Hypothermia with heparin-coated circuits and low dose systemic heparinization in neurosurgery.
The purpose of this study was to evaluate the safety of profound hypothermic circulatory arrest with heparin-coated circuits and low dose systemic heparinization in the treatment of cerebral aneurysms. Surgery for giant intracranial aneurysms not operable using standard neurosurgical techniques was performed in 8 patients. All patients were placed on cardiopulmonary bypass using the closed-chest technique, except for the first patient who underwent open-chest bypass. Heparin was administered systemically (3,000 IU) and into the circuit (1,500 IU). Total circulatory arrest was begun at 20 degrees C. The D-dimer, alpha2 plasmin inhibitor-plasmin complex, thrombin-antithrombin III, and beta-thromboglobulin concentrations were measured to evaluate the changes in the coagulation and fibrinolytic systems during bypass. There were no neurologic or cardiac complications. None of the indicators of platelet activation, coagulation, or fibrinolysis were elevated. Hypothermic circulatory arrest combined with heparin-coated circuits and low dose systemic heparinization is safe for use in neurosurgery.
Hachiro
Yoshikazu
Y
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan. hachiro@rf6.so-net.ne.jp
Morishita
Kiyofumi
K
Koshima
Ryuji
R
Nakashima
Shinji
S
Takagi
Nobuyuki
N
Tsukamoto
Masaru
M
Abe
Tomio
T
Hashi
Kazuo
K
D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D020099:Coated Materials, Biocompatible / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects* / Q000379:methods*; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000379:methods*; D002532:Intracranial Aneurysm / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D017063:Outcome Assessment, Health Care; D013997:Time Factors
D020099:Coated Materials, Biocompatible; D006493:Heparin