Abstract
Background: Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during temporary occlusion of the cerebral vasculature during intracranial aneurysm surgery (temporary clipping) is not established. Methods: A post hoc analysis of patients from the Intraoperative Hypothermia for Aneurysm Surgery Trial who underwent temporary clipping was performed. Univariate and multivariate logistic regression Methods were used to test for associations between hypothermia, supplemental protective drug, and short-(24-h) and long-term (3-month) neurologic outcomes. An odds ratio more than 1 denotes better outcome. Results: Patients undergoing temporary clipping (n = 441) were assigned to intraoperative hypothermia (33.3° ± 0.8°C, n = 208) or normothermia (36.7° ± 0.5°C, n = 233), with 178 patients also receiving supplemental protective drug (thiopental or etomidate) during temporary clipping. Three months after surgery, 278 patients (63%) had good outcome (Glasgow Outcome Score = 1). Neither hypothermia (P = 0.847; odds ratio = 1.043, 95% CI = 0.678-1.606) nor supplemental protective drug (P = 0.835; odds ratio = 1.048, 95% CI = 0.674-1.631) were associated with 3-month Glasgow Outcome Score. The effect of supplemental protective drug did not significantly vary with temperature. The effects of hypothermia and protective drug did not significantly vary with temporary clip duration. Similar findings were made for 24-h neurologic status and 3-month Neuropsychological Composite Score. CONCLUSION: In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short-or long-term neurologic outcomes of patients undergoing temporary clipping.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 86-101 |
| Number of pages | 16 |
| Journal | Anesthesiology |
| Volume | 112 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2010 |
Bibliographical note
Funding Information:Received from Department of Anesthesia, Carver College of Medicine and the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa. Supported by grant No. R01 NS38554 from the National Institute of Neurological Disease and Stroke, Bethesda, Maryland (to M.M.T.) . Additional funding was provided by the Department of Anesthesia, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa.
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In: Anesthesiology, Vol. 112, No. 1, 01.2010, p. 86-101.
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TY - JOUR
T1 - No association between intraoperative hypothermia or supplemental protective drug and neurologic outcomes in patients undergoing temporary clipping during cerebral aneurysm surgery
T2 - Findings from the intraoperative hypothermia for aneurysm surgery trial
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N1 - Funding Information: Received from Department of Anesthesia, Carver College of Medicine and the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa. Supported by grant No. R01 NS38554 from the National Institute of Neurological Disease and Stroke, Bethesda, Maryland (to M.M.T.) . Additional funding was provided by the Department of Anesthesia, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa.
PY - 2010/1
Y1 - 2010/1
N2 - Background: Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during temporary occlusion of the cerebral vasculature during intracranial aneurysm surgery (temporary clipping) is not established. Methods: A post hoc analysis of patients from the Intraoperative Hypothermia for Aneurysm Surgery Trial who underwent temporary clipping was performed. Univariate and multivariate logistic regression Methods were used to test for associations between hypothermia, supplemental protective drug, and short-(24-h) and long-term (3-month) neurologic outcomes. An odds ratio more than 1 denotes better outcome. Results: Patients undergoing temporary clipping (n = 441) were assigned to intraoperative hypothermia (33.3° ± 0.8°C, n = 208) or normothermia (36.7° ± 0.5°C, n = 233), with 178 patients also receiving supplemental protective drug (thiopental or etomidate) during temporary clipping. Three months after surgery, 278 patients (63%) had good outcome (Glasgow Outcome Score = 1). Neither hypothermia (P = 0.847; odds ratio = 1.043, 95% CI = 0.678-1.606) nor supplemental protective drug (P = 0.835; odds ratio = 1.048, 95% CI = 0.674-1.631) were associated with 3-month Glasgow Outcome Score. The effect of supplemental protective drug did not significantly vary with temperature. The effects of hypothermia and protective drug did not significantly vary with temporary clip duration. Similar findings were made for 24-h neurologic status and 3-month Neuropsychological Composite Score. CONCLUSION: In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short-or long-term neurologic outcomes of patients undergoing temporary clipping.
AB - Background: Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during temporary occlusion of the cerebral vasculature during intracranial aneurysm surgery (temporary clipping) is not established. Methods: A post hoc analysis of patients from the Intraoperative Hypothermia for Aneurysm Surgery Trial who underwent temporary clipping was performed. Univariate and multivariate logistic regression Methods were used to test for associations between hypothermia, supplemental protective drug, and short-(24-h) and long-term (3-month) neurologic outcomes. An odds ratio more than 1 denotes better outcome. Results: Patients undergoing temporary clipping (n = 441) were assigned to intraoperative hypothermia (33.3° ± 0.8°C, n = 208) or normothermia (36.7° ± 0.5°C, n = 233), with 178 patients also receiving supplemental protective drug (thiopental or etomidate) during temporary clipping. Three months after surgery, 278 patients (63%) had good outcome (Glasgow Outcome Score = 1). Neither hypothermia (P = 0.847; odds ratio = 1.043, 95% CI = 0.678-1.606) nor supplemental protective drug (P = 0.835; odds ratio = 1.048, 95% CI = 0.674-1.631) were associated with 3-month Glasgow Outcome Score. The effect of supplemental protective drug did not significantly vary with temperature. The effects of hypothermia and protective drug did not significantly vary with temporary clip duration. Similar findings were made for 24-h neurologic status and 3-month Neuropsychological Composite Score. CONCLUSION: In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short-or long-term neurologic outcomes of patients undergoing temporary clipping.
UR - http://www.scopus.com/inward/record.url?scp=74049151086&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=74049151086&partnerID=8YFLogxK
U2 - 10.1097/ALN.0b013e3181c5e28f
DO - 10.1097/ALN.0b013e3181c5e28f
M3 - Article
C2 - 19952722
AN - SCOPUS:74049151086
SN - 0003-3022
VL - 112
SP - 86
EP - 101
JO - Anesthesiology
JF - Anesthesiology
IS - 1
ER -