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

The purpose of this study was to investigate the effect of N-acetylcysteine (NAC) on spinal cord ischemia-reperfusion (I-R) in rabbits. Thirty rabbits were divided into five equal groups, group I (sham-operated, no I-R), group II (control, only I-R), group III (I-R+NAC), group IV (I-R+hypothermia), group V (I-R+NAC+hypothermia). Spinal cord ischemia was induced by clamping the aorta both below the left renal artery and above the aortic bifurcation. Forty-eight hours postoperatively, the motor function of the lower limbs was evaluated in each animal according to Tarlov Score. Spinal cord samples were taken to evaluate the histopathological changes. The sham-operated rabbits (group I) showed no neurologic deficit (Score=4). Paraplegia (Score=0) developed in all rabbits in the control group (group II). Administration of 50 mg/kg of NAC (group III) resulted in significant reduction of motor dysfunction (Score=3.1+/-1.3, p=0.002). Application of hypothermia alone (group IV) showed significant recovery of motor functions (Score=3.0+/-1.1, p=0.002), and combination of hypothermia and 50 mg/kg of NAC (group V) showed complete recovery of lower limb motor function (Score=4, p=0.001). Histologic examination of the spinal cord in rabbits with paraplegia revealed several injured neurons. The cords of animals with no motor function deficits showed only minimal cellular infiltrates in the gray matter, and there was good preservation of nerve cells. NAC showed protective effects of the spinal cord. Moderate hypothermia alone also showed protective effects. Combined use of NAC and hypothermia resulted in highly significant recovery of spinal cord function.
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PMID:Neuroprotective effect of N-acetylcysteine and hypothermia on the spinal cord ischemia-reperfusion injury. 1295 48

Each year in the Unites States there are over 10,000 new cases of para- and quadriplegia, and more than 100,000 cases of limited, but permanent, neurological losses. Many of these losses result from blunt trauma and ischemia to the spinal cord which leads to neuron death. Although blunt trauma directly kills neurons due to the physical trauma, over the subsequent 48 hours an even larger population of neurons dies due to secondary causes. One of leading triggers of this neuron death is ischemia due to the disruption of the blood circulation. Selective, but unavoidable, spinal cord ischemia occurs during thoracoabdominal surgery to repair aortic aneurysms. This ischemia leads to neuron death, functional neurological loss, and paraplegia in up to 33% of the cases. Thus, both blunt trauma and induced ischemia have similar triggers of neuron death. To reduce the neurological losses resulting from ischemia mechanisms must be found to make spinal neurons more tolerant to ischemic insult and other secondary causes of neuron death. In this review we discuss mechanisms being developed, predominantly using animal models, to provide neuroprotection to prevent neurological losses following blunt trauma and during induced spinal cord ischemia. In parallel, our own experiments are looking at neuroprotective techniques using adult human neurons. We believe the optimal neuroprotective approach will involve the perfusion of the ischemic region of the spinal cord with a hypothermia solution containing a combination of pharmacological agents.
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PMID:Neuroprotection of spinal neurons against blunt trauma and ischemia. 1461 55

This study evaluates the effectiveness and potential complications of stent-grafting for the treatment of distal arch aneurysms using profound hypothermia and circulatory arrest with retrograde cerebral perfusion. Between December 1998 and December 2001, 9 consecutive patients with a distal arch aneurysm (6 men and 3 women, mean age 71 years) underwent surgical repair using a stent-graft. Profound hypothermic circulatory arrest and retrograde cerebral perfusion were performed in all patients. Endovascular leakage was screened postoperatively using three-dimensional computerized tomography. The mean follow-up period was 27.4 months. Thirty day mortality was 0%. One patient died 3 months after stent-grafting due to proximal leakage into her aneurysm. The mean postoperative extubation period was 2.1 days. No patients suffered cerebral infarction or paraplegia. Although preliminary outcomes using this technique were good, endovascular leakage is a concern. We suggest that, if major proximal leakage is recognized postoperatively, re-intervention should be performed as soon as possible. Endovascular stent-grafting appears to be a good alternative treatment for distal arch aneurysms, although longer follow-up is necessary to more comprehensively evaluate this procedure.
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PMID:Surgical repair of a distal arch aneurysm with a stent-graft. 1468 Oct 95

Twenty-four consecutive patients underwent epidural cooling as an adjunct to elective thoracoabdominal aortic repair under moderate systemic hypothermia. One patient suffered from postoperative paraplegia (4%), and another died from subarachnoidal hemorrhage (4%). Details of the technique, the associated care, and the pitfalls will be discussed.
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PMID:Safety and efficacy of epidural cooling for regional spinal cord hypothermia during thoracoabdominal aneurysm repair. 1469 Jul 49

