60. One thousand, one hundred and sixty-one patients (49%) had urgent coronary artery bypass grafting (CABG). Ejection fraction was less than 0.4 in 843 patients (30%). Thirty-day operative mortality was 1% (23/2383 patients). Postoperative complications were: perioperative myocardial infarction (35 patients) = 1.5%; postoperative bleeding requiring reexploration (33 patients) = 1.4%; stroke (22 patients) = 0.9%; mediastinal infection (24 patients) = 1%; and renal insufficiency (25 patients) = 1%. During NCPB (warm), systemic vascular resistance was extremely low, cardiac output was high and it was easier to wean patients from the pump. No patient required the intraaortic balloon pump during peri- and post-operative periods. Pulmonary complications and coagulopathy were extremely rare. These results provide reassurance that NCPB (warm) in combination with cold cardioplegic arrest provides excellent myocardial and total body protection during myocardial revascularization and is particularly suitable for high-risk patients.
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PMID:Warm body, cold heart: myocardial revascularization in 2383 consecutive patients. 828 48

Potassium loss may cause arrhythmias and cardiac injury in patients undergoing heart surgery with cardiopulmonary bypass (CPB). In a prospective, randomized trial two different methods of potassium substitution were investigated regarding their influence on cardiac rhythm following reperfusion. Patients received either potassium chloride (Group I, n = 102) or potassium magnesium aspartate (Inzolen, group II, n = 105) to achieve intraoperative serum potassium concentrations of 4.5 mmol/l. St. Thomas cardioplegic solution was used. CPB was performed in moderate hypothermia (28-32 degrees C) with a non-pulsatile pump flow, a membrane oxygenator and a single two-stage venous catheter. The two study groups were comparable with regard to biometric data, preoperative state, duration of operation, ischemia and clinical outcome. In 6 patients in group I and in 3 patients in group II perioperative myocardial infarction was diagnosed based on ECG and CK-MB findings. One patient in each group died during the postoperative hospital stay. At the time of declamping mean serum potassium concentration was 4.9 +/- 0.7 mmol/l in group I and 4.8 +/- 0.5 mmol/l in group II (n.s.). The concentration of magnesium was significantly lower in the potassium chloride substitution group (1.48 mmol/l) compared to the other group (2.33 mmol/l) (p < 0.05). No significant differences in cardiac electric activity were observed between the two groups. The incidence of ventricular fibrillation in the early reperfusion period was 37% versus 45% (n. s.). In both groups patients with a potassium value of < 4.5 mmol/l showed a significantly higher incidence of ventricular fibrillation. Five percent of the patients had bradycardia requiring temporary pacing.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Potassium substitution during coronary surgery: K(+)-Mg+(+)-aspartate-complex (Inzolen) versus potassium chloride]. 829 48

From March 1991 through July 1992, 1,001 patients having elective coronary artery bypass grafting were randomized to receive either continuous warm (> or = 35 degrees C) blood cardioplegia with systemic normothermia (> or = 35 degrees C) or intermittent cold (< or = 8 degrees C) oxygenated crystalloid cardioplegia and moderate systemic hypothermia (< or = 28 degrees C). Preoperative variables including age, sex, prior coronary bypass grafting, hypertension, prior myocardial infarction, diabetes, angina class, and preoperative heart failure class were similar in both groups, as were the intraoperative variables of number of coronary grafts, mammary artery use, and cardiopulmonary bypass time. Aortic cross-clamp time was significantly longer in the warm group (46 +/- 23 minutes versus 40 +/- 21 minutes). Most postoperative variables including mortality (warm, 1.0%, and cold, 1.6%), Q wave infarction (warm, 1.4%, and cold, 0.8%), and need of an intraaortic balloon pump (warm, 1.4%, and cold, 2.0%) were similar between groups. Total neurologic events (warm, 4.5%, and cold, 1.4%; p < 0.005) and perioperative strokes (warm, 3.1%, and cold, 1.0%; p < or = 0.02) were significantly higher in the warm group. Neurologic events included perioperative stroke (warm, 15 patients, and cold, 5 patients; p < 0.02), perioperative encephalopathy (warm, 2 patients, and cold, 1 patient), and delayed (> or = 3 in-hospital days) stroke (warm, 5 patients, and cold, 1 patient). All patients experiencing a stroke had a persistent neurologic deficit at the time of discharge. Encephalopathy resolved completely in all instances.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prospective, randomized trial of retrograde warm blood cardioplegia: myocardial benefit and neurologic threat. 784 93

