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1. Perioperative Hypothermia (33°C) Does Not Increase the Occurrence of Cardiovascular Events in Patients Undergoing Cerebral Aneurysm Surgery

Author

D. Chartrand, Michael Beven, C. Salem, W. Burnett, S. Jackson, G. Downey, Michael T. Lawton, S. Lownie, R. Tack, E. Dy, Tord D. Alden, David R. McIlroy, Lis Evered, K. Lukitto, L. Kirby, Thomas A. Moore, R. Popovic, N. Robertson, Patrick W. Hitchon, A. Ashtari, R. Elbe, N. F. Kassell, D. Dulli, A. Wyss, G. Ghazali, S. Rice, Gavin W. Britz, P. Bennett, Karen B. Domino, A. Shahen, D. Dehring, Robert Greif, Argye E. Hillis, L. Meng, D. Fishback, Fred Gentili, Mark Buckland, B. Schaefer, H. Madder, C. Weasler, Anish Bhardwaj, E. Thomson, Ramez W. Kirollos, Basil F. Matta, Kevin H. Siu, H. Machlin, W. Pfisterer, A. Freymuth, N. Badner, R. Wilson, R. Grauer, Zhiyi Zuo, A. McAllister, Z. Sha, A. Rushton, D. Hill, William T. Clarke, L. Jensen, G. Heard, L. Clark, D. Chatfield, J. Haartsen, Jing Wang, S. Nobles, Renee Testa, P. D'Urso, Hossam El-Beheiry, David J. Stone, James C. Torner, Michael J. Souter, A. Meyer, Marek A. Mirski, Marlan R. Hansen, W. Jenkins, L. Pobereskin, J. Walkes, M. Quigley, R. Struthers, James H McMahon, Howard A. Riina, Behnam Badie, P. Heppner, Simon Jones, R. Silbergleit, Thomas N. Pajewski, T. Broderick, Katherine Harris, P. Smythe, N. Duggal, J. Quaedackers, J. Mason, P. E. Bickler, P. McNeill, V. Roelfsema, I. Gibmeier, C. Chambers, H. Gramke, D. Campbell, T. Novick, O. Moise, J. Woletz, Lorri A. Lee, H. Van Aken, Adrian W. Gelb, A. Kane, B. Rapf, Martin S. Angst, S. Shaikh, D. Sirhan, C. Miller, B. Hodkinson, D. Leggett, F. Johnson, Harry J. M. Lemmens, M. Langley, Y. Young, Jeffrey V. Rosenfeld, C. Moy, W. Hamm, C. Hall, G. Henry, R. Burnstein, Lisa Hannegan, A. Buchmann, R. Schatzer, Bruce P. Hermann, John E. McGillicuddy, Bruno Giordani, John C. VanGilder, Keith H. Berge, D. Sage, L. Sternau, N. Page, Marc R. Mayberg, B Thompson, T. Hartman, Laurel E. Moore, S. Bhatia, Richard A. Jaffe, G. Seever, D. Cowie, Jonathan G. Zaroff, C. Duffy, Deborah A. Rusy, Elana Farace, H R Winn, Paul H. Ting, R. Spinka, J. Marler, Patricia H. Petrozza, S. Harding, Lauren C. Berkow, E. Cunningham, D. Bisnaire, D. Wilhite, P. Blanton, S. Laurent, O. Odukoya, Issam A. Awad, P. Chery, C. Lind, B. Bauer, D. Lindholm, K. Kieburtz, J. Ormrod, Michael P. Murphy, Timothy G. Short, Y. Painchaud, R. Peters, Peter C. Whitfield, D. Bain, B. Hindman, A. Shelton, A. Morris, D. Milovan, L. Salvia, William L. Young, S. Wallace, W. Lilley, H. Yi, R. Chelliah, David W. Newell, R. Deam, John Laidlaw, P. Mak, J. Woelfer, K. Graves, Peter M. C. Wright, D. Van Alstine, M. Hemstreet, Phillip A. Scott, Steven D. Chang, S. Poustie, M. Clausen, I. Herrick, Daniel H. Kim, Vladimir Zelman, John L.D. Atkinson, Marcel E. Durieux, Alessandro Olivi, G. Smith, James R. Munis, F. Vasarhelyi, S. Olson, C. Greiner, C. Hoenemann, G. Kleinpeter, J. Kish, Daniel K. Resnick, J. Lang, Dhanesh K. Gupta, E. Knosp, N. Monteiro de Oliveira, D. Moskopp, Carin A. Hagberg, J. Howell, Klaus Hahnenkamp, Gregory M. Davis, T. Phan, Paul