CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by McCONNELL, J. A.
Right arrow Articles by GRAVES, H. B.
Right arrow Search for Related Content
PubMed
Right arrow Articles by McCONNELL, J. A.
Right arrow Articles by GRAVES, H. B.

Canadian Journal of Anesthesia, Vol 10, 5-17, Copyright © 1963 by Canadian Anesthesiologists' Society

The Value of Hypothermia in Surgery of the Abdominal Aorta

J. A. McCONNELL M.D., W. A. DODDS M.D.1, and H. B. GRAVES M.D., C.M.2

1 Clinical Assistant Professor, Department of Surgery, Sub-section Anaesthesia, University of British Columbia Medical School
2 Clinical Associate Professor, Department of Surgery, Sub-section Anaesthesia, University of British Columbia Medical School

A retrospective analysis was made of 113 operations involving clamping of the abdominal aorta for aneurysms or thrombosis and the results of 54 operations under induced hypothermia are compared with 59 operations under ordinary operating room conditions. The two groups are shown to be comparable as to age and sex distribution. Similar surgical and anaesthetic techniques were, used. Supportive blood transfusions, used in every case, averaged 500 c.c. more in the hypothermia group. Only 3 cases in the hypothermia group were cooled to less than the recommended 27° C. (81° F.). Cardiac arrhythmias were recorded in 7 hypothermia patients and 1 normothermia patient. One cardiac arrest occurred in the hypothermia group.

Complications occurring during the hospital stay were comparable except for an increased incidence of prolonged postoperative hypotension and of pulmonary complications in the hypothermia group. There was no proof of a protective effect of hypothermia in respect to the incidence of oliguria, and in all the cases, serious oliguria was uncommon. The death rates were comparable except for those with ruptured aneurysms, both operative and late deaths being higher in the normothermia group. An attempt has been made to explain this difference.

Consideration is given as to the use of hypothermia in other centres and to the pertinent literature regarding anaesthetic problems encountered in these challenging operative procedures. Factors associated with hypotension are reviewed as well as those relating to postoperative depression of renal function.

Considering the lack of convincing benefit in our series, the known untoward effects, and the available evidence that it is not beneficial in haemorrhagic shock, it is recommended that induced hypothermia not be used in operations requiring cross-clamping of the abdominal aorta below the renal arteries and that Mannitol should be seriously considered in doses adjusted to measured urine output. Hypothermia is felt to have a place if occlusion of the renal arteries is contemplated.

The oesophageal temperature should be monitored and a warming blanket used in instances of inadvertent hypothermia of less than 32° C. (90° F.). The use of pneumatic tourniquets on the upper thighs should be considered for control of blood flow to the legs at the critical time of release of the aortic clamps.

Note:

From the Department of Anaesthesiology, The Vancouver General Hospital, and the Medical Faculty, University of British Columbia.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1963 by the Canadian Anesthesiologists' Society.