Past over two years, thirteen cases of aortic arch aneurysm, including 5 proximal arch aneurysms, 5 transverse arch aneurysms and 3 distal arch aneurysms, were operated under retrograde cerebral perfusion with deep hypothermia. In the operation, tympanic temperature, rectal temperature and SEP were monitored. When the rectal temperature fell to 20 degrees C, circulatory arrest was done and retrograde cerebral perfusion was started through SVC venous cannula, at the rate of 200-300 ml/min. During cerebral perfusion, PGE1, Mannitol, Solumedrol were administered and defroxamine as radical scavenger was injected before reperfusion for protection of the brain edema. The duration of retrograde cerebral perfusion was from 28 min to 67 min. (mean 42.8 min). In the retrograde cerebral perfusion, cerebral embolization was prevented and good operative field without cannulation was obtained. Of 13 patients, 3 patients were died of intraoperative myocardial infarction and acute renal failure. Ten patients were alive and recovery of consciousness was complete. In conclusion, retrograde cerebral perfusion method is very simple and useful for the operation of aortic arch aneurysm.
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PMID:[Retrograde cerebral perfusion with circulator arrest for aortic arch aneurysm]. 837 29

Supraventricular tachyarrhythmias following coronary artery bypass grafting are a common cause of postoperative morbidity, with a reported incidence of 10-40%. Two techniques of myocardial protection were assessed to determine their influence on the occurrence of postoperative supraventricular tachyarrhythmias. Group I (n = 82) received cold potassium cardioplegia combined with topical hypothermia and systemic cooling to 28 degrees C. Group II (n = 88) were protected by intermittent aortic cross-clamping with a systemic temperature of 32 degrees C. The overall incidence of atrial fibrillation/flutter was 22.3%. No significant difference was detected in the incidence of clinically important atrial fibrillation/flutter between the two groups [21/82 (25.6%) in group I versus 17/88 (19.3%) in group II, P > 0.25]. There was a positive association with age: in patients over 60 years the incidence of arrhythmias (31.8%) was significantly greater than in those less than 60 years (12.9%), P < 0.01. Sex, cardiopulmonary bypass times, aortic cross-clamp times, number of coronary grafts, end-operative creatine kinase myocardial band isoenzyme, right coronary endarterectomy and perioperative myocardial infarction had no association with the occurrence of postoperative atrial tachyarrhythmias.
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PMID:Atrial fibrillation after coronary artery bypass grafting: a comparison of cardioplegia versus intermittent aortic cross-clamping. 843 Dec 98

Systemic hypothermia is used almost universally in cardiac surgery. Since 1987, 2817 patients have had normothermic cardiopulmonary bypass (NCPB, "warm body", bladder temperature 36 degrees C) with cold blood cardioplegic arrest ("cold heart", 8 degrees-14 degrees C) during open heart surgery. No patients were denied this technique regardless of age, condition or severity of surgery. Clinical Characteristics in Patients: Age range: 16-84 years, mean 66; male/female ratio 3:1; pump time (min) 24-183, mean 91; cross-clamp time (min) 15-148, mean 68; types of surgery: coronary artery bypass (n = 2214), valvular (n = 489) and miscellaneous (aneurysms, tumors, arrhythmias, congenital, etc) (n = 114). One thousand and sixty-nine (1069) patients had urgent coronary artery bypass grafting (CABG). The ejection fraction was less than 0.40 in 843 patients (30%). The thirty-day operative mortality for the entire group was 1.7% (48/2817 patients): CABG = 1% (23/2214 patients), valvular = 3% (15/489 patients) and miscellaneous 9% (10/114 patients). Postoperative complications were: perioperative myocardial infarction (34 patients) = 1.2%, postoperative bleeding requiring reexploration (37 patients) = 1.3%, stroke (27 patients) = 1%, and mediastinal infection (21 patients) = 0.7%. During NCPB (WARM) systemic vascular resistance was extremely low, cardiac output was high and it was easier to wean patients from the pump. No intraaortic balloon pump was used during this period. Pulmonary complications and coagulopathy were extremely rare. These results provide reassurance that NCPB (WARM) in combination with cold cardioplegic arrest provides excellent myocardial and total body protection during cardiac surgery and is particularly suitable for high-risk patients.
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PMID:Warm body, cold heart surgery. Clinical experience in 2817 patients. 851 49

Normothermic versus hypothermic cardiopulmonary bypass was evaluated in 1442 consecutive patients undergoing primary coronary artery bypass grafting (CABG). Group 1 (n = 545) were operated on in moderate systemic hypothermia (rectal temperature 28 degrees C) and group 2 (n = 897) in normothermia (rectal temperature 37 degrees C). Both groups had cold cardioplegic arrest (10 degrees C) and local cooling of the heart with slush. Anaesthesia and operative techniques were identical in both groups. The mean age was 60 years; group 2 contained significantly more patients aged > 65 years (P < 0.05) and had more frequent emergency operations (P < 0.001) than group 1. Other preoperative patient characteristics were similar between groups. Aortic cross-clamping time was similar in both groups but cardiopulmonary bypass time was significantly longer in group 1 than in group 2 (97.9(28.8) versus 76.6(26.0) min, P < 0.001). Perioperative mortality rate was 3.3% in group 1 and 2.6% in group 2. The incidence of myocardial infarction was significantly higher in group 1 than in group 2 (2.0% versus 0.7%) Perioperative low cardiac output needing inotropic support was similar in both groups, but group 1 patients required more intra-aortic balloon insertions (4.6% versus 2.2%, P < 0.05). Lower incidence of postoperative ventricular arrhythmias, shorter intubation time and less transient renal failures were significant in group 2 compared with those in group 1 (P < 0.001), while re-exploration of bleeding, wound infections, pulmonary, neurological and gastrointestinal complications did not differ. Blood transfusion was less in group 2 (1.2(1.1) units, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Normothermic versus hypothermic perfusion during primary coronary artery bypass grafting. 857 37

