Reemplazo de aorta ascendente con paro circulatorio con hipotermia sistémica moderada y perfusión cerebral retrógrada / Total replacement of the ascending aorta with moderate systemic hypothermic circulatory arrest and retrograde cerebral perfusion

Resumen: Antecedentes: El daño neurológico es una complicación devastadora de la cirugía con paro circulatorio del cayado aórtico y aorta ascendente. La perfusión anterógrada del encéfalo permite disminuir la incidencia de esta complicación, pero es un procedimiento engorroso que interfiere el campo quirúrgico. Para procedimientos más simples que requieran de paro circulatorio de menor duración, la Perfusión Cerebral Retrógrada (PCR) es una alternativa válida. Objetivo: Evaluar nuestros resultados en la cirugía del reemplazo total de la aorta ascendente tubular con paro circulatorio con hipotermia sistémica moderada y PCR. Material y Método: Entre enero de 2015 y enero de 2020 se identificaron los pacientes en la Base de Datos del Servicio de Cirugía Cardiaca de nuestra institución, se revisaron los protocolos operatorios, registros de perfusión y epicrisis, para obtener datos demográficos, clínicos y quirúrgicos pertinentes. La supervivencia alejada se certificó a través del "Servicio Registro Civil e Identificación de Chile". Resultados: En el periodo en estudio, 27 pacientes (21 hombres) tuvieron un reemplazo total de la aorta ascendente tubular con paro circulatorio con hipotermia moderada y PCR. Ocho pacientes tenían una cirugía previa; 7 de estos un reemplazo valvular aórtico. El 75% de los otros 20 pacientes tenía una válvula aórtica bicúspide. El diámetro máximo de la aorta ascendente fue en promedio 53,7 mm (45 a 67), y fue reemplazada en el 52% de los casos con un tubo protésico de 34 mm (promedio:32,4 mm; margen:30 a 34 mm). En 20 pacientes se efectuó un reemplazo valvular aórtico (15 con prótesis biológica). El tiempo promedio de circulación extracorpórea fue 174,6 min (97 a 243) y la temperatura sistémica mínima promedio fue 21ºC (18 a 25). El tiempo promedio de paro circulatorio fue 22,3 min (12 a 40) y de PCR 13 min (6 a 27). No hubo mortalidad operatoria. La morbilidad más frecuente fue la fibrilación auricular (33%). Una paciente presentó un episodio convulsivo aislado y otro fue reoperado por hemorragia postoperatoria. Una paciente falleció a los 48 meses de su operación. Conclusión: El paro circulatorio con hipotermia sistémica moderada y PCR para la cirugía de reemplazo total de la aorta ascendente facilitó la operación, con baja mortalidad y morbilidad en este grupo de pacientes.

Abstract: Background. Neurological damage is a devastating complication of aortic arch and ascending aorta surgery with deep hypothermic circulatory arrest. Antegrade cerebral perfusion significantly decreases the incidence of this complication, but it is a cumbersome procedure that interfere the surgical field. For more simple procedures, requiring a shorter period of circulatory arrest, retrograde cerebral perfusion (RCP) would be a valid alternative. Objective. To evaluate the results of total surgical replacement of the tubular ascending aorta with moderate hypothermic circulatory arrest and retrograde cerebral perfusion (RCP). Methods. Patients operated between January 2015 and January 2020 were included.Demographic, clinical and surgical information was obtained from the operatives notes, perfusion registry and discharge reports. Long-term survival was certified by the "Chilean Civil and Identification Registry". Results. 27 patients (21 men) underwent a total replacement of the tubular ascending aorta with circulatory arrest with moderate hypothermia and RCP. Eight patients had been previously operated on;7 of them had a previous aortic valve replacement. Of the remaining 20 patients, 75% had a bicuspid aortic valve. Average maximum diameter of the ascending aorta was 53.7 mm (45 - 67). Average size of the ascending aorta replacement graft was 32.4 mm (30 -34). In 20 patients a concomitant aortic valve replacement was performed (15 with a biological valve). Mean extracorporeal circulation time was 174.6 min (97 - 243) and mean minimal systemic temperature was 21ºC (18 - 25). Mean circulatory arrest time was 22.3 min (12 - 40) and mean RCP time was 13 min (6 - 27), There was no operative mortality. Atrial fibrillation was the most frequent post-operative morbidity (33%). One patient presented an isolated convulsive episode and another was re-operated due to postoperative hemorrhage. One patient died, 48 months after her operation. Conclusion. Moderate hypothermic circulatory arrest with RCP simplifies total tubular ascending aorta replacement, with low mortality and morbidity.