S. Myles, C. Beven, F. Salevsky, Maria Matuszczak, E. Mee, David L. Bogdonoff, P. Berklayd, J. Freyhoff, P. Tanzi, A. Law, Barbara A. Dodson, Z. Thayer, R. Govindaraj, Alex Konstantatos, Ralph F. Frankowski, Pirjo H. Manninen, David G. Piepgras, K. Willmann, E. Babayan, Donald S. Prough, Leslie C. Jameson, John A. Wilson, Mary Pat McAndrews, M. Abou-Madi, Steven S. Glazier, Vincent C. Traynelis, Derek A. Taggard, Fredric B. Meyer, C. Bradfield, Hoang P. Nguyen, Mary L. Marcellus, J. Ogden, M. Maleki, M. Lotto, Michael A. Olympio, C. Merhaut, D. Nye, K. Webb, Richard Leblanc, Nichol McBee, William L. Lanier, A. Molnar, Peter J. Lennarson, S. Wadanamby, H. Hulbert, Christopher R. Turner, H. Fraley, Kevin K. Tremper, Sesto Cairo, J. Shafer, J. Krugh, D. Blair, L. Coghlan, P. Schmid, K. O'Brien, K. Littlewood, T. Anderson, R. Eliazo, S. Wirtz, Carol B. Applebury, Jennifer O. Hunt, S. Hickenbottom, Hendrik Freise, Gary D. Steinberg, M. Woodfield, Robert J. Dempsey, Kirk J. Hogan, M. Harrison, H. Stanko, Teresa Bell-Stephens, N. Merah, T. Blount, J. Sanders, J. Biddulph, Tsutomu Sasaki, F. Mensink, P. Balestrieri, Lisa D. Ravdin, H. Lohmann, M. Todd, James Gebel, Lawrence Litt, Christoph Schul, B. White, Bradley J. Hindman, S. Salerno, A. James, D. Manke, Mvon Lewinski, D. Luu, Michael M. Todd, A. Drnda, S. Salsbury, J. Palmisano, L. Connery, Michael Tymianski, E. Tuffiash, Cynthia A. Lien, R. Sawyer, A. Sills, D. Sinclair, J. Bramhall, Ira J. Rampil, David M. Colonna, M. Geraghty, Steven W. Anderson, V. Petty, S. Pai, J. Sheehan, S. Black, K. English, N. Scurrah, Diana G. McGregor, P. Davies, P. Doyle-Pettypiece, H. Bone, Neal J. Naff, M. Lenaerts, James Mitchell, K. Pedersen, Matthew A. Howard, M. Angliss, Daniel Tranel, Bongin Yoo, M. Irons, Emine O. Bayman, C. Skilbeck, Nicholas G. Bircher, Wendy C. Ziai, S. Micallef, Chuanyao Tong, Kathryn Chaloner, Mark T. Wallace, John Moloney, Gavin Fabinyi, P. Sutton, Edward C. Nemergut, Elizabeth Richardson, C. McCleary, M. Graf, Mrinalini Balki, P. Porter, James J. Evans, A. Prabhu, L. Kim, R. Hendrickson, A. Dashfield, V. Portman, Michel T. Torbey, J. Kruger, Donna L. Auer, J. Sorenson, Patricia H. Davis, John A. Walker, M. Mosier, H. Smith, J. Heidler, Andrew Silvers, P. Fogarty-Mack, William F. Chandler, F. Shutway, F. Rasulo, S. Alatakis, Stephen Samples, A. Wray, Henry H. Woo, John A. Ulatowski, Steven L. Giannotta, D. Chandrasekara, J. Sturm, S. Crump, Peter A. Rasmussen, Max R. Trenerry, D. Novy, Wink S. Fisher, N. Quinnine, F. Bardenhagen, M. Angle, W. Ng, G. Ferguson, A. Blackwell, Christopher M. Loftus, James H. Fitzpatrick, David S. Warner, E. Tuerkkan, W. Kutalek, Ferenc E. Gyulai, D. Daly, Helen Fletcher, J. Smith, Mazen A. Maktabi, Howard Yonas, J. Sneyd, M. Menhusen, Johnny E. Brian, K. Smith, R. Watson, T. Weber, D. Greene-Chandos, M. Wichman, Peter Szmuk, J. Birrell, Pekka Talke, J. Jane, L. Atkins, J. Smart, T. Han, B. O'Brien, R. Mattison, Bermans J. Iskandar, J. Ridgley, S. Dalrymple, L. Lindsey, D. Anderson, Julie B. Weeks, M. Felmlee-Devine, P. Deshmukh, D. Ellegala, L. Moss, A. Mathur, F. Lee, F. Sasse, H. Macgregor, R. Peterson, Margaret R. Weglinski, Karen