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

In a prospective study, patients who had an ejection fraction of 40% or more and who were undergoing elective coronary artery operation were randomly divided into three groups that differed in the method of anaerobic substrate enhancement during cardiopulmonary bypass. Group 1, the controls (n = 157), received no additional glucose, insulin, and potassium solutions and experienced immediate spontaneous defibrillation (10%), transmural myocardial infarction (10.3%), malignant ventricular arrhythmias (26%), and severe atrial arrhythmias (20%). Group 2 (n = 120) received a bolus of hypertonic glucose, insulin, and potassium in the pump perfusate before aortic cross-clamping. In this group, the rate of spontaneous defibrillation was 41%, of transmural infarction, 8.3%, of malignant ventricular arrhythmias, 31%, and of severe atrial arrhythmias, 19%. Group 3 (n = 114) had the aortic root continuously infused with glucose, insulin, and potassium solution at 4 degrees C during aortic cross-clamping. This group was significantly improved; the rate of spontaneous defibrillation was 60%, there were no transmural myocardial infarctions and the incidence of severe atrial arrhythmias was 6% and that of malignant ventricular arrhythmias, 5%. It is proposed that the superior clinical results in Group 3 resulted from better myocardial preservation achieved by more efficient means of providing continuous anaerobic substrate, coronary washout, and elution of lactic acidosis, uniform global hypothermia, and direct supplemental myocardial potassium in addition to mere cardioplegic effects.
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PMID:Reduction of intraoperative myocardial infarction by means of exogenous anaerobic substrate enhancement: prospective randomized study. 31 65

Extracorporeal circulation has been reported to produce abnormalities of glucose, metabolism. Pancreatic endocrine function and peripheral glucose utilisation were studied in 11 nondiabetic patients who underwent myocardial revascularization. Nonpulsatile flow with hemodilution and moderate hypothermia to 28 degrees C were used in each case. Following the onset of cardiopulmonary bypass, serum glucose values rose rapidly to a mean of 972 mg/dl (54.0 mmol/l) and were associated with high circulating concentrations of insulin in the range of 216 microU/ml [1549.8 pmol/l]. High circulating concentrations for both insulin and glucose were maintained throughout the bypass period. These returned to normal postoperatively when the patient was in the recovery room. The results of this study indicate that both the pancreatic endocrine response and the peripheral utilization of glucose are impaired during cardiopulmonary bypass with hemodilution and moderate hypothermia to 28 degrees C.
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PMID:Effect of cardiopulmonary bypass and hypothermia on pancreatic endocrine function and peripheral utilization of glucose. 37 70

The effect of glucose on the release of insulin from the pancreas of 19.5- to 21.5-day-old rat fetuses has been studied in utero. Fetal hyperglycemia was induced by a square-wave glucose infusion into pregnant rats over a period of 150 min. The infusion of glucose raised the fetal blood glucose concentration to that of the mother and induced a rapid increase of plasma insulin levels on day 19.5 of gestation. There was a progressive rise of the insulin response as the gestation proceeded, with an increase of the two phases of the hormonal secretion. Maternal hypothermia induced by pentobarbital anesthesia decreased markedly the insulin response to hyperglycemia in the mothers and their fetuses. In fetuses decapitated on day 18.5 and studied on day 21.5, the increase of plasma insulin concentration after a 1-hour hyperglycemia was similar to that in the littermate control fetuses.
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PMID:Dynamics of glucose-induced plasma insulin increase in the rat fetus at different stages of gestation. Effects of maternal hypothermia and fetal decapitation. 38 63

Hemodynamic and metabolic effects of a lethal 5-hour infusion of Ps. aeruginosa at a dose 10(8) organisms per ml per min were studied in 39 dogs. Blood glucose, insulin, catecholamines, body temperature, WBC, and hemodynamic parameters were measured before and at 1-hour intervals during controlled bacterial infusions. Induced bacteremia in the upper 10(4) range per ml of blood was accompanied by a decline of mean arterial blood presure from 130+/-6 mm Hg to 84+/-12 mm Hg at 4 hours, hypothermia, leukopenia, and hypoglycemia. Death within 24 hours was associated with hypoinsulinemia and increased blood catecholamines. Survival was characterized by maintenance of arterial blood pressure, only moderate decline in blood glucose levels, and normal plasma insulin concentrations with little change in plasma catecholamines. Mortality could be reduced significantly by glucose administration. This was associated with correction of hypoglycemia, rise in plasma insulin activity and increased energy production.
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PMID:Metabolic effects of experimental bacteremia. 40 94

Plasma lipids, blood glucose, plasma insulin (IRI) and serum dopamine-beta-hydroxylase (DBH) were measured in 30 subjects undergoing surface-induced deep hypothermia with circulatory arrest for open-heart surgery. Non-esterified fatty acid (NEFA) in the plasma rapidly increased at the lowest temperature (23 degrees C) reached and other lipids in the plasma decreased during the cooling period. An increase of NEFA and a decrease of triglyceride have been attributed to the action of lipoprotein lipase activity stimulated by heparin. It is also likely that the decrease of other lipids and beta-lipoprotein in the plasma results from the transient hypofunction of the liver due to hypothermia. Blood glucose increased during the cooling period, while plasma insulin showed no significant change. Serum DBH reflecting catecholamine also showed no significant change during the cooling or rewarming periods. Therefore, hyperglycemia in hypothermic open-heart surgery may result from the decrease of peripheral utilization of glucose and from the inhibition of insulin secretion due to the transient pancreatic hypofunction.
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PMID:Studies on lipid and carbohydrate metabolism during surface-induced deep hypothermia with circulatory arrest for open-heart surgery. 60 91