Aortic Arch Endarterectomy Associated with On-Pump Cardiac Surgery in Patients with a Mobile Arch Atheroma / 대한흉부외과학회지

We describe aortic arch endarterectomy performed concomitantly with on-pump cardiac surgery in 2 patients with grade V arch atherosclerosis. In both patients, transesophageal echocardiographic findings led to the diagnosis of severe arch atherosclerosis associated with a mobile atheromatous plaque in the aortic arch. The severe arch atherosclerosis was managed with endarterectomy under deep hypothermic circulatory arrest. In patients with severe grade V atherosclerosis in the aortic arch, performing endarterectomy simultaneously with primary cardiac surgery may be justified as a way to reduce the risk of peripheral embolism, including cerebrovascular accidents, with minimal additional surgical risk.

Predictors of outcomes after correction of acute type a aortic dissection under moderate hypothermic circulatory arrest and antegrade cerebral perfusion

Abstract Introduction: Hypothermic circulatory arrest is widely used for correction of acute type A aortic dissection pathology. We present our experience of 45 consecutive patients operated in our unit with bilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest. Methods: Between January 2011 and April 2015, 45 consecutive patients were admitted for acute type A aortic dissection and operated emergently under moderate hypothermic circulatory arrest and bilateral antegrade cerebral perfusion. Results: Mean age was 58±11.4 years old. Median circulatory arrest time was 41.5 (30-54) minutes while the 30-day mortality and postoperative permanent neurological deficits rates were 6.7% and 13.3%, respectively. Unadjusted analysis revealed that the factors associated with 30-day mortality were: preoperative hemodynamic instability (OR: 14.8, 95% CI: 2.41, 90.6, P=0.004); and postoperative requirement for open sternum management (OR: 5.0, 95% CI: 1.041, 24.02, P=0.044) while preoperative hemodynamic instability (OR: 8.8, 95% CI: 1.41, 54.9, P=0.02) and postoperative sepsis or multiple organ dysfunction (OR: 13.6, 95% CI: 2.1, 89.9, P=0.007) were correlated with neurological dysfunction. By multivariable logistic regression analysis, postoperative sepsis and multiple organ dysfunction independently predicted (OR: 15.9, 95% CI: 1.05, 96.4, P=0.045) the incidence of severe postoperative neurological complication. During median follow-up of 6 (2-12) months, the survival rate was 86.7%. Conclusion: Bilateral antegrade cerebral perfusion and direct carotid perfusion for cardiopulmonary bypass, in the surgical treatment for correction of acute aortic dissection type A, is a valuable technique with low 30-day mortality rate. However, postoperative severe neurological dysfunctions remain an issue that warrants further research.

