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Milde und moderate Hypothermie in der Anästhesie und Intensivmedizin — Neuroprotektive Ansätze

  • C. Werner
Conference paper
Part of the Refresher Course Aktuelles Wissen für Anästhesisten book series (REFRESHER COUR, volume 23)

Zusammenfassung

Die neuroprotektiven Effekte einer tiefen (28–17 °C) oder profunden (16–4 °C) Hy-pothermie sind seit Jahrzehnten bekannt, werden aber wegen spezifischer Nebenwirkungen nur bei besonderen Indikationen in Rahmen herzchirurgischer (extra-korporale Zirkulation, systemischer Kreislaufstillstand) oder neurochirurgischer Eingriffe (z.B. Resektion intrakranieller Aneurysmen oder anderer Gefäßfehlbildungen unter systemischem Kreislaufstillstand) genutzt. Das Interesse an den neuroprotektiven Effekten der Hypothermie hat in den vergangenen Jahren wieder stark zugenommen, nachdem tierexperimentelle und klinische Studien zeigen konnten, daß selbst durch milde (36–34 °C) oder moderate (33–29 °C) Hypothermie eine relevante Hirnprotektion erreichbar ist, ohne gleichzeitig gefährliche Nebenwirkungen auszulösen [1–3]. Die vorliegende Übersicht analysiert den Einfluß einer systemischen milden und moderaten Hypothermie auf den Hirnstoffwechsel und die Hirndurchblutung, die neuroprotektiven Mechanismen, sowie die Nebenwirkungen und Gefahren der systemischen Hypothermie.

