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

Clinical application of hypothermic pharmacologic cardioplegia in pediatric cardiac surgery is less than satisfactory, despite its well known benefits in adults. Protection of the ischemic immature rabbit heart with hypothermia alone is better than with hypothermic St. Thomas' II cardioplegic solution. Control of cellular calcium is a critical component of cardioplegic protection. We determined whether the existing calcium content of St. Thomas' II solution (1.2 mmol/L) is responsible for suboptimal protection of the ischemic immature rabbit heart. Modified hypothermic St. Thomas' II solutions (calcium content, 0 to 2.4 mmol/L) were compared with hypothermic Krebs bicarbonate buffer in protecting ischemic immature (7- to 10-day-old) hearts. Hearts (n = 6 per group) underwent aerobic "working" perfusion with Krebs buffer, and cardiac function was measured. The hearts were then arrested with a 3-minute infusion of either cold (14 degrees C) Krebs buffer (1.8 mmol calcium/L) as hypothermia alone or cold St. Thomas' II solution before 6 hours of hypothermic (14 degrees C) global ischemia. Hearts were reperfused, and postischemic enzyme leakage and recovery of function were measured. A bell-shaped dose-response profile for calcium was observed for recovery of aortic flow but not for creatine kinase leakage, with improved protection at lower calcium concentrations. Optimal myocardial protection occurred at a calcium content of 0.3 mmol/L, which was better than with hypothermia alone and standard St. Thomas' II solution. We conclude that the existing calcium content of St. Thomas' II solution is responsible, in part, for its damaging effect on the ischemic immature rabbit heart.
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PMID:Calcium content of St. Thomas' II cardioplegic solution damages ischemic immature myocardium. 192 65

The concentration of calcium (1.2 mmol/L) in clinical St. Thomas' Hospital cardioplegic solution was chosen several years ago after dose-response studies in the normothermic isolated heart. However, recent studies with creatine phosphate in St. Thomas' Hospital solution demonstrated that additional myocardial protection during hypothermia resulted principally from its calcium-lowering effect in the solution. The isolated working rat heart model was therefore used to establish the optimal calcium concentration in St. Thomas' Hospital solution during lengthy hypothermic ischemia (20 degrees C, 300 minutes). The calcium content of standard St. Thomas' Hospital solution was varied from 0.0 to 1.5 mmol/L in eight treatment groups (n = 6 for each group). During ischemia, hearts were exposed to multidose cardioplegia (3 minutes every 30 minutes). Postischemic recovery of function was expressed as a percentage of preischemic control values. Release of creatine kinase and the time to return of sinus rhythm during the reperfusion period were also measured. These dose-response studies during hypothermic ischemia revealed a broad range of acceptable calcium concentrations (0.3 to 0.9 mmol/L), which appear optimal in St. Thomas' Hospital solution at 0.6 mmol/L. This concentration improved the postischemic recovery of aortic flow from 22.0% +/- 5.9% with control St. Thomas' Hospital solution (calcium concentration 1.2 mmol/L) to 86.0% +/- 4.0% (p less than 0.001). Other indices of functional recovery showed similar dramatic results. Creatine kinase release was reduced 84% (p less than 0.01) in the optimal calcium group. Postischemic reperfusion arrhythmias were diminished with the loser calcium concentration, with a significant decrease in the time between initial reperfusion until the return of sinus rhythm. In contrast, acalcemic St. Thomas' Hospital solution precipitated the calcium paradox with massive enzyme release and no functional recovery. Unlike prior published calcium dose-response studies at normothermia, these results demonstrate that the optimal calcium concentration during clinically relevant hypothermic ischemia is considerably lower than that of normal serum ionized calcium (1.2 mmol/L) and appears ideal at 0.6 mmol/L to realize even greater cardioprotective and antiarrhythmic effects with St. Thomas' Hospital solution.
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PMID:Lowering the calcium concentration in St. Thomas' Hospital cardioplegic solution improves protection during hypothermic ischemia. 199 42