Surgical treatment of total anomalous pulmonary venous connection under 6 months of age / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the experience of surgical treatment of total anomalous pulmonary venous connection (TAPVC) in infants.</p><p><b>METHODS</b>The clinic data of 84 cases with TAPVC under 6 months of age underwent surgical treatment at Department of Cardiac Surgery, Guangzhou Women and Children's Medical Center from January 2012 to October 2015 were analyzed retrospectively. There were 58 male and 26 female patients. The patients were aged 1 days to 6 months with a mean of (2.4±2.2) months at surgery, including 22 newborns. Body weight was 1.8 to 6.8 kg with a mean of (4.3±1.2) kg. There were 24 cases of intracardiac type, 46 cases of supracardiac type, 10 cases of infracardiac type and 4 cases of mixed type. There were 26 cases received emergent operation. There were 14 cases used Sutureless technique in operations and 46 cases used conventional methods in the no-intracardiac type cases, and 2 cases enlarged the anastomsis with autologous pericardium. According to the condition, corrective surgeries of other anomalies were performed in the meantime, including 3 Warden operations (right side), 3 bilateral bidirectional Gleen operation, 2 correction of unroofed coronary sinus syndrome, 1 coarctation of aorta correction with deep hypothermic circulation arrest, and 1 repair of ventricular septal defect.</p><p><b>RESULTS</b>The ratio of newborn was higher in Sutureless technique group than in conventional methods group (7/14 vs. 32.6%, χ(2)=4.927, P=0.043), and mean age was less ((1.8±0.4) months vs. (2.4±2.2) months, F=4.257, P=0.042), but there were no difference in body weight, cardiopulmonary bypass time and aorta clamped time between the two groups. Followed up for 1 to 46 months, 10 cases (11.9%) died overall and the mortality of intracardiac (3/10) and mixed (2/4) type were much higher than in intracardiac (4.2%) and supracardiac (13.0%) type. The mortality were no difference between newborn and infants, or whether emergent operation, or Sutureless technique and conventional methods. The maximal pulmonary venous flow velocity was abnormal speed-up >1.8 m/s at 1 week and 1 to 3 months post-operation mostly.</p><p><b>CONCLUSIONS</b>The mortality of TAPVC was differed by different types. Intrinsic pulmonary vein stenosis maybe the main cause of mortality. The high quality of anastomsis could reduce the operative mortality.</p>

Cerebral Metabolic Profiling of Hypothermic Circulatory Arrest with and Without Antegrade Selective Cerebral Perfusion: Evidence from Nontargeted Tissue Metabolomics in a Rabbit Model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Antegrade selective cerebral perfusion (ASCP) is regarded to perform cerebral protection during the thoracic aorta surgery as an adjunctive technique to deep hypothermic circulatory arrest (DHCA). However, brain metabolism profile after ASCP has not been systematically investigated by metabolomics technology.</p><p><b>METHODS</b>To clarify the metabolomics profiling of ASCP, 12 New Zealand white rabbits were randomly assigned into 60 min DHCA with (DHCA+ASCP [DA] group, n = 6) and without ( DHCA [D] group, n = 6) ASCP according to the random number table. ASCP was conducted by cannulation on the right subclavian artery and cross-clamping of the innominate artery. Rabbits were sacrificed 60 min after weaning off cardiopulmonary bypass. The metabolic features of the cerebral cortex were analyzed by a nontargeted metabolic profiling strategy based on gas chromatography-mass spectrometry. Variable importance projection values exceeding 1.0 were selected as potentially changed metabolites, and then Student's t-test was applied to test for statistical significance between the two groups.</p><p><b>RESULTS</b>Metabolic profiling of brain was distinctive significantly between the two groups (Q 2 Y = 0.88 for partial least squares-DA model). In comparing to group D, 62 definable metabolites were varied significantly after ASCP, which were mainly related to amino acid metabolism, carbohydrate metabolism, and lipid metabolism. Kyoto Encyclopedia of Genes and Genomes analysis revealed that metabolic pathways after DHCA with ASCP were mainly involved in the activated glycolytic pathway, subdued anaerobic metabolism, and oxidative stress. In addition, L-kynurenine (P = 0.0019), 5-methoxyindole-3-acetic acid (P = 0.0499), and 5-hydroxyindole-3-acetic acid (P = 0.0495) in tryptophan metabolism pathways were decreased, and citrulline (P = 0.0158) in urea cycle was increased in group DA comparing to group D.</p><p><b>CONCLUSIONS</b>The present study applied metabolomics analysis to identify the cerebral metabolic profiling in rabbits with ASCP, and the results may shed new lights that cerebral metabolism is better preserved by ASCP compared with DHCA alone.</p>

