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Systemic and cerebral haemodynamics during craniotomy under mild hypothermia in patients with acute subarachnoid haemorrhage.

Abstract：

BACKGROUND:Mild hypothermia provides cerebral protection against ischaemic insults in various animal models. We compared systemic and cerebral oxygenation between mild hypothermic and normothermic management in 60 patients with acute subarachnoid haemorrhage who underwent clipping of cerebral aneurysms. METHOD:The temperature in the pulmonary artery was maintained at 36 degrees C in 28 patients and was reduced to 34 degrees C in 32 patients. Parameters in the systemic and cerebral haemodynamics from pulmonary artery and internal jugular vein catheters were compared between the two groups immediately after the induction of anaesthesia (TI). and just before temporary occlusion or aneurysm clipping (T2). FINDINGS:Cardiac index, oxygen delivery index, oxygen consumption index, and oxygen saturation of the jugular bulb were significantly lower at T2 in hypothermic group (H) (2.9 +/- 0.6 L/min/m2, 400.8 +/- 106.3 ml/min x m2, 87.0 +/- 14.8 ml/min x m2, 55.2 +/- 6.6%, respectively) than normothermic group (N) (3.7 +/- 0.6, 521.0 +/- 105.5, 109.9 +/- 21.7, 60.9 +/- 6.6) (p < 0.05). The arterial lactate and arteriojugular difference in oxygen content were significantly higher in H (2.3 +/- 1.3 mmol/L, 6.5 +/- 1.5 ml/dl, respectively) than in N (1.7 +/- 1.0, 5.6 +/- 1.2) (p < 0.05). Arteriojugular differences in carbon dioxide tension and hydrogen ion content were significantly lower at T2 in H (-10.8 +/- 2.1 mm Hg, -6.4 +/- 1.3 nmol/L, respectively) than in N (-8.9 +/- 2.8, -5.3 +/- 1.0) (p < 0.05). INTERPRETATION:The balance between oxygen supply and demand systemically and in the brain may worsen during aneurysm surgery for patients with acute subarachnoid haemorrhage under mild hypothermia. Oxygenation of the brain and the whole body should be monitored closely during this surgery, and adequate circulatory assistance is recommended under mild hypothermia.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

Sato K,Sato K,Yoshimoto T

doi

10.1007/s007010070056

subject

Has Abstract

pub_date

2000-01-01 00:00:00

pages

1013-9; discussion 1019-20

issue

eissn

0001-6268

issn

0942-0940

journal_volume

142

pub_type

杂志文章

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Systemic and cerebral haemodynamics during craniotomy under mild hypothermia in patients with acute subarachnoid haemorrhage.