Eighty-six patients undergoing coronary artery bypass graft (n = 63) or intracardiac (n = 23) surgery were randomly assigned with respect to the target value for PaCO2 during cardiopulmonary bypass. In 44 patients the target PaCO2 was 40 mmHg, measured at the standard electrode temperature of 37 degrees C, while in 42 patients the target PaCO2 was 40 mmHg, corrected to the patient's rectal temperature (lowest value reached: mean 30.1, SD 1.9 degrees C). Other salient features of bypass management include use of bubble oxygenators without arterial filtration, flows of 1.8-2.4 l.min-1.m-2, mean hematocrit of 23%, and mean arterial blood pressure of approximately 70 mmHg, achieved by infusion of phenylephrine or sodium nitroprusside. Neuropsychologic function was assessed with series of tests administered on the day prior to surgery, just before discharge from the hospital (mean 8.0, SD 5.8 days postoperatively, n = 82), and again 7 months later (mean 220.7, SD 54.4 days postoperatively, n = 75). The scores at 8 days showed wide variability and generalized impairment unrelated to the PaCO2 group or to hypotension during cardiopulmonary bypass. At 7 months no significant difference was observed in neuropsychologic performance between the PaCO2 groups. Regarding cardiac outcome, there were no significant differences between groups in the appearance of new Q-waves on the electrocardiogram, the postoperative creatine kinase-MB fraction, the need for inotropic or intraaortic balloon pump support, or the length of postoperative ventilation or intensive care unit stay. These findings support the hypothesis that CO2 management during cardiopulmonary bypass at moderate hypothermia has no clinically significant effect on either neurobehavioral or cardiac outcome.
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PMID:A randomized study of carbon dioxide management during hypothermic cardiopulmonary bypass. 235 31

Organic cosolvents are used in many intramuscular formulations for solubilization of drugs and have been shown to cause skeletal muscle damage (myotoxicity). This study explored the influence of organic cosolvent-induced myotoxicity on the bioavailability of a model compound, diazepam. A tracer (C14) dose of diazepam was selected which did not elicit any systemic pharmacologic effects (viz., hypothermia and sedation) that might alter the pharmacokinetics of the drug. Male New Zealand White rabbits were injected with diazepam dissolved in three cosolvent: water mixtures (20% v/v propylene glycol, 20% v/v polyethylene glycol 400, and 50% v/v polyethylene glycol 400). These mixtures have similar physicochemical properties, but vary 10-fold in their in vitro myotoxicity. Using plasma total radioactivity following intramuscular administration of diazepam, statistical differences were not detected in the area under the curve (AUC), the peak concentration, and the time of the observed peak concentration among these treatments, although the in vivo myotoxicity of these systems (measured by the plasma creatine kinase AUC) varied by 10-fold (p less than 0.01). Limited data on unchanged diazepam levels confirmed these observations. Thus, the degree of skeletal muscle damage caused by these organic cosolvent systems does not seem to affect the bioavailability of a tracer dose of intramuscular diazepam.
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PMID:Effect of organic cosolvent-induced skeletal muscle damage on the bioavailability of intramuscular [14C]diazepam. 227 57

The effect of verapamil administered before aortic cross-clamping was assessed in 40 patients undergoing elective coronary artery bypass grafting. Myocardial protection consisted of cold blood potassium cardioplegia, topical ice slush, and moderate (28 degrees C) systemic hypothermia. Patients were randomly divided into two groups: group 1 (18 patients) received verapamil (0.1 mg/kg up to 10 mg) intravenously three to five minutes before aortic cross-clamping; group 2 (22 patients) did not (control). Myocardial injury was assessed by cumulative release of the cardiac-specific isoenzyme of creatine kinase (CK-MB) after release of the aortic cross-clamp. Release of CK-MB was significantly lower in the verapamil group (44.9 +/- 6.2 versus 72.2 +/- 9.0 IU at 24.5 hours, p = 0.005). Calculated total infarct size was also lower in the verapamil group (6.0 +/- 0.9 versus 8.9 +/- 1.0 g-Eq, p = 0.035). Individual CK-MB release curves showed either one or two peaks. The two-peak pattern was more frequent in control patients (18 of 21 control patients versus 6 of 18 verapamil patients, p = 0.001) and was associated with a larger infarct size. Atrioventricular pacing was not required in any verapamil patient, but was needed in 1 control patient. We conclude that verapamil administered before aortic cross-clamping protects against myocardial injury during coronary artery bypass grafting with no increase in the incidence of atrioventricular block.
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PMID:Reduction of myocardial injury with verapamil before aortic cross-clamping. 231 Feb 48