Surgical Treatment Strategies of Intravenous Leiomyomatosis withRight Cardiac Cavities Extension / 中国医学科学院学报

Objective To investigate the diagnosis and surgical treatment strategies of intravenous leiomyomatosis(IVL)extending through inferior vena cava into the right cardiac cavities. Methods Thirty patients of IVL extending through inferior vena cava into the right cardiac cavities were treated in Peking Union Medical College Hospital from November 2002 to January 2015.The following variables were studied: age,cardiopulmonary bypass time,deep hypothermic circulatory arrest time,origins of IVL,blood loss,duration of post-operative hospital stay,hospitalization expenses,edema of lower extremity,blood transfusion,postoperative complication,residual IVL,and re-grow or recurrence. Results Thirteen of 30 patients reported double lower limb edema. The cardiopulmonary bypass was applied in 27 cases,and the average duration of cardiopulmonary bypass was(106.9±53.7)min. Then,21 patients were treated with the deep hypothermic circulatory arrest,and the mean time was(28.2±11.6) min. The tumors originated from the genital veins in 9 cases,the iliac vein in 13 cases,and both veins in 8 cases. The average intra-operative blood loss volume was (2060.5±2012.3)ml,and 21 patients received blood transfusion. The average hospitalization time was(18.9±8.3)days and the average hospitalization expenses was (80 840.4±28 264.2)RMB yuan. While 14 patients had postoperative complications,there was no serious postoperative complication or death.All patients have shown a favorable outcome.Conclusions Tumor embolus extending through inferior vena cava into the right cardiac cavities should be suspected in patients with multiple hysteromyoma. Successful therapy for IVL with right cardiac cavities extension is dependent on reasonable surgical treatment strategies. Surgical removal of the ovaries is vital to avoid IVL re-grow or recurrence.

Hipotermia terapéutica en la lesión traumática cerebral / Therapeutic hypothermia in traumatic brain injury

El trauma craneoencefálico severo es una causa importante de mortalidad en pacientes jóvenes a nivel internacional. La hipertensión intracraneal es la causa de más del 80 por ciento de los pacientes con lesión traumática cerebral. Al presentar una traumática secundaria, se inician una seria de mecanismos metabólicos que incrementan la lesión al tejido cerebral, la inducción de hipotermia ha demostrado que puede alterar el curso natural del proceso patológico. Los fundamentos biológicos apuntan a que la hipotermia puede tener un potencial beneficio, aunque algunas publicaciones no han demostrado mejoría, es claro que en un grupo de pacientes principalmente jóvenes, la hipotermia temprana puede ser beneficiosa. Presentamos una práctica revisión de la literatura sobre esta temática.

The severe head trauma is a major cause of mortality in young patients worldwide. Intracranial hypertension is the cause of more than 80 percent of patients with traumatic brain injury. When a traumatic secondary presenter, begin a series of mechanisms that increase metabolic injury to brain tissue, induction of hypothermia has been shown to alter the natural course of the disease process. The biological foundations suggest that hypothermia may have a potential benefit, although some publications have not shown improvement, it is clear that in a group of mostly young patients, early hypothermia may be beneficial. We present a practical review of the literature on this subject.

Complicações da hipotermia terapêutica: diagnósticos e intervenções de enfermagem / Complicaciones de la hipotermia: los diagnósticos y las intervenciones de enfermería / Complications in therapeutic hypothermia: diagnosis and interventions

Objective: To identify nursing diagnoses according to the NANDA, upon the potential complications of patients undergoing Therapeutic Hypothermia after Cardiorespiratory arrest and propose nursing interventions, according to the Nursing Interventions Classification (NIC). Method: this is a bibliometric review of the literature from January 2003 to May 2013, in LILACS, MEDLINE, and SCIELO. Results: Five articles selected, which enabled us to identify eight Nursing diagnoses, as well as the corresponding nursing interventions. Conclusion: Despite the high efficacy of Therapeutic Hypothermia to reduce the extent of neurological damage Post-Cardiopulmonary arrest, their use is not as widespread in clinical practice. Thus, this research has aimed to provide an initial basis for considering the practice of the professional nurse assisting this patient.