Lane, Daniele Rigamonti, L. Carriere, Mark Wilson, R. Morgan, T. Costello, C. Thien, Arthur M. Lam, H. Bybee, C. Salmond, Robert E. Breeze, Peter Karzmark, Monica S. Vavilala, S. Yantha, Philip E. Stieg, Guy L. Clifton, Kenneth Manzel, D. Papworth, Rafael J. Tamargo, Rosemary A. Craen, Harold P. Adams, B. Radziszewska, Y. Kuo, Satwant K. Samra, B. Frankel, R. Fry, T. Cunningham, M. Mosa, M. McTaggart, F. Steinman, Alex Abou-Chebl, Michael J. Link, Rona G. Giffard, N. Lapointe, C. Meade, Robert F. Bedford, J. Cormack, Robert P. From, J. Reynolds, Paul A. Leonard, K. Quader, N. Subhas, C. Lothaller, S. Ryan, J. Winn, H. Brors, Amin B. Kassam, A. Gelb, J. Zaroff, Gregory M. Malham, A. Redmond, Gordon J. Chelune, J. Findlay, Zeyd Ebrahim, L. Forlano, Mark E. Shaffrey, C. Chase, Peter J. Kirkpatrick, Armin Schubert, L. Koller, Jana E. Jones, P. Li, and B. Chen

Subjects
medicine.medical_specialty, Subarachnoid hemorrhage, Interventional cardiology, business.industry, Vascular disease, Perioperative, Hypothermia, medicine.disease, Preoperative care, Anesthesiology and Pain Medicine, Aneurysm, Anesthesia, Anesthesiology, Medicine, medicine.symptom, business
Abstract

Background Perioperative hypothermia has been reported to increase the occurrence of cardiovascular complications. By increasing the activity of sympathetic nervous system, perioperative hypothermia also has the potential to increase cardiac injury and dysfunction associated with subarachnoid hemorrhage. Methods The Intraoperative Hypothermia for Aneurysm Surgery Trial randomized patients undergoing cerebral aneurysm surgery to intraoperative hypothermia (n = 499, 33.3 degrees +/- 0.8 degrees C) or normothermia (n = 501, 36.7 degrees +/- 0.5 degrees C). Cardiovascular events (hypotension, arrhythmias, vasopressor use, myocardial infarction, and others) were prospectively followed until 3-month follow-up and were compared in hypothermic and normothermic patients. A subset of 62 patients (hypothermia, n = 33; normothermia, n = 29) also had preoperative and postoperative (within 24 h) measurement of cardiac troponin-I and echocardiography to explore the association between perioperative hypothermia and subarachnoid hemorrhage-associated myocardial injury and left ventricular function. Results There was no difference between hypothermic and normothermic patients in the occurrence of any single cardiovascular event or in composite cardiovascular events. There was no difference in mortality (6%) between groups, and there was only a single primary cardiovascular death (normothermia). There was no difference between hypothermic and normothermic patients in postoperative versus preoperative left ventricular regional wall motion or ejection fraction. Compared with preoperative values, hypothermic patients had no postoperative increase in cardiac troponin-I (median change 0.00 microg/l), whereas normothermic patients had a small postoperative increase (median change + 0.01 microg/l, P = 0.038). Conclusion In patients undergoing cerebral aneurysm surgery, perioperative hypothermia was not associated with an increased occurrence of cardiovascular events.