From January 1984 to May 1994, 17 of 239 children under 15 years old stung by Tityus serrulatus (15.1%) or Tityus bahiensis (84.9%) presented severe envenoming. Of these 17 patients (1-11 years old; median = 2 yr) 14 were stung by T. serrulatus and three by T. bahiensis. All of them received scorpion antivenom i.v. at times ranging from 45 min. to 5 h after the accident (median = 2 h). On admission, the main clinical manifestations and laboratory and electrocardiographic changes were: vomiting (17), diaphoresis (15), tachycardia (14), prostration (10), tachypnea (8), arterial hypertension (7), arterial hypotension (5), tremors (5), hypothermia (4), hyperglycemia (17), leukocytosis (16/16), hypokalemia (13/17), increased CK-MB enzyme activity (> 6% of the total CK, 11/12), hyperamylasemia (11/14), sinusal tachycardia (16/17) and a myocardial infarction-like pattern (11/17). Six patients stung by T. serrulatus had depressed left ventricular systolic function assessed by means of echocardiography. Of these, five presented pulmonary edema and four had shock. A child aged two-years old presented severe respiratory failure and died 65 h after being stung by T. serrulatus. Severe envenomations caused by T. serrulatus were 26.2 times more frequent than those caused by T. bahiensis (p < 0.001).
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PMID:A comparative study of severe scorpion envenomation in children caused by Tityus bahiensis and Tityus serrulatus. 859 62

The management of patients with coexisting severe carotid and coronary artery disease continues to be controversial. To evaluate the actual risks we have reviewed our experience of 92 patients that underwent simultaneous cardiac surgery and carotid thrombendarterectomy (TEA) over a 10 year period. The mean age was 65 +/- 7 year (41-80), 75% were men. There were 11 REDO cardiac procedures. There were 15 symptomatic and 77 asymptomatic carotid artery stenosis, including 21 with bilateral carotid disease. Mean preop.LVEF was 57.4% (15-80%). Carotid TEA was performed under hypothermia (26 degrees C), preferably with beating heart after an equilibration period of 10 min. The overall mortality was 5.4% (5 patients). 4 of the deaths were reoperative cardiac surgery. Non-fatal myocardial infarction occurred in 1 patient. Postop. neurological complications were diagnosed in 7 patients (8%), 3 transient and 4 permanent neurological deficits occurred. 33 patients had no post-operative complications at all and 25 patients had as only complication, transient arrhythmia. Follow-up revealed a 5-year survival rate of 83% and a cardiac event-free survival of 70%, without neurological events. We therefore conclude that simultaneous carotid TEA and cardiac surgery can be performed using controlled hypothermic cardiopulmonary bypass (26 degrees C), in experienced hands, with an acceptable mortality (5.4%) and low morbidity. Carotid TEA combined with two or more cardiac procedures has the highest mortality and morbidity and should be avoided.
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PMID:[Should heart surgery and thromboendarterectomy of the carotid artery be done simultaneously?]. 865 69

To compare the safety and efficacy of coronary artery bypass grafting without using extracorporeal circulation with standard cardiopulmonary bypass technique, based on certain early postoperative criteria, we designed a fully randomized and prospective study on two similar groups of 25 patients (off-pump and on-pump groups). The groups were compared for hemodynamic data (cardiac index, systemic vascular resistance, left- and right-ventricular stroke-work indices, inotropic and mechanical support needs) and enzyme levels (CK-MB and SGOT), as well as mortality, perioperative infarction rate, homologous transfusion requirements, and the symptomatology in the first follow-ups. There was no mortality or perioperative myocardial infarction in either group. Inotropic (25% vs. 4%) and mechanical (4% vs. 0) support requirements and homologous blood consumption (percentages of patients that needed no transfusion: 20% vs. 72%) were greater in the on-pump group. Results were otherwise similar. It is concluded that, in technically suitable cases, off-pump coronary artery bypass surgery is as safe and efficient as the standard on-pump technique and can be used in particular when cannulation, hypothermia, or cardiopulmonary bypass must be avoided. With these properties, this technique could take an important place in the cardiac surgeon's armamentarium.
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PMID:Comparison of the early results of coronary artery bypass grafting with and without extracorporeal circulation. 877 56


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