Best practice & research. Clinical anaesthesiology
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This chapter describes the incidence, mechanisms and possible consequences of hypothermia during cardiac surgery, including protection against ischaemia, alteration of the coagulation cascade and the inflammatory response. Various temperature-specific topics related to cardiac surgery are discussed, including the use of hypothermia or normothermia during cardiopulmonary bypass, and the temperature reached during rewarming at the end of cardiopulmonary bypass and its deleterious consequences for the brain (postoperative neurocognitive dysfunction). ⋯ Modern cardiac techniques, such as off-pump surgery and minimal extracorporeal circulation, and their implications for temperature preservation are discussed. Finally, a protocol is proposed that combines mild intra-operative hypothermia with peripheral active warming in order to avoid the need for fast, intense rewarming, thus avoiding the potential incidence of brain damage.
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Best Pract Res Clin Anaesthesiol · Dec 2008
ReviewThermoregulatory management for mild therapeutic hypothermia.
In recent years the use of mild therapeutic hypothermia as a means of neuroprotection has become an important concept for treatment after cerebral ischemic hypoxic injury. Mild therapeutic hypothermia has been shown to improve outcome after out-of-hospital cardiac arrest, and many studies suggest a beneficial effect of mild therapeutic hypothermia on patient outcome after traumatic brain injury, cerebrovascular damage and neonatal asphyxia. This review article explores the numerous possibilities and methods for the induction of mild therapeutic hypothermia, reviews thermoregulatory management during maintenance and discusses associated risks and complications.