Published
2010
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2. No Association between Intraoperative Hypothermia or Supplemental Protective Drug and Neurologic Outcomes in Patients Undergoing Temporary Clipping during Cerebral Aneurysm Surgery

Author

John A. Ulatowski, Steven L. Giannotta, J. Sturm, D. Cowie, D. Novy, N. Quinnine, James H. Fitzpatrick, David S. Warner, Ferenc E. Gyulai, D. Daly, S. Rice, H. Machlin, William T. Clarke, Philip E. Bickler, H. Van Aken, M. Langley, M. von Lewinski, G. Kleinpeter, J. Freyhoff, A. Morris, L. Salvia, Peter M. C. Wright, Wolfgang K. Pfisterer, K. English, M. Lenaerts, Nicholas G. Bircher, Simon Jones, L. Jensen, Issam A. Awad, P. Chery, B. Schaefer, S. Wallace, F. Johnson, H. Smith, J. Biddulph, T. Cunningham, N. Monteirode Oliveira, R. Watson, A. McAllister, D. Moskopp, Patricia H. Petrozza, B. Hindman, A. Shelton, D. Manke, F. Steinman, D. Luu, Alex Abou-Chebl, J. Birrell, M. Irons, J. Ridgley, Gavin Fabinyi, S. Alatakis, Basil F. Matta, James J. Evans, A. Prabhu, Rona G. Giffard, H. Gramke, Hendrik Freise, K. Graves, P. Fogarty-Mack, L. Clark, Wink S. Fisher, K. Smith, Renee Testa, P. D'Urso, A. Freymuth, James C. Torner, M. Wallace, R. Struthers, Howard A. Riina, Z. Thayer, Daniel Tranel, E. Knosp, E. Dy, Tord D. Alden, Henry H. Woo, Bruce P. Hermann, John C. VanGilder, Douglas Campbell, N. Lapointe, Gavin W. Britz, J. Sheehan, C. Meade, M. Balki, C. Bradfield, Alessandro Olivi, P. Doyle-Pettypiece, Robert F. Bedford, F. Bardenhagen, M. Angle, Donald S. Prough, John E. McGillicuddy, A. Drnda, M. Abou-Madi, S. Black, David R. McIlroy, Lis Evered, S. Poustie, J. Cormack, J. Sneyd, M. Menhusen, William L. Lanier, M. Maleki, T. Phan, D. Nye, M. Graf, Michael A. Olympio, N. Robertson, Teresa Bell-Stephens, E. Tuerkkan, N. Merah, S. Olson, L. Kirby, L. Moss, Peter Heppner, Thomas A. Moore, J. Bramhall, H. Madder, Christopher R. Turner, H. Fraley, James Mitchell, K. Pedersen, M. Angliss, Robert P. From, Y. Painchaud, Gary D. Steinberg, J. Woelfer, K. Littlewood, T. Anderson, J. Palmisano, M. Clausen, Paul H. Ting, Lisa D. Ravdin, H. Lohmann, R. Burnstein, R. Popovic, T. Hartman, D. Anderson, Julie B. Weeks, H. Macgregor, Kirk J. Hogan, D. Chatfield, Daniel H. Kim, James R. Munis, J. Lang, J. Reynolds, Michael M. Todd, F. Mensink, L. Pobereskin, J. Walkes, Mary Pat McAndrews, A. Sills, Bongin Yoo, P. Balestrieri, S. Micallef, Mary L. Marcellus, J. Wang, Kathryn Chaloner, Patrick W. Hitchon, Paul A. Leonard, C. McCleary, Lawrence Litt, N. Subhas, Wendy C. Ziai, James H McMahon, V. Petty, P. Smythe, G. Heard, Michael J. Souter, R. Hendrickson, A. Dashfield, V. Portman, Edward C. Nemergut, Patricia H. Davis, W. Burnett, M. Lotto, Y. Young, S. Jackson, J. Quaedackers, S. Ryan, Helen Fletcher, A. Ashtari, N. F. Kassell, Anish Bhardwaj, E. Thomson, Ramez W. Kirollos, Margaret R. Weglinski, Karen Lane, Daniele Rigamonti, J. Winn, Bradley J. Hindman, S. Salerno, L. Kim, R. Sawyer, Peter J. Lennarson, S. Wadanamby, Zhiyi Zuo, William F. Chandler, F. Shutway, P. Bennett, C. Merhaut, D. Hill, J. Haartsen, N. Badner, T. Weber, Rafael J. Tamargo, D. Fishback, Rosemary A. Craen, Michel T. Torbey, O. Odukoya, D. Chartrand, J. Jane, Michael T. Lawton, A. Buchmann, Richard A. Jaffe, P. Berklayd, T. Blount, J. Sanders, J. Marler, L. Meng, R. Grauer, Y. Kuo, O. Moise, P. Tanzi, R. Govindaraj, Alex Konstantatos, D. Greene-Chandos, G. Downey, M. Wichman, D. Chandrasekara, Amin B. Kassam, Max R. Trenerry, R. Elbe, A. Wyss, R. Peterson, D. Sirhan, C. Miller, Marek A. Mirski, Stephen Samples, H. Brors, Michael Beven, M. Woodfield, William L. Young, D. Leggett, A. Wray, Karen B. Domino, Robert Greif, Argye E. Hillis, Gary G. Ferguson, Steven S. Glazier, J. Shafer, J. Krugh, I. Gibmeier, G. Ghazali, W. Ng, R. Tack, R. Schatzer, B. O'Brien, Bermans