Abstract/References

Deliberate mild hypothermia is safer from the point of view of adverse events and does not require a specific technique, unlike deep or moderate hypothermia. Therefore, mild hypothermia was widely used for neurosurgical procedures. Unfortunately, the neuroprotective efficacy of intraoperative mild hypothermia has not yet been proven; however, temperature management for intraoperative deliberate mild hypothermia has been improved over the past two decades. It is very important to achieve mild hypothermia before the commencement of the main surgery, and to maintain the patient’s body temperature until the procedure is completed. In addition, it is also important to complete rewarming by the end of the surgery so that an accurate neurological evaluation can be made. Regarding the effects of mild hypothermia on outcomes, a large randomized controlled study reported that unfavorable outcomes did not differ between participants with or without hypothermia. Apart from these unfavorable outcomes, it is known that temperature management during deliberate intraoperative mild hypothermia has contributed to improvement of anesthesia practice. The accumulation of experience in this field is important. Clinical interest in deliberate mild hypothermia is currently low; however, anesthesiologists should be prepared for the time when it is required again in the future.

1. Griepp RB, Stinson EB, Hollingsworth JF, Buehler D. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg, 70:1051-1063, 1975.

2. Lougheed WM, Sweet WH, White JC, Brewster WR. The use of hypothermia in surgical treatment of cerebral vascular lesions;a preliminary report. J Neurosurg, 12:240-255, 1955.

3. Maspes PE, Marini G. INTRACRANIAL ANEURYSMS RESULTS OF DIRECT SURGICAL TREATMENT WITH SPECIAL REFERENCE TO THE USE OF MODERATE HYPOTHERMIA AND CIRCULATORY ARREST. J Neurosurg, 21:284-287, 1964.

4. Busto R, Dietrich WD, Globus MY, Valdés I, Scheinberg P, Ginsberg MD. Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab, 7:729-738, 1987.

5. Kader A, Brisman MH, Maraire N, Huh JT, Solomon RA. The effect of mild hypothermia on permanent focal ischaemia in the rat. Neurosurgery, 31:1056-1061, 1992.

6. Choi HA, Badjatia N, Mayer SA. Hypothermia for acute brain injury--mechanisms and practical aspects. Nat Rev Neurol, 8:214-222, 2012.

7. Karibe H, Sato K, Shimizu H, Tominaga T, Koshu K, Yoshimoto T. Intraoperative mild hypothermia ameliorates postoperative cerebral blood flow impairment in patients with aneurysmal subarachnoid hemorrhage. Neurosurgery, 47:594-599, 2000.

8. Kimme P, Fridrikssen S, Engdahl O, Hillman J, Vegfors M, Sjöberg F. Moderate hypothermia for 359 operations to clip cerebral aneurysms. Br J Anaesth, 93:343-347, 2004.

9. Sessler DI, McGuire J, Moayeri A, Hynson J. Isoflurane-induced vasodilation minimally increases cutaneous heat loss. Anesthesiology, 74:226-232, 1991.

10. Matsukawa T, Sessler DI, Sessler AM, et al. Heat flow and distribution during induction of general anesthesia. Anesthesiology, 82:662-673, 1995.

11. Hynson J, Sessler DI. Intraoperative warming therapies:a comparison of three devices. J Clin Anesth, 4:194-199, 1992.

12. Annetta MG. Postoperative shivering:prevention or treatment? Minerva Anestesiol, 88:425-427, 2022.

13. Théard MA, Tempelhoff R, Crowder CM, Cheng MA, Todorov A, Dacey RG Jr. Convection versus conduction cooling for induction of mild hypothermia during neurovascular procedures in adults. J Neurosurg Anesthesiol, 9:250-255, 1997.

14. Kawaguchi M, Inoue S, Sakamoto T, Kawaraguchi Y, Furuya H, Sakaki T. The effects of prostaglandin E1 on intraoperative temperature changes and the incidence of postoperative shivering during deliberate mild hypothermia for neurosurgical procedures. Anesth Analg, 88:446-451, 1999.

15. Inoue S, Kawaguchi M, Sakamoto T, Kitaguchi K, Furuya H, Sakaki T. High-dose amrinone is required to accelerate rewarming from deliberate mild intraoperative hypothermia for neurosurgical procedures. Anesthesiology, 97:116-123, 2002.

16. Baker KZ, Young WL, Stone JG, Kader A, Baker CJ, Solomon RA. Deliberate mild intraoperative hypothermia for craniotomy. Anesthesiology, 81:361-367, 1994.

17. Inoue S, Kawaguchi M, Sakamoto T, et al. Amrinone can accelerate the cooling rate of core temperature during deliberate mild hypothermia for neurosurgical procedures. Br J Anaesth, 86:663-668, 2001.

18. Iwata T, Inoue S, Kawaguchi M, et al. Comparison of the effects of sevoflurane and propofol on cooling and rewarming during deliberate mild hypothermia for neurosurgery. Br J Anaesth, 90:32-38, 2003.