Objetivo: Identificar os diagnósticos de enfermagem, segundo a NANDA, mediante as complicações potenciais dos pacientes submetidos à Hipotermia Terapêutica Pós-parada Cardiorrespiratória e propor as intervenções de enfermagem, conforme a Classificação de Intervenções de Enfermagem (NIC). Método: trata-se de uma revisão bibliométrica de literatura a partir de janeiro de 2003 até maio 2013, nas bases de dados LILACS, MEDLINE e SCIELO. Resultados: foram selecionados 5 artigos, os quais possibilitou identificar 8 diagnósticos de Enfermagem, bem como, as intervenções de Enfermagem correspondentes. Conclusão: apesar da alta eficácia da Hipotermia Terapêutica em reduzir a extensão do dano neurológico Pós-parada Cardiorrespiratória, sua utilização não é tão ampla na prática clínica. Dessa forma, esta pesquisa tem intuito de fornecer uma base inicial de reflexão para a prática do profissional enfermeiro que assiste este paciente.

Objetivo: Identificar los diagnósticos de enfermería según la NANDA, sobre las posibles complicaciones de los pacientes sometidos a Hipotermia Terapéutica después parada cardiorrespiratoria y proponer intervenciones de enfermería, de acuerdo con la Clasificación de Intervenciones de Enfermería (NIC). Método: se trata de una revisión bibliométrica de la literatura entre enero de 2003 mayo de 2013, en LILACS, MEDLINE y SCIELO. Resultados: 5 artículos fueron seleccionados, lo que nos ha permitido identificar 8 Diagnósticos de enfermería, así como las intervenciones de enfermería correspondientes. Conclusión: A pesar de la alta eficacia de la hipotermia terapéutica para reducir la magnitud del daño neurológico post-paro cardiopulmonar, su uso no está tan extendido en la práctica clínica. Por lo tanto, esta investigación ha tenido como objetivo proporcionar una base inicial para la consideración de la práctica de la enfermera profesional asistiendo a este paciente.

Severe tracheobronchial compression in a patient with Turner's syndrome undergoing repair of a complex aorto-subclavian aneurysm: Anesthesia perspectives.

We present a case of severe tracheobronchial compression from a complex aorto‑subclavian aneurysm in a patient with Turner’s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events.

Outcomes of Open Surgical Repair of Descending Thoracic Aortic Disease

BACKGROUND: To determine the predictors of clinical outcomes following surgical descending thoracic aortic (DTA) repair. METHODS: We identified 103 patients (23 females; mean age, 64.1+/-12.3 years) who underwent DTA replacement from 1999 to 2011 using either deep hypothermic circulatory arrest (44%) or partial cardiopulmonary bypass (CPB, 56%). RESULTS: The early mortality rate was 4.9% (n=5). Early major complications occurred in 21 patients (20.3%), which included newly required hemodialysis (9.7%), low cardiac output syndrome (6.8%), pneumonia (7.8%), stroke (6.8%), and multi-organ failure (3.9%). None experienced paraplegia. During a median follow-up of 56.3 months (inter-quartile range, 23.1 to 85.1 months), there were 17 late deaths and one aortic reoperation. Overall survival at 5 and 10 years was 80.9%+/-4.3% and 71.7%+/-5.9%, respectively. Reoperation-free survival at 5 and 10 years was 77.3%+/-4.8% and 70.2%+/-5.8%. Multivariable analysis revealed that age (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.05 to 1.15; p<0.001) and left ventricle (LV) function (HR, 0.88; 95% CI, 0.82 to 0.96; p<0.003) were significant and independent predictors of long-term mortality. CPB strategy, however, was not significantly related to mortality (p=0.49). CONCLUSION: Surgical DTA repair was practicable in terms of acceptable perioperative mortality/morbidity as well as favorable long-term survival. Age and LV function were risk factors for long-term mortality, irrespective of the CPB strategy.