J. Iskandar, B. Bauer, C. Lind, C. Weasler, Michael Tymianski, E. Tuffiash, W. Hamm, C. Hall, L. Sternau, N. Page, Marc R. Mayberg, B Thompson, Richard Leblanc, A. Shahen, Laurel E. Moore, S. Bhatia, Nichol McBee, P. Davies, James Gebel, Cynthia A. Lien, J. Ormrod, David M. Colonna, D. Dehring, A. Rushton, P. Blanton, C. Lothaller, Diana G. McGregor, S. Harding, Lauren C. Berkow, D. Van Alstine, M. Hemstreet, A. Blackwell, Christopher M. Loftus, Klaus Hahnenkamp, J. Woletz, D. Lindholm, K. Kieburtz, M. Geraghty, Steven W. Anderson, D. Dulli, M. McTaggart, Fred Gentili, Johnny E. Brian, R. Peters, C. Greiner, Marlan R. Hansen, W. Jenkins, T. Broderick, Katherine Harris, B. Radziszewska, Maria Matuszczak, David L. Bogdonoff, K. Quader, Pekka Talke, B. Hodkinson, C. Hoenemann, C. Duffy, Deborah A. Rusy, R. Silbergleit, J. Findlay, Gregory M. Davis, J. Ogden, Adrian W. Gelb, A. Kane, Satwant K. Samra, E. Babayan, S. Dalrymple, Harry J. M. Lemmens, Tsutomu Sasaki, Lisa Hannegan, R. Eliazo, B. Frankel, D. Bisnaire, F. Salevsky, Michael J. Link, Jeffrey V. Rosenfeld, D. Sage, D. Sinclair, Keith H. Berge, D. Wilhite, Steven D. Chang, J. Kish, Carin A. Hagberg, Matthew A. Howard, Elizabeth Richardson, Peter C. Whitfield, D. Bain, Barbara A. Dodson, S. Crump, David G. Piepgras, John A. Wilson, David W. Newell, R. Deam, John Laidlaw, K. Willmann, J. Heidler, Vincent C. Traynelis, K. Webb, P. Li, A. Mathur, S. Hickenbottom, S. Wirtz, L. Lindsey, H. Stanko, Mark Wilson, S. Salsbury, L. Connery, Robert J. Dempsey, Edward W. Mee, R. Morgan, Ira J. Rampil, V. Roelfsema, Christoph Schul, B. White, A. James, N. Scurrah, C. Thien, Arthur M. Lam, P. Mak, Behnam Badie, Guy L. Clifton, R. Wilson, J. Kruger, Donna L. Auer, M. Mosier, S. Nobles, David J. Stone, A. Law, Timothy G. Short, W. Lilley, H. Yi, Marcel E. Durieux, Daniel K. Resnick, Dhanesh K. Gupta, Paul S. Myles, C. Beven, Thomas N. Pajewski, J. Mason, P. McNeill, F. Lee, Bruno Giordani, Leslie C. Jameson, G. Seever, Stephen P. Lownie, Fredric B. Meyer, P. Porter, K. O'Brien, Vladimir Zelman, John L.D. Atkinson, A. Molnar, H. Hulbert, S. Pai, Neal J. Naff, S. Shaikh, M. Mosa, Pirjo H. Manninen, Derek A. Taggard, Ian A. Herrick, Mark E. Shaffrey, Carol B. Applebury, C. Chase, Neil Duggal, Mark Buckland, M. Quigley, D. Milovan, Michael J. Harrison, Peter J. Kirkpatrick, Armin Schubert, R. Mattison, Ralph F. Frankowski, R. Chelliah, Jana E. Jones, J. Howell, H. Bone, Emine O. Bayman, P. Deshmukh, C. Skilbeck, P. Sutton, B. Chen, L. Carriere, J. Sorenson, Andrew Silvers, F. Sasse, F. Rasulo, Gordon J. Chelune, Zeyd Ebrahim, L. Forlano, Chuanyao Tong, John Moloney, Michael P. Murphy, S. Yantha, W. Kutalek, Kevin K. Tremper, C. Chambers, Sesto Cairo, Robert E. Breeze, A. Meyer, Monica S. Vavilala, C. Salem, H. El-Beheiry, Gregory M. Malham, A. Redmond, L. Koller, Kenneth Manzel, D. Papworth, C. Moy, G. Henry, Elana Farace, H R Winn, E. Cunningham, B. Rapf, J. Smith, Mazen A. Maktabi, Howard Yonas, D. Ellegala, Kevin H. Siu, Lorri A. Lee, Phillip A. Scott, K. Lukitto, Jennifer O. Hunt, D. Blair, P. Schmid, M. Felmlee-Devine, Peter A. Rasmussen, Peter Szmuk, L. Atkins, J. Smart, T. Han, T. Costello, H. Bybee, C. Salmond, Peter Karzmark, Philip E. Stieg, Harold P. Adams, T. Novick, Z. Sha, Martin S. Angst, S. Laurent, G. Smith, F. Vasarhelyi, R. A. Fry, and John A. Walker

Subjects
medicine.medical_specialty, business.industry, Vascular disease, Glasgow Outcome Scale, Odds ratio, Hypothermia, medicine.disease, law.invention, Surgery, Anesthesiology and Pain Medicine, Aneurysm, Randomized controlled trial, law, Anesthesia, Anesthesiology, Medicine, medicine.symptom, business, Prospective cohort study
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 degrees +/- 0.8 degrees C, n = 208) or normothermia (36.7 degrees +/- 0.5 degrees 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.