To evaluate the importance of time, temperature, and cardioplegia on the ability of the canine myocardium to maintain functional and ultrastructural integrity following induced arrest, we studied 220 dogs by varying myocardial temperature (34 degrees, 24 degrees, and 11 degrees C.), arrest time (0 to 120 minutes), and cardioplegic agents. Change in left ventricular function (LVF) was defined as the arithmetic difference in the center of mass between prearrest and postarrest LVF curves and was expressed as percent recovery of left ventricular stroke work. Left ventricular biopsies were obtained for semiquantitative electron microscopic analysis. After 90 minutes of cross-clamping, only hearts protected with combined hypothermia (H) and potassium-induced cardioplegia (K) significantly recovered prearrest function (24 degrees C.--80 percent, 11 degrees C.--99 percent). Hypothermia (H) alone for 90 minutes was less protective (24 degrees C.--49 percent, 11 degrees C.--59 percent). H preserved 84 percent of function after 60 minutes and 91 percent after 45 minutes. Normothermic arrest resulted in only 39 percent return of function at 45 minutes but could be extended with potassium-induced cardioplegia(K) to 78 percent at 60 minutes and 54 percent at 90 minutes. The addition of procaine plus HK improved protection over HK alone (95 percent versus 80 percent) but by itself was not effective. Neither hydrocortisone nor pretreatment with glucose-insulin-potassium, branched chain amino acids, or propranolol increased the protective effect of HK plus procaine. Inadequately protected groups (normothermia or H without K) showed more myocytic and capillary endothelial damage than the HK groups. No technique of myocardial protection studied completely preserved LVF, but the combination of HK plus procaine resulted in maximal recovery of LVF following cross-clamping for up to 120 minutes.
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PMID:Effect of cross-clamp time, temperature, and cardioplegic agents on myocardial function after induced arrest. 70 64

Diabetic ketoacidosis may be associated with a wide variety of complications, some of which are uncommon and not widely appreciated. A case of severe ketoacidosis with multiple complications including septicaemia, pneumomediastinum, gastro-intestinal haemorrhage, magnesium depletion and multiple mononeuropathy is reported in a 17-year old girl who made a successful recovery. The patient had not taken insulin for almost 4 days, had no preceding illness and was admitted in a near moribund state with hypothermia (34.2 degrees C), hypotension (80/50) and an arterial pH less than 6.8. There was a leukocytosis 41,200, the blood culture grew haemolytic streptococci and chest radiology showed pneumomediastinum. I.v. therapy was continued for some days and the patient developed clinical features of magnesium depletion. During the recovery period she developed multiple mononeuropathy. A brief review of these complications is given.
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PMID:Multiple complications in severe diabetic ketoacidosis. A short review of the literature. 82 Dec 84

Carbohydrate and lipid metabolism was studied in 8 patients who underwent open-heart surgery with the aid of extracorporeal circulation. Hyperglycemia was observed during perfusion. Despite the high glucose levels during perfusion, insulin responses were depressed. A rise of insulin levels was observed one hour after perfusion, and at the same time the glucose levels dropped. Suppression of insulin secretion during perfusion may be the result of increased catecholamine secretion, induced hypothermia, or heparin administration. High levels of non-esterified fatty acids (NEFA) and low levels of triglycerides were observed immediately before, during, and after perfusion while heparin was being utilized. This phenomenon was considered to be strongly affected by the use of heparin. The levels of growth hormone were depressed during perfusion but significantly elevated one hour after the end of perfusion. These phenomena may be caused by the fluctuations in glucose and NEFA levels.
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PMID:Carbohydrate and lipid metabolism in open-heart surgery. 83 44

The concentrations of blood glucose, serum insulin, free fatty acids, and triglycerides were examined preoperatively, during anesthesia, during extracorporeal circulation, and during the following 3 postoperative days in 29 patients. The patients were divided into three groups according to the duration of extracorporeal circulation and the use of hypothermia: short perfusion group (SPG, bypass time shorter than 60 minutes, 15 patients), long perfusion group in normothermia (LPGN, bypass time longer than 60 minutes, 8 patients), and long perfusion group in hypothermia (LPGH, temperature during bypass below 33 degrees C., 6 patients). In all three groups, the concentrations of free fatty acids and blood glucose rose significantly because of anesthesia (p less than 0.001). After cardiopulmonary bypass, the concentrations of free fatty acids diminished significantly. The blood glucose remained at high level until the second postoperative day and was significantly higher in the LPG than in the SPG (p less than 0.05). The serum insulin level remained low during anesthesia and extracorporeal circulation in the SPG and LPGH but rose during the postoperative period; the maximal values were recorded on the first postoperative day. There were no significant differences between the groups with regard to serum insulin during the study. These changes and their metabolic background are discussed.
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PMID:Effects of open-heart surgery on carbohydrate and lipid metabolism. 85 Apr 24

The variations of plasma glucose and insulin levels were studied during the course of deep hypothermia with cardiocirculatory arrest of 60 minutes in 3 experimental groups of dogs using a pump mixture of homologous blood and Ringer's lactate solution at 33%, 50%, and 100% hemodilution. Insulin levels decreased in all groups during the cooling period and remained stable throughout the rest of the experiments, showing a slight significant increase only at the end of rewarming after a temperature of 30 degrees C was reached. Glucose levels reacted similarly except during rewarming, where an important increase in glucose concentration greatly preceded the rise in insulin. We stress the importance of this dissociation in view of the possible clinical implications that may exist.
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PMID:Plasma levels of glucose and insulin during deep hypothermia with varying degrees of hemodilution in dogs. 86 70


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