A novel rat model of cardiopulmonary bypass for deep hypothermic circulatory arrest without blood priming / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Large animal cardiopulmonary bypass (CPB) models are expensive, and prevent assessment of neurocognitive function, and difficulties with long-term recovery. The purpose of this study was to establish a novel rat model of cardiopulmonary bypass for deep hypothermic circulatory arrest without blood priming.</p><p><b>METHODS</b>Twenty adult male Sprague-Dawley rats weighing 450-560 g were randomized to CPB with deep hypothermic circulatory arrest (DHCA) and control groups, with 10 rats each. The experimental protocols, including blood and crystalloid fluid administration, anesthesia, orotracheal intubation, ventilation, cannulation, and heparinization were identical in both groups. After inducing cardiac arrest, the circuit was turned off and rats were left in a DHCA state for 15 minutes. Rats were rewarmed to 34°C to 35°C over a period of 36 to 42 minutes using CPB-assisted rewarming, a heating blanket, and a heating lamp along with administration of 0.1 mEq of sodium bicarbonate and 0.14 mEq of calcium chloride. The remaining priming volume was reinfused and animals were weaned from CPB.</p><p><b>RESULTS</b>All CPB with DHCA processes were successfully achieved. Blood gas analysis and hemodynamic parameters were in the normal range. The vital signs of all rats were stable.</p><p><b>CONCLUSIONS</b>Our CPB circuit has several novel features, including a small priming volume, active cooling/rewarming processes, vacuum-assisted venous drainage, peripheral cannulation without thoracotomy or sternotomy, and an accurate means of monitoring peripheral tissue oxygenation.</p>

Hipotermia y corazón / Hypothermia and heart

Las ondas J o de Osborn son deflexiones positivas al final del complejo QRS, que han sido descritas en electrocardiogramas de pacientes con hipotermia. Se presenta el caso de un paciente masculino de 62 años de edad con hipotermia, cuyo electrocardiograma mostró bradicardia sinusal y ondas de OSBORN...

A Successful Management of the Renal Sarcoma with an Extension of the Tumor into the Inferior Vena Cava and the Right Ventricle Progressing Multi-Organ Failure Using a Deep Hypothermic Circulatory Arrest / 대한혈관외과학회지

There has been an improvement in the prognosis of the tumor thrombi invading the inferior vena cava (IVC) and the right atrium (RA) of the renal cell carcinoma with radical nephrectomy and tumor thrombectomy with the aid of a cardiopulmonary bypass. A 26 year old man was diagnosed with the right renal tumor with a tumor invading the right renal vein and the IVC above the right renal vein to the RA and right venticle. He was presented with dyspnea on the exertion, the ascites and the lower extremity edema due to IVC total obstruction. An acute hepatic failure occurred due to an obstruction of the hepatic vein. She received a radical nephrectomy and a removal of the tumor in the IVC and the right cardiac camber under a hypothermic total circulatory arrest using the cardiopulmonary bypass.

Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfusion.

Deep hypothermia, which is used during thoracic aortic surgery for neuroprotection, is associated with coagulation abnormalities in animal and in vitro models. However, there is a paucity of data regarding the impact of deep hypothermia duration on perioperative bleeding. The objective of the current study was to examine the relationship between the duration of deep hypothermia and perioperative bleeding. A retrospective review of 507 consecutive thoracic aortic surgery patients who had surgery with deep hypothermic circulatory arrest was performed. The degree of bleeding and coagulopathy was estimated using perioperative transfusion. Log linear modeling with Poisson regression was used to analyze the relationship between deep hypothermia duration and perioperative bleeding, while controlling for other preselected variables. There was a significant association between deep hypothermia duration and RBC transfusion (P = 0.001). There was no significant association between deep hypothermia duration and FFP and platelet transfusion (P = 0.18 and P = 0.06). The association between deep hypothermia duration and the amount of bleeding (RBC transfusion) was dependent on total CPB time. In general, for shorter CPB times (approximately 120 to 180 minutes) there was an upward sloping line or positive relationship between deep hypothermia duration and bleeding. However, for cases with longer CPB times (300 to 360 minutes), there was no such relationship. The relationship between deep hypothermia duration and perioperative bleeding is dependent on CPB time. For surgeries with short CPB times (120 to 180 minutes), prolonged deep hypothermia is associated with increased post-operative bleeding, as estimated by RBC transfusion. For cases with longer CPB times (300 to 360 minutes), there appears to be no relationship.