Published
2010
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3. Perioperative fever and outcome in surgical patients with aneurysmal subarachnoid hemorrhage

Author

David G. Piepgras, David R. McIlroy, John A. Wilson, H. Yi, Lis Evered, J. Sheehan, Marcel E. Durieux, Daniel K. Resnick, L. Kirby, M. Abou-Madi, Michael A. Olympio, Dhanesh K. Gupta, Peter Heppner, Thomas A. Moore, Paul S. Myles, S. Wirtz, Richard Leblanc, C. Beven, Robert J. Dempsey, Edward W. Mee, Nichol McBee, P. Davies, V. Roelfsema, Christoph Schul, B. White, Leslie C. Jameson, A. James, R. Popovic, Kirk J. Hogan, Fredric B. Meyer, Klaus Hahnenkamp, Patrick W. Hitchon, L. Clark, M. Geraghty, Qian Shi, R. Struthers, Howard A. Riina, A. Drnda, D. Chartrand, Bradley J. Hindman, S. Salerno, E. Knosp, J. Bramhall, Bruce P. Hermann, A. Ashtari, N. F. Kassell, Steven W. Anderson, Maria Matuszczak, David L. Bogdonoff, B. Schaefer, John C. VanGilder, K. O'Brien, A. McAllister, D. Luu, L. Jensen, Issam A. Awad, P. Chery, S. Wallace, H. Smith, N. Monteirode Oliveira, G. Downey, R. Elbe, A. Wyss, E. Babayan, J. Woletz, H. Gramke, M. Irons, Gavin Fabinyi, O. Odukoya, R. Hendrickson, Vincent C. Traynelis, A. Dashfield, V. Portman, Alessandro Olivi, James J. Evans, A. Prabhu, Peter C. Whitfield, Gary D. Steinberg, S. Rice, H. Machlin, D. Bisnaire, P. Berklayd, G. Kleinpeter, Patricia H. Davis, D. Bain, William F. Chandler, R. Wilson, W. Ng, K. Webb, F. Shutway, D. Manke, W. Pfisterer, K. Smith, M. Mosa, Michael M. Todd, R. Tack, Philip E. Bickler, S. Alatakis, A. Shahen, D. Dehring, David W. Newell, A. Sills, K. Lukitto, Wink S. Fisher, R. Watson, Teresa Bell-Stephens, Donald S. Prough, M. Maleki, D. Nye, M. Graf, S. Nobles, David J. Stone, Hendrik Freise, R. Deam, John Laidlaw, K. Quader, Douglas Campbell, Fred Gentili, S. Hickenbottom, Marlan R. Hansen, W. Jenkins, T. Broderick, Katherine Harris, Gavin W. Britz, M. Langley, Mary Pat McAndrews, Wendy C. Ziai, Behnam Badie, C. Duffy, Deborah A. Rusy, K. Littlewood, T. Anderson, J. Palmisano, H. Stanko, Henry H. Woo, Edward C. Nemergut, C. Bradfield, A. Molnar, John A. Walker, Christina M. Spofford, D. Dulli, A. Kane, J. Birrell, Harry J. M. Lemmens, M. Lotto, Y. Young, J. Biddulph, T. Cunningham, L. Kim, K. Graves, B. Radziszewska, S. Salsbury, Lawrence Litt, S. Black, F. Bardenhagen, M. Angle, L. Connery, Lisa Hannegan, Helen Fletcher, John A. Ulatowski, Steven L. Giannotta, J. Sturm, R. Sawyer, H. Hulbert, A. Morris, James Mitchell, M. von Lewinski, C. Merhaut, L. Salvia, A. Freymuth, James C. Torner, D. Cowie, Bongin Yoo, Y. Kuo, S. Micallef, Kathryn Chaloner, Neil Duggal, J. Ogden, Peter M. C. Wright, K. Pedersen, C. McCleary, P. Mak, Paul H. Ting, S. Shaikh, B. Hodkinson, J. Sneyd, D. Novy, M. Menhusen, N. Quinnine, James H. Fitzpatrick, Timothy G. Short, M. Angliss, R. Burnstein, D. Moskopp, N. Robertson, Mark Buckland, Jeffrey V. Rosenfeld, W. Lilley, T. Phan, D. Greene-Chandos, M. Wichman, David S. Warner, M. Quigley, P. Tanzi, Ferenc E. Gyulai, D. Daly, Satwant K. Samra, B. Frankel, D. Wilhite, L. Lindsey, K. English, M. Lenaerts, Michel T. Torbey, T. Hartman, John E. McGillicuddy, R. Govindaraj, Alex Konstantatos, M. Woodfield, Steven S. Glazier, Steven D. Chang, C. Greiner, F. Steinman, Alex