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Literatur

  1. 1.
    Shiozaki T, Sugimoto H, Taneda M, Yoshida H, Iwai A, Yoshioka T, Sugimoto T: Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. J Neurosurg 1993; 79: 363–8PubMedCrossRefGoogle Scholar
  2. 2.
    Marion DW, Obrist WD, Carlier PM, Penrod LE, Darby JM: The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. J Neurosurg 1993; 79: 354–62PubMedCrossRefGoogle Scholar
  3. 3.
    Minamisawa H, Nordström C-H, Smith M-L, Siesjö BK: The influence of mild body and brain hypothermia on ischemic damage. J Cereb Blood Flow Metab 1990; 10: 365–74PubMedCrossRefGoogle Scholar
  4. 4.
    Nemoto EM, Klementavicius R, Melick JA, Yonas H: Suppression of cerebral metabolic rate for oxygen (CMRO2) by mild hypothermia compared with thiopental. J Neurosurg Anesth 1996; 8: 52–9CrossRefGoogle Scholar
  5. 5.
    Rosomoff HL, Holaday DA. Cerebral blood flow and cerebral oxygen consumption during hypothermia. Am J Physiol 1954; 179: 85–8PubMedGoogle Scholar
  6. 6.
    Prough DS, Rogers AT, Stump DA, Roy RC, Cordell AR, Phipps J, Taylor CL: Cerebral blood flow decreases with time whereas cerebral oxygen consumption remains stable during hypothermic cardiopulmonary bypass in humans. Anesth Analg 1991; 72: 161–8PubMedCrossRefGoogle Scholar
  7. 7.
    Verhaegen MJJ, Todd MM, Hindman BJ, Warner DS: Cerebral autoregulation during moderate hypothermia in rats. Stroke 1993; 24: 407–14PubMedCrossRefGoogle Scholar
  8. 8.
    Hindman BJ, Funatsu N, Harrington J, Cutkomp J, Dexter F, Todd MM, Tinker JH: Cerebral blood flow response to PaCO2 during hypothermic cardiopulmonary bypass in rabbits. Anesthesiology 1991; 75: 662–8PubMedCrossRefGoogle Scholar
  9. 9.
    Morikawa E, Ginsberg MD, Dietrich WD, Duncan RC, Kraydieh S, Globus MY-T, Busto R: The significance of brain temperature in focal cerebral ischemia: histopathological consequences of middle cerebral artery occlusion in the rat. J Cereb Blood Flow Metab 1992; 12: 380–9PubMedCrossRefGoogle Scholar
  10. 10.
    Busto R, Dietrich WD, Globus MY-T, Valdz I, Scheinberg P, Ginsberg MD: Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab 1987; 7: 729–38PubMedCrossRefGoogle Scholar
  11. 11.
    Weinrauch V, Safar P, Tisherman S, Kuboyama K, Radovsky A: Beneficial effect of mild hypothermia and detrimental effect of deep hypothermia after cardiac arrest in dogs. Stroke 1992; 23: 1454–62PubMedCrossRefGoogle Scholar
  12. 12.
    Steen PA, Milde JH, Michenfelder JD. The detrimental effects of prolonged hypothermia and rewarming in the dog. Anesthesiology 1980; 52: 224–30PubMedCrossRefGoogle Scholar
  13. 13.
    Steen PA, Soule EH, Michenfelder JD. Detrimental effect of prolonged hypothermia in cats and monkeys with and without regional cerebral ischemia. Stroke 1979; 10: 522–9PubMedCrossRefGoogle Scholar
  14. 14.
    Zhang R-L, Chopp M, Chen H, Garcia JH, Zhang ZG: Postischemic (1 hour) hypothermia significantly reduces ischemic cell damage in rats subjected to 2 hours of middle cerebral artery occlusion. Stroke 1993; 24: 1235–40PubMedCrossRefGoogle Scholar
  15. 15.
    Hoffman WE, Werner C, Baughman VL, Thomas C, Miletich DJ, Albrecht RF: Postischemic treatment with hypothermia improves outcome from incomplete cerebral ischemia in rats. J Neurosurg Anesth 1991; 3: 34–8CrossRefGoogle Scholar
  16. 16.
    Kuboyama K, Safar P, Radovsky A, Tisherman SA, Stezoski SW, Alexander H: Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac arrest in dogs: A prospcetive, randomized study. Crit Care Med 1993; 21: 1348–58PubMedCrossRefGoogle Scholar
  17. 17.
    Clifton GL, Jiang JY, Lyeth BG, Jenkins LW, Hamm RJ, Hayes RL: Marked protection by moderate hypothermia after experimental traumatic brain injury. J Cereb Blood Flow Metab 1991; 11: 114–21PubMedCrossRefGoogle Scholar
  18. 18.
    Lazorthes G, Campan L: Hypothermia in the treatment of craniocerebral traumatism. J Neurosurg 1985; 15: 162–7Google Scholar
  19. 19.
    Sedzimir CB: Therapeutic hypothermia in cases of head injury. J Neurosurg 1959; 16: 407–14.PubMedCrossRefGoogle Scholar
  20. 20.
    Drake CG, Jory TA: Hypothermia in the treatment of critical head injury. Canad Med Ass J 1962; 87: 887–91PubMedGoogle Scholar
  21. 21.
    Hendrick EB: The use of hypothermia in severe head injuries in childhood. Arch Surg 1969; 79: 362–4Google Scholar
  22. 22.
    Clifton GL, Allen S, Barrodale P, Plenger P, Berry J, Koch S, Fletcher J, Hayes RL, Choi SC: A phase II study of moderate hypothermia in severe brain injury. J Neurotrauma 1993; 10: 263–71PubMedCrossRefGoogle Scholar
  23. 23.
    Metz C, Holzschuh M. Bein T, Woertgen C, Frey A, Frey I, Taeger K, Brawanski A: Moderate hypothermia in patients with severe head injury: cerebral and extracerebral effects. J Neurosurg 1996, 85: 533–41PubMedCrossRefGoogle Scholar
  24. 24.
    Karibe H, Zarow GJ, Graham SH, Weinstein PR: Mild intraischemic hypothermia reduces postischemic hyperperfusion, delayed hypoperfusion, blood-brain barrier disruption, brain edema, and neuronal damage volume after temporary focal cerebral ischemia in rats. J Cereb Blood Flow Metab 1994; 14: 620–7PubMedCrossRefGoogle Scholar
  25. 25.
    Illievich UM, Zornow MH, Choi KT et al. Effects of hypothermia or anesthetics on hippocampus glutamate and glycine concentrations after repeated transient global cerebral ischemia. Anesthesiology 1994; 80: 177–86PubMedCrossRefGoogle Scholar
  26. 26.
    Schubert A: Side effects of mild hypothermia. J Neurosurg Anesth 1995; 7: 139–47CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1996

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  • C. Werner

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