Hypothermia intraoperative

In the first 2 weeks post-MI, caution is advised and careful dose titration is especially important, particularly in patients with markedly impaired ventricular function. Intraoperative and postoperative tachycardia and hypertension Do not use esmolol as the treatment for hypertension in patients in whom the increased blood pressure is primarily caused by the vasoconstriction associated with hypothermia. Renal/Hepatic function impairment Use with caution. 

Steinberg G. K., Grant G., and Yoon E. (1995) Deliberate hypothermia. In Intraoperative Neuroprotection (Andrews R., ed.), Williams Wilkins, Baltimore, pp. 65-84. 

Wenisch C., Narzt E., Sessler D. I., et al. (1996) Mild intraoperative hypothermia reduces production of reactive oxygen intermediates by polymorphonuclear leukocytes. Anesth. Analg. 82, 810-816. 

Intraoperative and Intensive Care Management of the Patient Undergoing Mild Hypothermia... 

Deliberate mild hypothermia has been shown to be an extremely effective means of neuroprotection during periods of ischemia in experimental models. Intraoperative mild hypothermia has become a standard of practice for many neurosurgeons performing complex intracranial procedures. Recent findings of neurologic benefit in prospective, randomized, controlled clinical studies of cardiac arrest patients are encouraging, but more research is required to confirm and extend these positive results to other patients with stroke and traumatic insults. Further investigation must be completed to establish the optimal time and duration when treatment should be instituted to offer the optimal protection for patients with acute ischemic and traumatic injuries. 

Heier T., Caldwell J. E., Sessler D. I., and Miller, R. D. (1991) Mild intraoperative hypothermia increases duration of action and recovery time of vecuronium blockade during nitrous oxide-isoflurane anesthesia in humans. Anesthesiology 74, 815-819. 

Discussion of intraoperative and intensive care management of hypothermia patients... 

Resurgence of Hypothermia as a Treatment for Brain Injury. The Effects of Hypothermia and Hyperthermia in Global Cerebral Ischemia. Mild Hypothermia in Experimental Focal Cerebral Ischemia. Hypothermic Protection in Traumatic Brain Injury. Postischemic Hypothermia Provides Long-Term Neuroprotection in Rodents. Combination Therapy With Hypothermia and Pharmaceuticals for the T reatment of Acute Cerebral Ischemia. Intraoperative and Intensive Care Management of the Patient Undergoing Mild Hypothermia. Management of Traumatic Brain Injury With Moderate Hypothermia. Hypothermia Clinical Experience in Stroke Patients. Hypothermia Therapy Future Directions in Research and Clinical Practice. Index. 

Hypothermia is common during anesthesia, and adversely affects outcome. It primarily results from internal redistribution of body heat from the core to the periphery. Premedication with sedative agents can affect perioperative heat loss by altering core-to-peripheral heat distribution. This has been analysed in a prospective randomized study in 45 patients undergoing arthroscopic knee ligament reconstruction surgery (47). Heavy premedication caused initial hypothermia. Moderate premedication reduced perioperative heat loss. No premedication was associated with significantly lower intraoperative core temperatures than in sedated patients. 

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