Abou-Chebl, G. Heard, S. Yantha, Michael J. Souter, C. Hoenemann, Nicholas G. Bircher, H. Van Aken, S. Poustie, D. Hill, J. Kish, Carin A. Hagberg, A. Buchmann, B. O'Brien, J. Shafer, J. Krugh, D. Chandrasekara, R. Eliazo, Mary L. Marcellus, Anish Bhardwaj, E. Thomson, H. El-Beheiry, Bermans J. Iskandar, J. Ormrod, D. Milovan, Michael J. Link, Barbara A. Dodson, S. Crump, K. Willmann, H. Madder, William R. Clarke, Max R. Trenerry, Ramez W. Kirollos, James Gebel, Lisa D. Ravdin, D. Sirhan, C. Miller, R. Grauer, Ira J. Rampil, W. Burnett, Marek A. Mirski, D. Chatfield, J. Haartsen, Jing Wang, H. Lohmann, T. Weber, S. Jackson, J. Quaedackers, Michael Beven, N. Scurrah, L. Pobereskin, J. Walkes, Zhiyi Zuo, Rona G. Giffard, J. Ridgley, James H McMahon, P. Bennett, J. Freyhoff, J. Reynolds, R. Chelliah, J. Jane, Basil F. Matta, P. Smythe, I. Gibmeier, A. Mathur, Karen B. Domino, Robert Greif, A. Wray, W. Hamm, C. Hall, Ralph F. Frankowski, H. Brors, Renee Testa, D. Fishback, Laurel E. Moore, Richard A. Jaffe, O. Moise, P. D'Urso, Argye E. Hillis, C. Weasler, Michael Tymianski, E. Tuffiash, Cynthia A. Lien, David M. Colonna, C. Lothaller, S. Bhatia, H. Bone, S. Harding, Diana G. McGregor, Lauren C. Berkow, A. Gelb, Paul A. Leonard, N. Subhas, Emine O. Bayman, William L. Young, A. Rushton, J. Marler, J. Kruger, Donna L. Auer, D. Lindholm, K. Kieburtz, R. Schatzer, D. Leggett, M. Mosier, D. Anderson, Julie B. Weeks, B. Bauer, F. Saleversusky, Mark Wilson, C. Skilbeck, R. Morgan, D. Van Alstine, S. Olson, M. Hemstreet, Y. Painchaud, P. Sutton, A. Blackwell, Christopher M. Loftus, S. Ryan, J. Winn, R. Silbergleit, R. Peters, J. Woelfer, M. Clausen, Daniel H. Kim, James R. Munis, J. Lang, A. Law, N. Badner, Keith H. Berge, D. Ellegala, Kevin H. Siu, Gordon J. Chelune, Rafael J. Tamargo, Rosemary A. Craen, C. Thien, Peter J. Lennarson, S. Wadanamby, R. Peterson, T. Blount, J. Sanders, Amin B. Kassam, Arthur M. Lam, Z. Thayer, N. Lapointe, C. Meade, Robert F. Bedford, Lorri A. Lee, J. Cormack, E. Tuerkkan, L. Carriere, N. Merah, Robert P. From, J. Sorenson, Phillip A. Scott, S. Pai, Neal J. Naff, Andrew Silvers, P. Fogarty-Mack, Jennifer O. Hunt, P. Porter, Guy L. Clifton, Zeyd Ebrahim, F. Rasulo, Pirjo H. Manninen, Derek A. Taggard, Michael J. Harrison, Ian A. Herrick, R. Mattison, Tsutomu Sasaki, P. Deshmukh, L. Forlano, Vladimir Zelman, Carol B. Applebury, John L.D. Atkinson, D. Sage, D. Sinclair, Matthew A. Howard, Elizabeth Richardson, F. Sasse, J. Heidler, Thomas N. Pajewski, J. Mason, P. McNeill, F. Lee, Bruno Giordani, G. Seever, Stephen P. Lownie, M. Wallace, Mark E. Shaffrey, C. Chase, Robert E. Breeze, Monica S. Vavilala, Kenneth Manzel, D. Papworth, Peter J. Kirkpatrick, Jana E. Jones, J. Howell, P. Li, B. Chen, A. Meyer, C. Salem, W. Kutalek, L. Koller, B. Rapf, J. Smith, Mazen A. Maktabi, Howard Yonas, Gregory M. Malham, A. Redmond, C. Moy, G. Henry, Elana Farace, H R Winn, E. Cunningham, Michael P. Murphy, Kevin K. Tremper, C. Chambers, Sesto Cairo, Chuanyao Tong, John Moloney, T. Novick, Z. Sha, Martin S. Angst, S. Laurent, G. Smith, F. Vasarhelyi, R. A. Fry, D. Blair, P. Schmid, Peter A. Rasmussen, Stephen Samples, Peter Szmuk, L. Atkins, J. Smart, T. Han, T. Costello, M. Balki, H. Bybee, C. Salmond, Peter