title: Cooling for cerebral protection during brain surgery.
abstract: BACKGROUND
  The brain is at risk of ischaemia during a variety of neurosurgical procedures, and this can lead to devastating results. Induced hypothermia is the controlled lowering of core body temperature for therapeutic purposes. This remains the current practice during neurosurgery for the prevention or minimization of ischaemic brain injury. Brain surgery may lead to severe complications due to factors such as requirement for brain retraction, vessel occlusion, and intraoperative haemorrhage. Many anaesthesiologists believe that induced hypothermia is indicated to protect the central nervous system during surgery. Although hypothermia is often used during brain surgery, clinical efficacy has not yet been established.
  
  
  OBJECTIVE
  To evaluate the effectiveness and safety of induced hypothermia versus normothermia for neuroprotection in patients undergoing brain surgery.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 10), MEDLINE, LILACS, EMBASE and Current Controlled Trials (from inception to November 2010), reference lists of identified trials, and bibliographies of published reviews. We also contacted researchers in the field. There were no language restrictions.
  
  
  METHODS
  We included randomized controlled trials and quasi-randomized controlled trials of induced hypothermia versus normothermia for neuroprotection in patients undergoing brain surgery.
  
  
  METHODS
  Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information.
  
  
  RESULTS
  We included four trials of cooling for cerebral protection during brain surgery, involving a total of 1219 patients. We did not find any evidence that hypothermia for neuroprotection in patients undergoing brain surgery is either effective or unsafe when compared to normothermia.
  
  
  CONCLUSIONS
  Although there is some evidence that mild hypothermia is safe, its effectiveness is not clear when compared with normothermia. We need to perform more clinical trials in order to establish the benefit, if any, of hypothermia for cerebral protection during brain surgery before making firm recommendations for the routine use of this intervention.
authors: Department of Anaesthesiology, Hospital Sírio Libanês, São Paulo Serviços Médicos de Anestesia, Rua Barão de Jaceguai,1062 ap. 91, São Paulo, São Paulo, Brazil, CEP: 04606-002.
authors: Wilson Roberto Oliveira
authors: WR
authors: Milani
authors: Pedro L
authors: PL
authors: Antibas
authors: Gilmar F
authors: GF
authors: Prado
mesh_terms: D001921:Brain / Q000601:surgery*; D002545:Brain Ischemia / Q000517:prevention & control*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods* / Q000401:mortality; D007431:Intraoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic