TY - JOUR
T1 - Intraoperative mild hypothermia ameliorates postoperative flow impairment in patients with aneurysmal hemorrhage
AU - Karibe, Hiroshi
AU - Sato, Kiyotaka
AU - Shimizu, Hiroaki
AU - Tominaga, Teiji
AU - Koshu, Keiji
AU - Yoshimoto, Takashi
PY - 2000
Y1 - 2000
N2 - OBJECTIVE: Intraoperative mild hypothermia has been used during cerebral aneurysm surgery to reduce ischemic injury induced by temporary vessel occlusion and brain retraction. However, the clinical effects on cerebral hemodynamics are unclear. This study investigated the effects of intraoperative mild hypothermia on cerebral blood flow (CBF) after surgery to treat aneurysmal subarachnoid hemorrhage. METHODS: Twenty-four patients with ruptured internal carotid or middle cerebral artery aneurysms, of preoperative Hunt and Hess Grade II or III, underwent aneurysm clipping within 72 hours after the onset of subarachnoid hemorrhage. During surgery, patients were randomly assigned to either intraoperative mild hypothermia (33.5°C, n = 12) or normothermia (37°C, n = 12). Brain single photon emission computed tomography with 99mTc- hexamethylpropylenamine oxime or 99mTc-L,L-ethylcysteinate dimer was performed on Days 4, 7, and 14 after subarachnoid hemorrhage. Regional CBF was determined in the basal ganglia and cingulate, frontal, and frontoparietal cortices, using a semiquantitative method. RESULTS: CBF in the frontal cortex ipsilateral to the aneurysm was significantly higher in the hypothermia group than in the normothermia group on Day 4 (P < 0.01) but not Day 7 or 14. There was a similar trend in the ipsilateral frontoparietal cortex, but it was not significant. There were no differences in regional CBF in the ipsilateral cingulate cortex or basal ganglia or in any contralateral region during the study period. CONCLUSION: Intraoperative mild hypothermia may reduce the severity of ischemia induced by intraoperative temporary vessel occlusion and brain retraction, thus ameliorating postoperative CBF: impairment.
AB - OBJECTIVE: Intraoperative mild hypothermia has been used during cerebral aneurysm surgery to reduce ischemic injury induced by temporary vessel occlusion and brain retraction. However, the clinical effects on cerebral hemodynamics are unclear. This study investigated the effects of intraoperative mild hypothermia on cerebral blood flow (CBF) after surgery to treat aneurysmal subarachnoid hemorrhage. METHODS: Twenty-four patients with ruptured internal carotid or middle cerebral artery aneurysms, of preoperative Hunt and Hess Grade II or III, underwent aneurysm clipping within 72 hours after the onset of subarachnoid hemorrhage. During surgery, patients were randomly assigned to either intraoperative mild hypothermia (33.5°C, n = 12) or normothermia (37°C, n = 12). Brain single photon emission computed tomography with 99mTc- hexamethylpropylenamine oxime or 99mTc-L,L-ethylcysteinate dimer was performed on Days 4, 7, and 14 after subarachnoid hemorrhage. Regional CBF was determined in the basal ganglia and cingulate, frontal, and frontoparietal cortices, using a semiquantitative method. RESULTS: CBF in the frontal cortex ipsilateral to the aneurysm was significantly higher in the hypothermia group than in the normothermia group on Day 4 (P < 0.01) but not Day 7 or 14. There was a similar trend in the ipsilateral frontoparietal cortex, but it was not significant. There were no differences in regional CBF in the ipsilateral cingulate cortex or basal ganglia or in any contralateral region during the study period. CONCLUSION: Intraoperative mild hypothermia may reduce the severity of ischemia induced by intraoperative temporary vessel occlusion and brain retraction, thus ameliorating postoperative CBF: impairment.
KW - Brain retraction
KW - Cerebral aneurysm
KW - Cerebral blood flow
KW - Hypothermia
KW - Subarachnoid hemorrhage Temporary vessel occlusion
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U2 - 10.1227/00006123-200009000-00012
DO - 10.1227/00006123-200009000-00012
M3 - Article
C2 - 10981746
AN - SCOPUS:0034521152
VL - 47
SP - 594
EP - 601
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 3
ER -