Hipotermia profunda com parada circulatória total: experiência no Centro Cirúrgico da Santa Casa de Belo Horizonte / Deep hypothermic circulatory arrest: the experience in the surgery Center at Santa Casa de Belo Horizonte

Apesar dos grandes avanços terapêuticos, a parada circulatória total em hipotermia profunda pode ser necessária para a correção cirúrgica de algumas cardiopatias congênitas. O manejo adequado da hipotermia e a parada circulatória são essenciais para menor morbidade, principalmente neurológica. Hematócrito entre 25 e 30%; resfriamento lento a 17-18ºC; e períodos de parada circulatória com menos de 20 minutos são algumas das recomendações a serem seguidas para melhor sobrevida do paciente.(AU)

Despite great therapeutic progress, deep hypothermic circulatory arrest may be necessary to surgically correct some congenital cardiopathies. Conducting hypothermia and circulatory arrest adequately is crucial to assure less morbidity, especially neurological morbidity. Hematocrit between 25 and 30 %; slow cooling to 17-18º C and periods of circulatory arrest for no longer than 20 minutes are some of the recommendations to be followed to assure patients' survival.(AU)

Intrathecal morphine in two patients undergoing deep hypothermic circulatory arrest during aortic surgery: A case report / 대한마취과학회지

We retrospectively report the first use of intrathecal morphine prior to incision in two male patients undergoing a complex aortic reconstruction, who required complete circulatory arrest under deep hypothermia for intraoperative and postoperative pain control. We administered intrathecal morphine to two male patients undergoing circulatory arrest and deep hypothermia. Patients were fully heparinized prior to cardiopulmonary bypass. Deep hypothermic circulatory arrest was performed by cooling the patients to 18degrees C. Following the surgery, the neurologic status was monitored. The management of postoperative pain is a quality standard in health care. During the first 24 hours after surgery, we observed excellent analgesia without the associated side effects, thus, reducing the time required for pain control by the nursing staff. A successful analgetic strategy not only enhances the patient satisfaction, but may improve the postoperative outcome. However, complications, such as increased risk of epidural hematoma formation, are of special concern in cardiac surgery.

Transient adenosine-induced asystole in the surgical treatment of intracranial aneurysms: A report of two cases

Advances in anesthetic and surgical management, such as deep hypothermic circulatory arrest and temporary clipping, have improved outcomes for intracranial aneurysm patients. However, these techniques are associated with significant risks. We report on two cases in which adenosine administration was used to induce transient periods of cardiac asystole during intracranial aneurysm surgery. This asystole resulted in profound hypotension and collapse of the aneurysm, which facilitated its safe clipping.

Falsely increased bispectral index score during deep hypothermic circulatory arrest in cardiac surgery / 대한마취과학회지

No abstract available.

Aortic arch replacement with moderate hypothermia and a modified three-pump circuit

A strategy employing moderate hypothermia for the replacement of the aortic arch is proposed to avoid the complications of profound hypothermic circulatory arrest. Two patients underwent the complete replacement of the aortic arch using three pumps - for the brain, thoracoabdominal aorta, and heart, respectively. There were no complications and the patients were extubated uneventfully. The method preserved the auto-regulation of the cerebral blood flow without high vascular resistance