Hypothermic cardiopulmonary bypass, usually in combination with an interval of circulatory arrest, was used for the treatment of 211 patients with extensive thoracic or thoracoabdominal aortic disease during a 17-year interval. Profound hypothermia, distal perfusion, and intravenous methylprednisolone and thiopental were used for neuroprotection. No other technique or other adjunctive agents were used. The 30-day mortality rate was 7.1% (15 patients). It was 40% (8 of 20) for patients undergoing emergent operations for aortic rupture or acute dissection and 3.7% (7 of 191) for all other patients (P<0.001). Paraplegia occurred in 5 and paraparesis in 1 of the 205 operative survivors whose lower limb function could be assessed postoperatively (2.9%). Of the 121 survivors with thoracoabdominal aortic disease, paraplegia occurred in 1 of 38 patients with Crawford type I disease (2.6%), 2 of 49 with type II (4.1%), and 2 of 34 with type III (5.9%). Paralysis developed in 1 (1.7%) of the 58 patients who underwent aortic dissection. Renal dialysis was required in 6 (2.9%) of the 205 operative survivors, prolonged inotropic support (>48 hours) in 23 (11%), reoperation for bleeding in 10 (5%), mechanical ventilation (>48 hours) in 50 (24%), and tracheostomy in 21 (10%). Four (1.9%) patients sustained a stroke. Hypothermic cardiopulmonary bypass provides safe and substantial protection against paralysis, and renal, cardiac, and visceral organ system failure that equals or exceeds that of other currently used techniques but without the need for other adjuncts.
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PMID:Hypothermic cardiopulmonary bypass and circulatory arrest in the management of extensive thoracic and thoracoabdominal aortic aneurysms. 1471 Mar 74

Spinal cord injury such as paraparesis and paraplegia remains one of the major concerns in surgery on the thoracoabdominal aortic aneurysm (TAAA). We utilize spinal cord protection including cerebrospinal fluid drainage (CSFD), adjuncts of aortic distal perfusion, reconstruction of the intercostal or lumbar arteries and deep hypothermia in TAAA repair. This report describes the results of surgical treatment for TAAA including postoperative neurological outcome. Between October 1999 and January 2004, 33 patients (mean age 66 years; range 26 to 81) underwent TAAA repair. Adamkiewicz artery could be detected using magnetic resonance angiography in 9 patients. CSFD was done in 20 patients. TAAA repair was achieved using adjuncts of aortic distal perfusion in 31 patients (partial cardiopulmonary bypass: 19, deep hypothermia: 9, left heart bypass: 3). We tried to reconstruct the intercostal or lumbar arteries which were located between Th8 and L2 as possible. Twenty-five patients underwent reconstruction of the intercostal or lumbar arteries. There were 6 hospital deaths. Postoperative spinal cord injury occurred in 4 patients (paraparesis: 1, paraplegia: 3). This clinical experience demonstrates that current technical strategies enable patients to undergo TAAA repair with acceptable early survival. However, despite aggressive spinal cord protection, few patients suffered from postoperative spinal cord injury. Future research should focus on spinal cord protection in patients with TAAA.
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PMID:[Surgical treatment for thoracoabdominal aortic aneurysm]. 1507 66

A 62-years old man had plural aneurysms from the aortic arch to the descending aorta. Y-grafting had been performed twice for an abdominal aortic aneurysm. We performed the first operation which involved aortic valve and arch replacement under deep hypothermia with selective cerebral perfusion. During the operation, hemodynamics was stable, but after the operation he developed paraplegia due to ischemic change in the spinal cord. It was considered that the cause of the ischemia might have been the changing of the blood supply to the spinal cord. In patients with severe atherosclerosis, the blood supply for the spinal cord needs to be very strictly determined.
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PMID:[Spinal cord ischemia after surgery for arch and aortic valve replacement with elephant trunk for plural thoracic aneurysms]. 1507 68

Our objective was to investigate different cardiopulmonary bypass (CPB) techniques for thoracic aortic aneurysm retrospectively. Four hundred and eighty-eight patients with thoracic aortic aneurysm received surgical treatment. Total CPB was used routinely in 331 cases with ascending aortic aneurysm. When the aneurysm expanded to the aortic arch, brain protection was executed by adopting deep hypothermia circulatory arrest (DHCA) or DHCA combined with retrograde cerebral perfusion (RCP). Selected cerebral perfusion via carotid artery was used in three cases and separated upper and lower body perfusion in five cases. Left heart bypass was adopted for the surgeries of 157 cases with descending aortic aneurysm. In two of the cases, ventricular defibrillation could not be achieved, and then bypass was altered to separated upper and lower body perfusion to acquire satisfactory outcome. In the ascending aortic aneurysm group, DHCA time in the 17 patients was 10-63 minutes (mean 35.58 +/- 18.81 min), and DHCA +/- RCP time in 61 patients was 16-81 minutes (mean 43.43 +/- 17.91 min). Total mortality of aortic aneurysm surgery requiring full CPB was 5.4% (18/331), in which eight patients died in emergency operations. The total mortality of emergency operation was 11.9% (8/67). In the descending aortic aneurysm group, time of left heart bypass was 125.56 +/- 57.28 min, and the total mortality was 7% (11 of 157 patients). Three patients developed postoperative paraplegia. Techniques for extracorporeal circulation for surgery of the aorta are dependent on the nature of the disease and require a flexible approach to meet the specific anatomical challenge. The ability to alter the perfusion circuit to meet unexpected situations should be anticipated and planned for. In this series, we have varied our approach to perfusion techniques as required with acceptable outcome data as compared to the international literature.
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PMID:Cardiopulmonary bypass for thoracic aortic aneurysm: a report on 488 cases. 1509 37

