Hypothermia--it's more than a toy.
OBJECTIVE
Perioperative hypothermia triples the incidence of adverse myocardial outcomes in high-risk patients; it significantly increases blood loss and augments allogeneic transfusion requirements. Even mild hypothermia increases the incidence of surgical wound infection following colon resection and therefore the duration of hospitalization. Hypothermia adversely affects antibody- and cell-mediated immune defenses, as well as the oxygen availability in the peripheral wound tissues. Mild perioperative hypothermia changes the kinetics and action of various anesthetic and paralyzing agents, increases thermal discomfort, and is associated with delayed postanesthetic recovery.


RESULTS
On the other hand however, therapeutic hypothermia may be an interesting approach in various settings. Lowering core temperature to 32-34 degrees C may reduce cell injury by suppressing excitotoxins and oxygen radicals, stabilizing cell membranes, and reducing the number of abnormal electrical depolarizations. Evidence in animals indicates that even mild hypothermia provides substantial protection against cerebral ischemia and myocardial infarction. Mild hypothermia has been shown to improve outcome after cardiac arrest in humans. Randomized trials are in progress to evaluate the potential benefits of mild hypothermia during aneurysm clipping and after stroke or acute myocardial infarction.


CONCLUSIONS
This article reviews recent publications in the field of accidental as well as therapeutic hypothermia, and tries to assess what evidence is available at the present time.
Department of Anesthesiology, Bern University Hospital (Inselspital), University of Bern, Switzerland. gunther.pestel@insel.ch
Gunther J
GJ
Pestel
Andrea
A
Kurz