Skip to main content

Hypothermia..the real cost


Most anesthesiologists are aware of the adverse effects associated with mild hypothermia in the perioperative period (e.g. increased risk of wound infection, cardiac morbidity, and PACU stay). However, in the ICU population, some of whom are exposed to environmental extremes, the manifestations of hypothermia become more numerous.

Hypothermia is classified as mild (core temperature 32-35C), moderate (28-32C), and severe (< 28C), and leads to multiple physiologic derangements, including in the CNS (fatigue, ataxia, reduced gag reflex, coma, decreased EEG activity), cardiovascular system (hypovolemia [secondary to diuresis], arrhythmias [including asystole]), pulmonary system (respiratory depression, apnea, pulmonary edema), kidneys (“cold diuresis”), and immune system (immunosuppression).

The mortality rate of hypothermic patients is approximately 17% (based on a multicenter review of over 400 non-operative cases)

In 2002, two large, prospective trials demonstrated that mild hypothermia after resuscitation from cardiac arrest and maintained for 12 to 24 hours improved survival and neurologic outcome in patients suffering from VF/VT arrest [Hypothermia after Cardiac Arrest Study Group. NEJM 346: 549, 2002; Bernard SA et al; NEJM 346: 557, 2002]. Additional studies have suggested that therapeutic hypothermia may be beneficial following respiratory arrest, electrical mechanical dissociation, and asystole, provided that it is initiated within 25 minutes [Oddo M et al. Crit Care Med 36: 2296, 2008].

In 2005, the IHAST trial demonstrated that therapeutic hypothermia was safe in patients undergoing aneurysm surgery (craniotomy) but resulted in no improvement in neurologic outcome [Todd MM et al. NEJM 352: 135, 2005], thus hypothermia cannot be recommended for intraoperative neuroprotection
Labels:

Comments

Post a Comment

Popular posts from this blog

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

The 12 decision making steps for post dural puncture headache treatment

Treatment decision-making algorithm for postdural puncture headache. 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment). 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10). 3. Virtually all patients will improve in time even without additional therapy. (dashed lines) 4. Symptoms worsen or fail to resolve within 5 days. 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP). 6. In patients with severe symptoms, EBP is strongly suggested. 7. The most common pharmacologic measure is  caffeine  prescription. 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP. 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg,  dextran , saline). 10. A period of 24 h should lapse before repeating EBP. 11...
1 comment
Read more

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more