Intraoperative hypothermia during vascular neurosurgical procedures.
ABSTRACT Increasing evidence in animal models and clinical trials for stroke, hypoxic encephalopathy for children, and traumatic brain injury have shown that mild hypothermia may attenuate ischemic damage and improve neurological outcome. However, it is less clear if mild intraoperative hypothermia during vascular neurosurgical procedures results in improved outcomes for patients. This review examines the scientific evidence behind hypothermia as a treatment and discusses factors that may be important for the use of this adjuvant technique, including cooling temperature, duration of hypothermia, and rate of rewarming.
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ABSTRACT: Background: Aneurysms of the anterior circulation larger than 2 cm have a complex relationship to the anterior skull base, requiring a multi-modality management approach. This retrospective study of 54 patients with such aneurysms who underwent clipping between 2001 and 2012 analyzes clinical and surgical data, aneurysm characteristics and correlates them with respect to the Glasgow outcome score at follow-up and immediate post-operative clinical status. Methods: Patients with an outcome score of 5 or 4 were categorized as "good", while those with score 3-1 were "poor". Fisher's exact test and paired T-test (p < 0.5) were used to test statistical significance for discrete and continuous variables respectively. Results: 44 (81.4%) patients had a good outcome. Patients with non-ophthalmic/paraclinoid aneurysms had significantly lower incidence of adverse intra-operative events (p = 0.035). Patients older than 50 years (p = 0.045), with adverse intra-operative events (p = 0.015) and post-operative infarction (p < 0.001) had a poor outcome compared to those younger than 50 years age and those without adverse intra-operative events or infarctions. The grouped age variable had maximum influence on patient outcome. Location and size of aneurysm did not have an overall impact on surgical outcome. There were 4 mortalities. Conclusions: Primary clipping of proximal non-cavernous aneurysms on the internal carotid artery is associated with adverse intra-operative events. A multi-modality treatment approach in these aneurysms should be individualized, more so in patients older than 50 years.Clinical Neurology and Neurosurgery 07/2014; 122C:42-49. DOI:10.1016/j.clineuro.2014.04.012 · 1.25 Impact Factor
Critical Care 06/2012; 16(2). DOI:10.1186/cc11259 · 5.04 Impact Factor
Article: Hypothermia in the operating theatreCritical Care 06/2012; 16(2). DOI:10.1186/cc11275 · 5.04 Impact Factor