The potential benefit of transient hypothermic reperfusion of the ischemic myocardium was investigated in isolated working rat hearts (n = 6/group) subjected to 25 min of global ischemia at 37 degrees C. Hearts were reperfused in the Langendorff mode at 5, 10, 20, 30, or 37 degrees C for 10 min plus 5 min at 37 degrees C before assessment of functional recovery (working mode). Compared with normothermic reperfusion (recovery of cardiac output = 42.3 +/- 6.1%), transient hypothermia failed to improve the recovery of cardiac output, which was 47.9 +/- 12.7 (P = NS), 54.3 +/- 11.5 (P = NS), 25.3 +/- 2.7 (P = NS), and 6.4 +/- 3.8% (P less than 0.05) in the 30, 20, 10, and 5 degrees C groups, respectively. Reduced recovery in the 5 degrees C group was reflected in increased creatine kinase leakage from 0.26 +/- 0.04 IU.ml-1.g dry wt-1 (37 degrees C reperfusion) to 0.62 +/- 0.12 IU. ml-1.g dry wt-1 (5 degrees C reperfusion; P less than 0.05). Brief periods (3 x 1 min) of hypothermic (5 degrees C) perfusion during normothermic Langendorff reperfusion (15 min) also reduced recovery of cardiac output to 12.1 +/- 7.2% (P less than 0.01). In additional studies, hearts were subjected to a 2-min preischemic infusion with the St. Thomas' Hospital cardioplegic solution before either 25 or 35 min of normothermic ischemia and reperfusion with transient hypothermia at 5, 10, 20, or 30 degrees C. Once again hypothermic reperfusion failed to improve recovery but detrimental effects were not observed in the 5 degrees C group. These results indicate no beneficial effect of transient hypothermic reperfusion on recovery of function measured following global normothermic ischemia.
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PMID:Transient hypothermic reperfusion and postischemic recovery in isolated rat heart. 239 94

The effect of aprotinin on intraoperative and postoperative CK-MB and left ventricular contractility in terms of dp/dt response to atrial pacing up to 150 beats/min was studied in 20 patients randomized before aortocoronary bypass surgery to either aprotinin or placebo administration. Cold cardioplegia and topical deep hypothermia were used in both groups. No difference could be demonstrated between the aprotinin and the placebo group, and the authors therefore concluded that aprotinin does not add substantially to the protective effect of cold cardioplegia and deep topical hypothermia during aortocoronary bypass surgery.
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PMID:Aprotinin does not add protective effect to cold cardioplegia during coronary artery bypass surgery. 242 44

Profound hypothermia and circulatory arrest in infants and children undergoing cardiac surgery were followed by abnormally high plasma levels of creatine kinase isoenzyme BB (CK-BB). Differences in the levels of enzymes in the femoral arterial and jugular venous blood indicated that the origin of the additional enzyme was the brain. The extent of the rise in enzyme levels was related to the duration of circulatory arrest. These data suggest that measurements of the CK-BB enzyme in plasma provide quantitative information about cerebral damage during cardiac surgery.
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PMID:Serial measurement of arterial and internal jugular venous creatine kinase isoenzyme BB (CK-BB) after deep hypothermic total circulatory arrest in pediatric cardiac surgery. 242 88

Twenty-seven children with complex congenital heart malformations necessitating early repair were studied before and after deep hypothermic procedures. The children were allocated into two groups. One group underwent total circulatory arrest (40 +/- 6 minutes). In the other group perfusion was maintained during deep hypothermia but reduced a 25% of normal at normothermia. The temperature was reduced to 15 degrees C (nasopharynx) in both groups with a combination of topical and core cooling. To study cerebral injury, were made serial measurements of creatine kinase isoenzyme BB from arterial samples before and for 8 hours after the deep hypothermic procedure. Creatine kinase isoenzyme BB increased after both procedures from 4.3 +/- 0.9 ng/ml to 10.4 +/- 1.8 ng/ml in the circulatory arrest group and from 2.8 +/- 0.7 ng/ml to 9.9 +/- 1.9 ng/ml in the low-flow group (no significant difference). The results were analyzed in relation to age, size, study group, hemoglobin, blood glucose, and blood gases. The creatine kinase BB levels were positively related to preoperative hemoglobin and blood glucose values before the hypothermic procedures.
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PMID:No flow or low flow? A study of the ischemic marker creatine kinase BB after deep hypothermic procedures. 250 90

The lack of a satisfactory method for long-term preservation of hearts during transport limits the source of human hearts for transplant to the geographic vicinity of the transplant center. Experimentally, reduction of myocardial oxygen requirements with hypothermia and cardioplegia prolong storage time to 48 h, but always with some evidence of myocardial damage. In this study, the combination of hypothermia with a procedure known to increase oxygen tension in cardiac muscle, gas perfusion, preserved contractile activity in guinea pig hearts for 24 h and did not cause edema. Cardioplegia or gas perfusion at temperatures below 10 degrees C or above 20 degrees C resulted in failure of hearts to contract upon rewarming. Contracture, dehydration, elevation of tissue calcium, reduced perfusate flow, and elevated creatine kinase levels occurred if liquid reperfusion was begun at 15 degrees C but not 25 degrees C. The results suggest that under the appropriate conditions, hypothermic gas perfusion is a potentially useful means of extending storage time of hearts for transplant.
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PMID:Preservation of guinea pig hearts by hypothermic gas perfusion. 250 68


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