19. Nakano J, Cole B. Effects of prostaglandin E 1 and F 2a on systemic pulmonary and splanchnic circulations in dogs. Am J Physiol, 217:222-227, 1969.

20. Cheng C, Matsukawa T, Sessler DI, et al. Increasing mean skin temperature linearly reduces the core-temperature thresholds for vasoconstriction and shivering in humans. Anesthesiology, 82:1160-1168, 1995.

21. Shitara T, Wajima Z, Ogawa R. Dobutamine infusion modifies thermoregulation during general anesthesia. Anesth Analg, 83:1154-1159, 1996.

22. Greene PS, Cameron DE, Mohlala ML, Dinatale JM, Gardner TJ. Systolic and diastolic left ventricular dysfunction due to mild hypothermia. Circulation, 80:III44-III48, 1989.

23. Baker KZ, Stone JG, Jackson L, et al. Intraoperative nitroprusside does not speed rewarming from mild hypothermia. J Neurosurg Anesthesiol, 7:316, 1995.

24. Kawaguchi M, Ishimura N, Kurehara K, Sakamoto T, Kitaguchi K, Furuya H. Mild hypothermia can attenuate nitroglycerin-induced vasodilation of pial arterioles in the cat. Anesth Analg, 86:546-551, 1998.

25. Berner M, Jaccard C, Oberhansli I, Rouge JC, Friedli B. Hemodynamic effects of amrinone in children after cardiac surgery. Intensive Care Med, 16:85-88, 1990.

26. Ikeda T, Kazama T, Sessler DI, et al. Induction of anesthesia with ketamine reduces the magnitude of redistribution hypothermia. Anesth Analg, 93:934-938, 2001.

27. Ikeda T, Sessler DI, Kikura M, Kazama T, Ikeda K, Sato S. Less core hypothermia when anesthesia is induced with inhaled sevoflurane than with intravenous propofol. Anesth Analg, 88:921-924, 1999.

28. Kelly FE, Nolan JP. The effects of mild induced hypothermia on the myocardium:a systematic review. Anaesthesia, 65:505-515, 2010.

29. Frank SM, Beattie C, Christopherson R, et al. Unintentional hypothermia is associated with postoperative myocardial ischemia. The Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology, 78:468-476, 1993.

30. Rohrer MJ, Natale AM. Effect of hypothermia on the coagulation cascade. Crit Care Med, 20:1402-1405, 1992.

31. Yoshihara H, Yamamoto T, Mihara H. Changes in coagulation and fibrinolysis occurring in dogs during hypothermia. Thromb Res, 37:503-512, 1985.

32. Valeri CR, Feingold H, Cassidy G, Ragno G, Khuri S, Altschule MD. Hypothermia-induced reversible platelet dysfunction. Ann Surg, 205:175-181, 1987.

33. Heier T, Caldwell JE, Sessler DI, Miller RD. Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isoflurane anesthesia in humans. Anesthesiology, 74:815-819, 1991.

34. Leslie K, Sessler DI, Bjorksten AR, Moayeri A. Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg, 80:1007-1014, 1995.

35. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med, 334:1209-1215, 1996.

36. Todd MM, Hindman BJ, Clarke WR, Torner JC. Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) Investigators. Mild intraoperative hypothermia during surgery for intracranial aneurysm. N Engl J Med, 352:135-145, 2005.

37. Alfonsi P. Postanaesthetic shivering. Epidemiology, pathophysiology and approaches to prevention and management. Minerva Anestesiol, 69:438-442, 2003.

38. Wadhwa A, Sengupta P, Durrani J, et al. Magnesium sulphate only slightly reduces the shivering threshold in humans. Br J Anaesth, 94:756-762, 2005.

39. Hasannasab B, Banihashem N, Khoshbakht A. Prophylactic Effects of Doxapram, Ketamine and Meperidine in Postoperative Shivering. Anesth Pain Med, 6:e27515, 2016.

40. Hindman BJ, Todd MM, Gelb AW, et al. Mild hypothermia as a protective therapy during intracranial aneurysm surgery: a randomized prospective pilot trial. Neurosurgery, 44:23-32, 1999.

41. Hindman BJ, Bayman EO, Pfisterer WK, Torner JC, Todd MM;IHAST Investigators. No association between intraoperative hypothermia or supplemental protective drug and neurologic outcomes in patients undergoing temporary clipping during cerebral aneurysm surgery:findings from the Intraoperative Hypothermia for Aneurysm Surgery Trial. Anesthesiology, 112:86-101, 2010.

42. Milani WR, Antibas PL, Prado GF. Cooling for cerebral protection during brain surgery. Cochrane Database Syst Rev:CD006638, 2011.

43. Li LR, You C, Chaudhary B. Intraoperative mild hypothermia for postoperative neurological deficits in people with intracranial aneurysm. Cochrane Database Syst Rev, 3:CD008445, 2016.

44. D’Souza S. Aneurysmal Subarachnoid Hemorrhage. J Neurosurg Anesthesiol, 27:222-240, 2015.