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PubMed1997

Metabolic fuel privation in hibernating and awake ground squirrels.

The nature of metabolic fuel utilization during hibernation and periodic arousal is not completely understood. 2-Deoxy-D-glucose (2DG) and mercaptoacetate (MA) were administered to hibernating ground squirrels. These drugs disrupt glucose and fatty acid oxidation, respectively. Telemetrically recorded body temperature (Tb) was analyzed to determine rate of rewarming from hibernation, duration of euthermia during periodic arousal, and proportion of animals arousing after treatments. 2DG given during hibernation significantly increased latency to regain euthermia, especially during the initial phase of rewarming (from first Tb > 10 degrees C to first Tb > 15 degrees C), without affecting the duration or other features of the ensuing euthermic period; MA did not affect rate of rewarming. MA treatment during hibernation affected thermoregulation after the animals aroused, including an increased duration of euthermia and maintenance of erratic patterns of Tb. The percentage of animals that aroused from hibernation was increased in a dose-dependent fashion by each drug. 2DG and MA treatments had little or no impact on nonhibernating ground squirrels in the cold. We suggest that glucose oxidation is important for rewarming from deep torpor; limited glucose availability cannot, however, support normal levels of euthermia when fatty acid oxidation is compromised. On the other hand, fatty acid oxidation may be less necessary for normal arousal from torpor, but critical for the maintenance of euthermia during the arousal phase.

Animals↗
PubMed1990

Successful CPR in a severely hypothermic patient using continuous thoracostomy lavage.

Severe hypothermia with cardiopulmonary arrest often requires prolonged resuscitation while rewarming procedures are implemented. A 63-year-old male in cardiopulmonary arrest with a core body temperature of 23.7 C was resuscitated successfully after core rewarming by means of a two-chest-tube continuous thoracostomy lavage procedure. This lavage procedure resulted in effective and rapid rewarming after other conventional rewarming methods had failed.

Body Temperature↗
PubMed1987

Comparison of gastric lavage and thoracic cavity lavage in the treatment of severe hypothermia in dogs.

A study was undertaken to compare warm gastric (Group 1) and closed thoracic cavity (Group 2) lavage for rewarming severely hypothermic dogs. Adult mongrel dogs were monitored by intra-arterial catheter, central venous catheter, and ECG, and by central venous, esophageal, and rectal temperature probes. Animals were externally cooled to an average of 21.2 C using ice bags. Eight Group 1 and eight Group 2 animals underwent continuous warm saline gastric or closed thoracic cavity lavage, respectively, using afferent and efferent nasogastric and thoracostomy tubes. No animal suffered ventricular fibrillation during tube placement. The closed lavage system consisted of a high-efficiency heat exchanger, a roller pump infusion device, and a heat exchange fluid bath. The lavage fluid circulated at a flow rate of 550 mL/min and a temperature of 39 C. Thoracic lavage animals were followed clinically for 24 hours for evidence of complications, then euthanized and autopsied. The mean time required to rewarm the animals 10 C by central venous temperature probe was 210.9 +/- 18.6 minutes for the gastric group and 99.3 +/- 23.0 minutes for the thoracic group (P less than .001). Rectal temperature consistently lagged behind central venous temperature during both the cooling and rewarming phases in both treatment groups. All of the thoracic lavage animals made an uneventful recovery. Continuous warm saline thoracic cavity lavage for core rewarming of severely hypothermic dogs is more effective than gastric lavage, and appears to be safe.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2002

Effects of moderate hypothermia on in situ cardiac sympathetic nerve endings.

Although hypothermia is known to alter neuronal control of circulation, it has been uncertain whether clinically used hypothermia (moderate hypothermia) affects in situ cardiac sympathetic nerve endings. We examined the effects of moderate hypothermia on cardiac sympathetic nerve ending function in anesthetized cats. By use of a cardiac dialysis technique, we implanted dialysis probes in the midwall of the left ventricle and monitored dialysate norepinephrine (NE) levels as an index of NE output from cardiac sympathetic nerve endings. Hypothermia (27.0+/-0.5 degrees C) induced decreases in dialysate NE levels. Dialysate NE levels did not return to the control level at normothermia after rewarming. Dialysate NE response to inferior vena cava occlusion was attenuated at hypothermia but restored at normothermia after rewarming. Dialysate NE response to high K(+) (100 mM) was attenuated at hypothermia and was not restored at normothermia after rewarming. Hypothermia induced increases in dialysate dihydroxyphenylglycol (DHPG) levels. There were no differences in desipramine (neuronal NE uptake blocker, 10 microM) induced increment in dialysate NE level among control, hypothermia, and normothermia after rewarming. However, hypothermia induced an increase in DHPG/NE ratio. These data suggest that hypothermia impairs vesicle NE mobilization rather than membrane NE uptake. We conclude that moderate hypothermia suppresses exocytotic NE release via central mediated reflex and regional depolarization.

Animals↗
PubMed1977

Accidental hypothermia: peritoneal dialysis.

Accidental hypothermia may develop within a few minutes by immersion in cold water, in a matter of hours by exposure to cold weather, and in a matter of days in debilitatted victims by continuous exposure to milder cold stress. The prognosis in accidental hypothermia depends on the patient's premorbid condition, the depth and duration of the hypothermia and the degree of exhaustion and metabolic acidosis that result from physiologic attempts to compensate for the heat loss. For deep hypothermia (deep body temperature below 20 C [82.4F]), internal rewarming is strongly recommended as a means of supporting function in body core organs and minimizing the risk of "rewarming shock". For lesser degrees of hypothermia, recoverability depends more on the adequacy of supportive care than on the method of rewarming. The rapid and complete recovery experienced in the case presented is not surprising since the patient's premorbid condition was good, chilling had been rapid, metabolic exhaustion was mild, and internal rewarming was accomplished without delay, using heated peritoneal dialysis.

Acidosis↗
PubMed1999

In vitro capacitation of fresh, chilled and frozen-thawed dog spermatozoa assessed by the chloretetracycline assay and changes in motility patterns.

The effect of preservation on capacitation status of dog spermatozoa was investigated. Split ejaculates from six dogs were assessed as fresh, chilled for 24 h and rewarmed, and frozen-thawed samples. Capacitation-like status was assessed using the chlortetracycline (CTC)-assay and the measurement of sperm motility patterns using a computer-assisted sperm analyzer. Evaluations were performed on washed spermatozoa immediately after dilution in a Tris-fructose-citrate buffer (TFC) or in canine capacitation medium (CCM), and at 2-h intervals during 8 h of incubation in 5% CO2 in air, at 37 degrees C. Preservation decreased significantly the proportion of uncapacitated spermatozoa. In TFC, at hour 0, chilled-rewarmed and frozen-thawed samples had a significantly lower proportion of uncapacitated, viable spermatozoa than the fresh samples (P<0.05) according to the CTC-assay. The time course of capacitation was accelerated in the preserved samples, compared to the fresh ones. During incubation in CCM, the mean time from hour 0 to when, according to the CTC-assay, the highest proportion of capacitated spermatozoawas present in the samples (time-to-peak), was 4 h for fresh and 2 h for chilled-rewarmed and frozen-thawed samples (P<0.1). The highest values for curvilinear line velocity (VCL) and lateral head displacement (LHD), thought to be descriptive of sperm hyperactivation, were also observed 4 and 2 h after incubation began, in the fresh and the preserved samples, respectively. The difference in time-to-peak for VCL and LHD between fresh, chilled-rewarmed and frozen-thawed semen samples was statistically significant (P<0.02). It can be concluded that based on the CTC-assay and the analysis of motility patterns, capacitation-like changes in dog semen seem to be both initiated and accelerated by the preservation procedures.

Acrosome Reaction↗
PubMed2000

Determinants of core temperature at the time of admission to intensive care following cardiac surgery.

OBJECTIVE: To determine the predictors of core temperature on arrival in the intensive care unit (ICU) after cardiac surgery. DESIGN: Prospective, randomized trial. SETTING: Tertiary care medical center, operating rooms (ORs), and ICU. PATIENTS: 72 patients presenting for coronary artery bypass surgery. INTERVENTIONS: Randomized assignment for ambient OR temperature (16-18 degrees C vs. 21-23 degrees C) and rewarming endpoint on cardiopulmonary bypass (CPB; nasopharyngeal and urinary bladder temperatures >/=36.5 degrees C and 34.0 degrees C, respectively, vs. nasopharyngeal and urinary bladder temperatures >/=37.5 degrees C and 36.0 degrees C, respectively) at the time of separation from bypass. MEASUREMENTS AND MAIN RESULTS: The best (and only significant) predictor of core temperature on arrival in the ICU was rewarming endpoint at the time of separation from CPB (p = 0.004). Patient weight, height, body habitus, and nitroprusside administration did not significantly predict core temperature. Ambient temperature affected only body temperature when the duration of time in the OR after separation from bypass was prolonged (>90 min). A weighted average body temperature was a better predictor of complete rewarming than was any single monitoring site. CONCLUSIONS: To reduce the incidence of hypothermia after cardiac surgery, the most important variable is rewarming endpoint achieved before separation from bypass. A warm ambient temperature (>21 degrees C) may be beneficial if the duration of time in the OR after bypass is prolonged (>90 min).

Aged↗
PubMed1997

Continuous jugular venous versus nasopharyngeal temperature monitoring during hypothermic cardiopulmonary bypass for cardiac surgery.

STUDY OBJECTIVE: To compare jugular venous to nasopharyngeal temperature during hypothermic cardiopulmonary bypass (CPB). DESIGN: Prospective observational study. SETTING: Tertiary care teaching hospital. PATIENTS: 5 ASA physical status IV patients (40 to 65 years of age) having cardiac surgery with hypothermic CPB. INTERVENTIONS, MEASUREMENTS AND MAIN RESULTS: Jugular venous and nasopharyngeal temperatures were recorded throughout the procedure with comparisons made during four time periods: pre-CPB, during CPB, during rewarming, and post-CPB. The patients underwent 85.8 +/- 45.8 minutes (mean +/- SD) of hypothermic CPB, cooling to 26.3 +/- 7.6 degrees C (nasopharyngeal) followed by rewarming at 0.35 +/- 0.1 degree C (nasopharyngeal)/min. There was a high degree of precision between the two temperature sites, but marked differences in bias. In particular, temperature bias was more pronounced during rewarming from CPB compared with other time periods (p < 0.05) where jugular venous temperature was greater than nasopharyngeal temperature by 3.4 degrees C. CONCLUSION: Nasopharyngeal temperature underestimates jugular venous temperature during rewarming from hypothermic CPB. As a result, the brain may be exposed to periods of hyperthermia, possibly increasing the risk of neurologic injury associated with CPB.

Adult↗
PubMed1997

Effects of chilling on the expression of ethylene biosynthetic genes in Passe-Crassane pear (Pyrus communis L.) fruits.

Passe-Crassane pears require a 3-month chilling treatment at 0 degrees C to be able to produce ethylene and ripen autonomously after subsequent rewarming. The chilling treatment strongly stimulated ACC oxidase activity, and to a lesser extent ACC synthase activity. At the same time, the levels of mRNAs hybridizing to ACC synthase and ACC oxidase probes increased dramatically. Fruit stored at 18 degrees C immediately after harvest did not exhibit any of these changes, while fruit that had been previously chilled exhibited a burst of ethylene production associated with high activity of ACC oxidase and ACC synthase upon rewarming. ACC oxidase mRNA strongly accumulated in rewarmed fruits, while ACC synthase mRNA level decreased. The chilling-induced accumulation of ACC synthase and ACC oxidase transcripts was strongly reduced when ethylene action was blocked during chilling with 1-methylcyclopropene (1-MCP). Upon rewarming ACC synthase and ACC oxidase transcripts rapidly disappeared in 1-MCP-treated fruits. A five-week treatment of non-chilled fruits with the ethylene analog propylene led to increased expression of ACC oxidase and to ripening. However, ethylene synthesis, ACC synthase activity and ACC synthase mRNAs remained at very low level. Our data indicate that ACC synthase gene expression is regulated by ethylene only during, or after chilling treatment, while ACC oxidase gene expression can be induced separately by either chilling or ethylene.

Alkenes↗
PubMed2001

Dynamic changes in cerebral oxygenation related to deep hypothermia and circulatory arrest evaluated by near-infrared spectroscopy.

BACKGROUND: Total circulatory arrest in deep hypothermia, which is used in corrective surgery of complex cardiovascular malformations, has been said to cause brain injury. Near-infrared spectroscopy (NIRS) is a new non-invasive method that potentially monitors changes in cerebral oxygenation and tissue oxygen utilisation. The aim of this experimental study in rabbits was to evaluate the change in intravascular and intracellular oxygenation patterns during cooling, deep hypothermic circulatory arrest and rewarming using a commercially available NIRS-cerebral oximeter. METHODS: Ten New Zealand White male rabbits (weight, 3.1+/-0.25 kg BW) were included in this study. All animals underwent cardiopulmonary bypass (CPB), cooling to a rectal temperature below 15 degrees C, 60 min of deep hypothermic circulatory arrest (DHCA) followed by reperfusion and rewarming. Cerebral oxyhaemoglobin (HbO2), deoxyhaemoglobin (HHb) and cytochrome oxidase aa3 (CytOxaa3) concentrations were continuously measured during the entire procedure using the Cerebral RedOx Monitor 2020 (Criticon cerebral redox monitor 2020, Johnson & Johnson Medical). Total haemoglobin concentration (tHb) and regional cerebral oxygen saturation (rSO2) values were calculated by integrated algorithm. RESULTS: In all animals an initial increase of oxygenated haemoglobin (HbO2, rSO2) and a fall in deoxygenated haemoglobin (HHb) were found during cooling on bypass. A slight decrease in CytOxaa3 signal was observed in response to initial cooling. Variation in intravascular haemoglobin oxygenation parameters (HbO2, HHb) were related to haemodynamic changes associated with fluid loading, initiation and termination of CPB, bypass flow rate and cooling and rewarming. When the pump flow was stopped all NIRS parameters, except the HHb value, decreased precipitously during the DHCA-period (P<0.01). After reperfusion and rewarming, all haemoglobin oxygen saturation readings returned nearly to pre-CPB levels (P=0.09), but the CytOxaa3 was still significantly lower than the pre-CPB levels (P<0.05). CONCLUSION: The change in the NIRS-derived haemoglobin oxygenation parameters may reflect physiological changes in systemic and cerebral haemodynamics. CytOxaa3 values may represent related effects on cellular oxygenation. Thus, continuous, real-time NIRS-monitoring may identify critical periods with inadequate brain tissue oxygenation, particularly during DHCA. The neurological implications of the observed changes in NIRS oxygenation parameters, however, require further quantitative morphological evaluation of the brain in animals surviving a longer reperfusion and observation period.

Animals↗
PubMed1983

Is anterograde amnesia a special case of retrograde amnesia?

In anterograde amnesia, memory loss is obtained for events that occur subsequent to the traumatic insult. But because the effects of an anterograde agent or treatment usually last for minutes, or even hours, after the nominal training event, processing of information may be altered during the postacquisition period as well as during acquisition. Since posttraining manipulations are themselves capable of modulating memory, or inducing retrograde amnesia, the memory loss due to a putative anterograde treatment may instead represent retrograde processes. The present experiment examined this potential source of confounding by using an amnestic treatment that can be quickly reversed after training in order to remove postacquisition effects. Thus, the presence of amnesia would isolate anterograde contributions as the source of loss. For induction of anterograde amnesia, rats were trained while at reduced body temperature (29 degrees C). A rapid rewarming procedure was introduced for some animals immediately after training to ensure that the hypothermic state did not extend into the postacquisition period. Other subjects were rapidly rewarmed 1 hr after training to control for any effects of the rewarming manipulation. Both groups showed severe anterograde amnesia that was indistinguishable from that obtained in the gradually rewarmed controls. These data provide an empirical example of an anterograde-induced memory deficit that is independent of retrograde influences.

Animals↗
PubMed1982

Influence of respiratory heat transfer on thermogenesis and heat storage after cold immersion.

1. Ten male subjects were cooled on three occasions to a rectal temperature of 35 degrees C by immersion to the neck in water at 11.3 degrees C. The subjects were rewarmed for 60 min, once by metabolic heat production alone (shivering), once by inhalation rewarming with spontaneous breathing of saturated air at 47 degrees C (control) and once by inhalation rewarming with ventilation regulated at 40 litres/min by respiring a controlled fraction of CO2 (hyperventilation). 2. Metabolic heat production was substantially reduced by inhalation rewarming (P less than 0.05), from 913 kJ when shivering to 766 kJ (control) and 613 kJ when hyperventilating. The fall in metabolic heat production was greater than the corresponding respiratory heat gain, which increased from a loss of 41 kJ when shivering to gains of 85 kJ (control) and 169 kJ (hyperventilation). 3. As differences in mean skin temperatures were small (less than 1.0 degrees C), it is concluded that the lower metabolic heat production in response to increased respiratory heat input must result from more rapid central temperature gains. This conclusion is supported by the relative values of rectal and tympanic temperatures. It was calculated that the percentage of the total heat supply which was donated to the core increased from 13% during shivering to 16% for the control and 23% in hyperventilation. Results imply that respiratory heat input is more efficient than metabolic heat production in elevating central temperature.

Adult↗
PubMed2000

Effect of temperature on responses of dog isolated lingual and mesenteric arteries to vasoactive substances.

1. The effects of temperature on submaximal vasoconstriction to an intraluminal administration of noradrenaline (NA), phenylephrine, tyramine and KCl were investigated in canine isolated and perfused lingual and mesenteric arteries, using the cannula-inserting method. 2. In lingual arteries, cooling (from 37 to 27 degrees C) caused significant depression of vasoconstriction to the four vasoactive substances used. Rewarming (to 37 degrees C) induced a significant augmentation of constriction by NA, phenylephrine and KCl, but not tyramine. 3. In mesenteric arteries, cooling depressed tyramine- and KCl-induced constrictions, but had no effect on NA- and phenylephrine-induced vasoconstriction. Only in the case of KCl-induced constrictions did rewarming induce a potentiation of the vasoconstrictor response. 4. We conclude that: (i) cooling induces a depression of voltage-dependent Ca2+ channels and rewarming may induce a potentiation of Ca2+ channels in both arteries; (ii) alpha1-adrenoceptor-operated Ca2+ channels are depressed by cooling in lingual arteries but not in mesenteric arteries; and (iii) cooling may induce an attenuation of the re-uptake function in sympathetic nerve terminals in both arteries and this attenuation may be not rapidly restored by acute rewarming.

Adrenergic alpha-Agonists↗
PubMed2001

Bispectral index monitoring in children undergoing mild hypothermic cardiopulmonary bypass.

BACKGROUND: In this prospective, cohort study of 15 children (median age 7.7 years, range 4.9-16.5 years) undergoing atrial septal defect repair, we evaluated changes in the Bispectral index (BIS) as a potential monitor of level of consciousness during cardiac anaesthesia. METHODS: Identical cardiac surgery, cardiopulmonary bypass (CPB) and anaesthetic techniques were used, including mild hypothermia and an early extubation protocol. BIS, mean arterial pressure, heart rate and tympanic temperature were recorded at baseline postinduction (Tbaseline), skin incision (Tincis), sternotomy (Tsternot), aortic cannulation (Tcann), nadir temperature (Tnadir), rewarmed (Trewarmed), immediate post-CPB (TpostCPB), chest drain insertion (Tdrains), sternal wires (Twire), skin closure (Tclosed) and spontaneous movement (Tmove). As a measure of stress response, serum lactate, glucose, norepinephrine and epinephrine levels were measured at Tbaseline, Tsternot, Tcann, Tnadir, Trewarmed and Tdrains. Explicit memory testing was undertaken prior to hospital discharge. RESULTS: BIS increased significantly during the rewarming phase (Trewarmed versus Tbaseline and Tnadir, P<0.001). Lactate, epinephrine and glucose levels were also significantly elevated at Trewarmed. There were no correlations between BIS and the increase in epinephrine, lactate and glucose during rewarming, nor with changes in heart rate or mean arterial pressure during surgery. All patients had an uneventful recovery without evidence for explicit recall. CONCLUSIONS: The increase in BIS during the rewarming phase could reflect an increase in conscious level, and is consistent with the reported risk for awareness during this phase of cardiac surgery.

Adolescent↗
PubMed2001

Higher hematocrit improves liver blood flow and metabolism during cardiopulmonary bypass in piglets.

OBJECTIVES: Hemodilution has been applied conventionally during cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) to counteract the increase in viscosity and deleterious rheological effects caused by hypothermia. However, liver dysfunction after low-flow bypass and DHCA is common, and little is known about the effects of hematocrit (Hct). The purpose of the present study is to evaluate the impact of two hemodilution priming protocols used clinically on liver perfusion and metabolism. MATERIALS AND METHODS: Ten piglets were randomized into 2 groups. One group (n = 5) had a crystalloid prime resulting in an Hct of about 15 % (low hematocrit; group L), the other (n = 5) a total-blood prime (Hct = 25 %; high hematocrit; group H). All animals underwent 70 min cooling at full flow (150 ml/kg/min), 30 min of low flow (50 ml/kg/min) at 15 degrees C followed by 45 min of DHCA and 75 min of rewarming at full flow. Liver blood flow (LBF) was assessed at the beginning of CPB at 34 degrees C, at the end of cooling at 15 degrees C, at the end of low flow, 5 min after the start of warming, and at the end of rewarming at 34 degrees C by injections of radioactive microspheres. Liver function was evaluated at the same time using the MEGX test, which measures the metabolism of lidocaine. RESULTS: LBF was insignificantly reduced during cooling, decreased during low flow (p = 0.001), and increased again after DHCA with the highest flow at the end of rewarming. LBF tended to be lower at all times in group L (p = 0.096). The liver lidocaine metabolic rate did not significantly decrease during cooling and low flow, but was increased at the end of rewarming (p = 0.01); the metabolism was higher in group H (p = 0.025). Multiregression analysis revealed liver blood flow (p = 0.003) and hematocrit (p < 0.001) as independent determinants of the liver lidocaine metabolism; arterial blood pressure and temperature did not have significant influence in this model. CONCLUSION: Hemodilution results in a tendency towards reduced liver blood flow during CPB; much worse is the resulting impaired liver metabolism, independent of reduced blood flow and pressure. Avoidance of low hematocrit during CPB may be a useful adjunct to preserve liver function in patients undergoing cardiac surgery with long duration CPB and DHCA.

Animals↗
PubMed1999

Cryopreservation of macropodid spermatozoa: new insights from the cryomicroscope.

This study examined the effects of cooling and cryopreservation upon macropod spermatozoa (eastern grey kangaroo, Macropus giganteus and red-necked wallaby, Macropus rufogriseus). Sperm survival during and after freezing to -30 degrees C or 70 degrees C in minimum essential medium (MEM) + 5, 10, 20 or 30% (v/v) glycerol, MEM + 10 or 20% (v/v) ethylene glycol and MEM containing a mixture of 7.5% (v/v) glycerol + 10% (v/v) dimethylsulphoxide was examined by cryomicroscopy. The MEM/glycerol mixtures permitted better post-thaw sperm recovery than the other cryoprotectants. After freezing to -30 degrees C at 10 degrees C min(-1) in 20% glycerol, then rewarming at 20 degrees C min(-1), flagellar activity resumed in more than 50% of spermatozoa when the temperature increased into the range 5-10 degrees C. However, as the temperature increased, into the range 20-25 degrees C, motility declined rapidly so that less than 5% motile cells were seen at 35 degrees C. Spermatozoa in MEM without cryoprotectant were also examined by cryomicroscopy to evaluate changes in flagellar configuration, swimming behaviour and viability during cooling from 35 degrees C to approximately -7 degrees C, and rewarming to 35 degrees C. Cooling from 35 to 28 degrees C induced kangaroo spermatozoa to exhibit rigid principal-piece bending and non-linear motility, which was reversed by further cooling and the spermatozoa resumed their normal linear movement. Rewarming induced principal-piece bending in the range of 20-30 degrees C, but this effect was reversed by further warming. Although red-necked wallaby spermatozoa showed these effects, they also exhibited a tendency to form rosette-like clusters during rewarming, especially when the temperature reached approximately 14 degrees C. The clusters were induced when the flagellar end-pieces became anteriorly reflected, producing hook-like flagellar conformations, which then became interlinked.

Animals↗
PubMed2003

Phentolamine administration increases blood S100B protein levels in pediatric open-heart surgery patients.

AIM: Phentolamine administration during open-heart surgery shortens the cooling and rewarming phases of cardiopulmonary bypass (CPB) and hastens weaning from mechanical ventilation and extubation. Data on the effects of phentolamine on cerebral circulation and function in this setting are lacking. This study reports the cerebral effects of phentolamine using blood S100B protein levels and the middle cerebral artery pulsatility index (MCA PI). METHODS: Sixty pediatric patients undergoing congenital heart disease repair were randomly assigned to receive either phentolamine 0.2 mg kg(-1) i.v. (n = 30) or placebo (n = 30) before the cooling and rewarming phases of CPB. Samples for S100B measurement were collected at seven predetermined time-points before, during and after surgery. MCA PI values were recorded at the same times as sampling. RESULTS: S100B blood levels were higher in the phentolamine-treated group than in controls after rewarming (3.53 +/- 1.88 vs 1.58 +/- 0.53 microg l(-1); p < 0.001), remained persistently higher at the end of surgery (2.95 +/- 0.91 vs 0.79 +/- 0.21 microg l(-1); p < 0.001) and returned to normal ranges 12 h later than in the placebo group (p > 0.05). MCA PI values were also significantly higher at the end of surgery in the phentolamine-treated group (1.83 +/- 0.50 vs 1.22 +/- 0.34; p < 0.01). Cooling and rewarming times were shorter in the phentolamine-treated group (p < 0.01, for all). CONCLUSION: Despite improved peripheral vasodilatation and perfusion, phentolamine administration in pediatric open-heart surgery is correlated with increased cerebrovascular resistance and brain damage.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

The utility of traditional prehospital interventions in maintaining thermostasis.

OBJECTIVE: Hypothermia can have a negative effect on the metabolic and hemostatic functions of patients with traumatic injuries. Multiple methods of rewarming are currently used in the prehospital arena, but little objective evidence for their effectiveness in this setting exists. The purpose of this study was to assess the relative effectiveness of traditional prehospital measures in maintaining thermostasis in trauma patients. METHODS: Participating helicopter and ground ambulance ALS units were prospectively randomized to provide either routine care only (passive or no warming) or routine care (passive warming) in conjunction with active warming (either reflective blankets, hot pack rewarming, or warmed IV fluids). A total of 174 trauma code patients, aged >14 years, who met inclusion criteria were prospectively enrolled by prehospital providers. Patients who received a non-assigned intervention or who had incomplete temperature data were dropped from the analysis. A total of 134 patients were included in the final analysis. RESULTS: Patients who received hot pack rewarming showed a mean increase in body temperature during transport (+1.36 degrees F/0.74 degrees C), while all other groups (no intervention, passive rewarming, reflective blankets, warmed IV fluids, warmed IV fluid plus reflective blanket) showed a mean decrease in temperature during transport [-0.34 to -0.61 degrees F (-0.2 to -0.4 degrees C); p<0.01]. In addition, the hot pack group was consistent, with every patient who received hot pack warming showing an increase in body temperature during transport, while in all other groups there were patients who had both increases and decreases in temperature. The intervention groups did not differ significantly on exposure to precipitation, transport unit temperature, total prehospital time, initial vital signs, amount of fluid administered, Injury Severity Score, or Glasgow Coma Score. CONCLUSIONS: Most traditional methods of maintaining trauma patient temperature during prehospital transport appear to be inadequate. Aggressive use of hot packs, a simple, inexpensive intervention to maintain thermostasis, deserves further study as a potential basic intervention for trauma patients.

Adolescent↗