This review presents the results of surgical repair of descending thoracic (DT) and thoracoabdominal aortic (TAA) aneurysms, using spinal drainage (SD) distal aortic perfusion (DAP), and other adjuncts intended to reduce complications. Records of patients undergoing repair of DT and TAA between 1986 and 2002 were reviewed. Elective operations were performed using single lung ventilation, invasive monitoring, SD, modest anticoagulation, permissive hypothermia (> or = 33 degrees F), liberal use of transaortic endarterectomy, and complete repair. Intercostal arteries were reimplanted when possible and DAP was used in DT and TAA types I, II, and III repair. Exceptions to this approach were noted. Some of these adjuncts were used in emergency cases. Actuarial survival was calculated. Fifty consecutive patients with DT (3) or TAA (47), type I (4), type II (16), type III (18), or type IV (9), aneurysms received elective (36) or emergency (14) repair between 1986 and 2002. Mortality was 2/36 (5.5%) in the elective group. In the emergency group, there were 2 intraoperative deaths and mortality was 4/14 (28.5%, p < 0.07). Overall survivor morbidity was 6/34 (17.6%) in elective and 7/10 (70%, p < 0.02) in emergency cases. Paraplegia occurred in one patient in the elective group (2.7%) with dissecting type II TAA aneurysm in whom the intercostal patch was sacrificed. Two of 12 initial survivors developed paraplegia in the emergency group (16.7%); one had SD but neither had DAP or intercostal reimplantation. Serious complications were associated with avoidable deviations from the approach. Five and 10-year survival for the entire series was 64.8% and 46.4%, respectively. These results parallel those in contemporary reports from centers where repair of descending and thoracoabdominal aortic aneurysm is frequently performed. Good long-term results can be achieved using spinal drainage and distal aortic perfusion, combined with other adjuncts as a means of reducing complications. When possible, the same approach should be used in emergency cases.
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PMID:Descending thoracic and thoracoabdominal aortic aneurysm repair: 15-year results using a uniform approach. 1535 36

To protect the spinal cord during thoracoabdominal aortic aneurysm repair, motor evoked potentials (MEP) monitoring and cerebrospinal fluid drainage are often employed. Herein, we report a case, where intraoperative diminishment of motor evoked potentials was accompanied by multiple cerebral infarction. A 63-year-old man underwent elective surgery for both thoracoabdominal aortic aneurysm and abdominal aortic aneurysm. He had a past history of cerebral infarction, resulting in Wernicke aphasia but no paralysis. Preoperative magnetic resonance angiography and echocardiography revealed occlusion of the intercostal and lumbar arteries, mild aortic regurgitation, and atherosclerotic lesions at the aortic arch as well as descending aorta. Anesthesia and muscular relaxation were maintained with fentanyl, propofol, and continuous administration of vecuronium at 0.5 mg x kg(-1) x h(-1). The thoracoabdominal aortic aneurysm was repaired under distal aortic perfusion with femorofemoral bypass. After terminating the bypass, we found that the MEP at the lower limb had disappeared. Although we reconstructed intercostal arteries under mild hypothermia and partial bypass, the amplitude of MEP remained very low. Suspecting spinal cord ischemia, we performed cerebrospinal fluid drainage immediately after the operation. On the postoperative day 4, when we stopped the cerebrospinal fluid drainage and propofol administration, his level of consciousness was poor and brain CT revealed multiple cerebral infarction. On the postoperative day 30, he was discharged from an intensive care unit with complications of hemiplagia and paraplegia. Although cerebrospinal fluid drainage may be recommended to protect spinal cord during thoracoabdominal aortic aneurysm repair, we should consider performing brain CT to exclude a risk of brain herniation secondary to cerebrospinal fluid drainage if there is a possibility of cerebral incidents.
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PMID:[A case report of a patient who developed hemiparaplegia with multiple cerebral infarction during thoracoabdominal aortic aneurysm repair]. 1574 19


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