The management of temperature during hypothermic cardiopulmonary bypass: II--Effect of prolonged hypothermia.
In animals mild hypothermia (32-35 degrees C) reduces ischaemic brain injury, but this has not been investigated in humans. During hypothermic cardiopulmonary bypass (CPB) patients are made hypothermic (usually to 30-32 degrees C) but are then rewarmed at a time when they are still at risk of ischaemic brain injury. We investigated the feasibility and safety of maintaining mild hypothermia throughout the CPB period. Thirty adult cardiac surgical patients were randomized to either rewarming to 36-37 degrees C or to maintaining temperature at 34 degrees C without rewarming. On arrival in the recovery room, patients in the hypothermic group had a mean bladder temperature of 33.8 +/- 0.45 degrees C compared with 35.4 +/- 0.58 degrees C (mean +/- SD, P < 0.05) in the rewarmed patients. There were no differences between groups in intra- or postoperative blood loss or blood use, inotrope use, dysrhythmias, or myocardial infarction. The hypothermic group received more muscle relaxant for the treatment of shivering postoperatively. Our results suggest that mild hypothermia following CPB did not increase morbidity although larger studies are needed for confirmation.
Nathan
H J
HJ
Department of Anaesthesia, University of Ottawa Heart Institute, Ontario, Canada.
Polis
T
T
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D001831:Body Temperature; D001833:Body Temperature Regulation; D002545:Brain Ischemia / Q000209:etiology; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009305:Nasopharynx / Q000502:physiology; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D017694:Rewarming / Q000009:adverse effects; D012307:Risk Factors; D012449:Safety; D012768:Shivering / Q000187:drug effects; D013997:Time Factors; D014432:Tympanic Membrane / Q000502:physiology; D001743:Urinary Bladder / Q000502:physiology; D014673:Vecuronium Bromide / Q000008:administration & dosage
D002316:Cardiotonic Agents; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide