Cooling for cerebral protection during brain surgery.

BACKGROUND: The brain is at risk of ischaemia during a variety of neurosurgical procedures, and this can lead to devastating results. Induced hypothermia is the controlled lowering of core body temperature for therapeutic purposes. This remains the current practice during neurosurgery for the prevention or minimization of ischaemic brain injury. Brain surgery may lead to severe complications due to factors such as requirement for brain retraction, vessel occlusion, and intraoperative haemorrhage. Many anaesthesiologists believe that induced hypothermia is indicated to protect the central nervous system during surgery. Although hypothermia is often used during brain surgery, clinical efficacy has not yet been established. OBJECTIVES: To evaluate the effectiveness and safety of induced hypothermia versus normothermia for neuroprotection in patients undergoing brain surgery. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 10), MEDLINE, LILACS, EMBASE and Current Controlled Trials (from inception to November 2010), reference lists of identified trials, and bibliographies of published reviews. We also contacted researchers in the field. There were no language restrictions. SELECTION CRITERIA: We included randomized controlled trials and quasi-randomized controlled trials of induced hypothermia versus normothermia for neuroprotection in patients undergoing brain surgery. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS: We included four trials of cooling for cerebral protection during brain surgery, involving a total of 1219 patients. We did not find any evidence that hypothermia for neuroprotection in patients undergoing brain surgery is either effective or unsafe when compared to normothermia. AUTHORS' CONCLUSIONS: Although there is some evidence that mild hypothermia is safe, its effectiveness is not clear when compared with normothermia. We need to perform more clinical trials in order to establish the benefit, if any, of hypothermia for cerebral protection during brain surgery before making firm recommendations for the routine use of this intervention.

O uso de manta térmica no intra-operatório de pacientes submetidos à prostatectomia radical está relacionado com a diminuição do tempo de recuperação pós-anestésica / The intraoperative use of warming blankets in patients undergoing radical prostatectomy is related with a reduction in post-anesthetic recovery time

JUSTIFICATIVA E OBJETIVOS: A anestesia e o procedimento cirúrgico causam alterações térmicas substanciais. A hipotermia pode causar complicações cardiovasculares, distúrbios da coagulação, alterações imunológicas e hidroeletrolíticas, além de diminuir o metabolismo de fármacos aumentando o período de recuperação pós-anestésica (RPA). A circulação de ar aquecido (manta térmica) é o método de aquecimento não-invasivo mais efetivo disponível atualmente. O objetivo do presente estudo foi comparar o tempo de permanência na RPA de pacientes submetidos à prostatectomia radical com e sem o uso de manta térmica no período intra-operatório. MÉTODO: Foram estudados pacientes ASA PS I, II, III, entre 45 e 75 anos, submetidos à prostatectomia radical sob anestesia geral no ano de 2004. Os dados coletados incluíram: idade, peso, estado físico, técnica anestésica, uso de manta térmica e tempo de permanência na RPA, que foram tabulados em planilha Excel e analisados pelo teste de Mann-Whitney. RESULTADOS: Os pacientes em que a manta térmica foi utilizada no período intra-operatório permaneceram em média 139,66 ± 58,6 minutos na RPA; já nos pacientes em que a manta térmica não foi utilizada o tempo de permanência foi em média 208,28 ± 65,8 minutos na RPA (p < 0,0001). CONCLUSÕES: Nas condições do presente estudo concluiu-se que o uso de manta térmica no intra-operatório de pacientes submetidos à prostatectomia radical esteve associado a diminuição significativa do tempo de permanência na RPA.

BACKGROUND AND OBJECTIVES: Anesthesia and the surgeries cause substantial thermal changes, and hypothermia can lead to cardiovascular complications, clotting disorders, immunologic changes, and disruption of water and electrolyte balances, besides decreasing drug metabolism and, therefore, increasing post-anesthetic recovery time (PART). Circulation of warm air (forced-air warming blanket) is the most effective non-invasive warming method currently available. The objective of the present study was to compare the time spent in the recovery room of patients undergoing radical prostatectomy with and without the intraoperative use of a forced-air warming blanket. METHODS: Male patients between 45 and 75 years, ASA PS I, II, and III undergoing radical prostatectomy under general anesthesia during 2004 were studied. Data gathered included: age, weight, physical status, anesthetic technique, use of warming blanket, and time spent in the recovery room. The data was recorded on an Excel chart and analyzed by the Mann-Whitney test. RESULTS: Patients in whom the warming blanket was used intraoperatively remained a mean of 139.66 ± 58.6 minutes in the recovery room, while patients without the warming blanket spent a mean of 208.28 ± 65.8 minutes in the recovery room (p < 0.0001). CONCLUSIONS: We concluded that the intraoperative use of the warming blanket in patients undergoing radical prostatectomy was associated with a significant reduction in the time patients spent in the recovery room.

JUSTIFICATIVA Y OBJETIVOS: La anestesia y el procedimiento quirúrgico causan alteraciones térmicas ostensivas, y la hipotermia puede causar complicaciones cardiovasculares, disturbios de la coagulación, alteraciones inmunológicas, hidro electrolíticas, además de reducir el metabolismo de fármacos aumentando el período de recuperación pos anestésica (RPA). La circulación de aire caliente (manta térmica), es el método de calentamiento no invasivo más efectivo que está a disposición actualmente. El objetivo del presente estudio fue comparar el tiempo de permanencia en el RPA de pacientes sometidos a la prostatectomía radical con y sin el uso de manta térmica en el período intraoperatorio. MÉTODO: Fueron estudiados pacientes, ASA PS I, II, III, entre 45 y 75 años, sometidos a prostatectomía radical con anestesia general en el año 2004. Los datos recolectados incluyeron: edad, peso, estado físico, técnica anestésica, uso de manta térmica y tiempo de permanencia en la RPA, esos fueron puestos en una planilla Excel y analizados por la prueba de Mann-Whitney. RESULTADOS: Los pacientes en que la manta térmica fue utilizada en el período intraoperatorio permanecieron en promedio 139,66 ± 58,6 minutos en la RPA, ya en los pacientes en que la manta térmica no fue utilizada el general de permanencia fue como promedio de 208,28 ± 65,8 minutos en la RPA (p < 0,0001). CONCLUSIONES: En las condiciones del presente estudio se concluyó que el uso de manta térmica en el intraoperatorio de pacientes sometidos a la prostatectomía radical estuvo asociado a la disminución significativa del tiempo general de permanencia en la RPA.

Intravenous versus inhalation anaesthesia for one-lung ventilation.

BACKGROUND: The technique called one-lung ventilation can confine bleeding or infection to one lung, prevent rupture of a lung cyst or, more commonly, facilitate surgical exposure of the unventilated lung. During one-lung ventilation, anaesthesia is maintained either by delivering a volatile anaesthetic to the ventilated lung or by infusing an intravenous anaesthetic. It is possible that the method chosen to maintain anaesthesia may affect patient outcomes. OBJECTIVES: The objective of this review was to evaluate the effectiveness and safety of intravenous versus inhalation anaesthesia for one-lung ventilation. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 3), MEDLINE, LILACS, EMBASE (from inception to June 2006), ISI web of Science (1945 to June 2006), reference lists of identified trials, and bibliographies of published reviews. We also contacted researchers in the field. There were no language restrictions. SELECTION CRITERIA: We included randomized controlled trials and quasi-randomized controlled trials of intravenous versus inhalation anaesthesia for one-lung ventilation. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS: We included nine studies that enrolled 291 participants. We could not perform meta-analyses as the included studies did not report the outcomes listed in the protocol for this review. AUTHORS' CONCLUSIONS: There is no evidence from randomized controlled trials of differences in patient outcomes for anaesthesia maintained by intravenous versus inhalational anaesthesia during one-lung ventilation. This review highlights the need for continued research into the use of intravenous versus inhalation anaesthesia for one-lung ventilation. Future trials should have standardized outcome measures such as death, adverse postoperative outcomes and intraoperative awareness. Dropouts and losses to follow up should be reported.

The intraoperative use of warming blankets in patients undergoing radical prostatectomy is related with a reduction in post-anesthetic recovery time.

BACKGROUND AND OBJECTIVES: Anesthesia and the surgeries cause substantial thermal changes, and hypothermia can lead to cardiovascular complications, clotting disorders, immunologic changes, and disruption of water and electrolyte balances, besides decreasing drug metabolism and, therefore, increasing post-anesthetic recovery time (PART). Circulation of warm air (forced-air warming blanket) is the most effective non-invasive warming method currently available. The objective of the present study was to compare the time spent in the recovery room of patients undergoing radical prostatectomy with and without the intraoperative use of a forced-air warming blanket. METHODS: Male patients between 45 and 75 years, ASA PS I, II, and III undergoing radical prostatectomy under general anesthesia during 2004 were studied. Data gathered included: age, weight, physical status, anesthetic technique, use of warming blanket, and time spent in the recovery room. The data was recorded on an Excel chart and analyzed by the Mann-Whitney test. RESULTS: Patients in whom the warming blanket was used intraoperatively remained a mean of 139.66 +/- 58.6 minutes in the recovery room, while patients without the warming blanket spent a mean of 208.28 +/- 65.8 minutes in the recovery room (p < 0.0001). CONCLUSIONS: We concluded that the intraoperative use of the warming blanket in patients undergoing radical prostatectomy was associated with a significant reduction in the time patients spent in the recovery room.