Karzmark, Philip E. Stieg, Harold P. Adams, C. Lind, M. McTaggart, Johnny E. Brian, Pekka Talke, S. Dalrymple, M. Felmlee-Devine, Simon Jones, G. Ghazali, F. Johnson, Patricia H. Petrozza, B. Hindman, A. Shelton, Daniel Tranel, P. Blanton, L. Moss, H. Macgregor, J. Findlay, J. Weeks, Margaret R. Weglinski, Karen Lane, Daniele Rigamonti, Gregory M. Davis, William L. Lanier, Christopher R. Turner, H. Fraley, F. Mensink, P. Balestrieri, V. Petty, Michael T. Lawton, L. Meng, Gary G. Ferguson, L. Sternau, N. Page, Marc R. Mayberg, B Thompson, E. Dy, Tord D. Alden, and P. Doyle-Pettypiece

Subjects
Perioperative fever, Adult, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Neuropsychological Tests, Severity of Illness Index, Neurosurgical Procedures, Statistics, Nonparametric, Hypothermia, Induced, Severity of illness, Medicine, Humans, Aged, Retrospective Studies, Neurologic Examination, Intraoperative Care, business.industry, Glasgow Outcome Scale, Incidence, Retrospective cohort study, Perioperative, Middle Aged, Subarachnoid Hemorrhage, outcome, aneurysmal subarachnoid hemorrhage, medicine.disease, Hydrocephalus, Surgery, Clinical trial, Logistic Models, Anesthesia, Female, Neurology (clinical), Intraoperative Period, business
Abstract

OBJECTIVE: We examined the incidence of perioperative fever and its relationship to outcome among patients enrolled in the Intraoperative Hypothermia for Aneurysm Surgery Trial. METHODS: One thousand patients with initial World Federation of Neurological Surgeons grades of I to III undergoing clipping of intracranial aneurysms after subarachnoid hemorrhage were randomized to intraoperative normothermia (36 degrees C-37 degrees C) or hypothermia (32.5 degrees C-33.5 degrees C). Fever (> or =38.5 degrees C) and other complications (including infections) occurring between admission and discharge (or death) were recorded. Functional and neuropsychologic outcomes were assessed 3 months postoperatively. The primary outcome variable for the trial was dichotomized Glasgow Outcome Scale (good outcome versus all others). RESULTS: Fever was reported in 41% of patients. In 97% of these, fever occurred in the postoperative period. The median time from surgery to first fever was 3 days. All measures of outcome were worse in patients who developed fever, even in those without infections or who were World Federation of Neurological Surgeons grade I. Logistic regression analyses were performed to adjust for differences in preoperative factors (e.g., age, Fisher grade, initial neurological status). This demonstrated that fever continued to be significantly associated with most outcome measures, even when infection was added to the model. An alternative stepwise model selection process including all fever-related measures from the preoperative and intraoperative period (e.g., hydrocephalus, duration of surgery, intraoperative blood loss) resulted in the loss of significance for dichotomized Glasgow Outcome Scale, but significant associations between fever and several other outcome measures remained. After adding postoperative delayed ischemic neurological deficits to the model, only worsened National Institutes of Health Stroke Scale score, Barthel Activities of Daily Living index, and discharge destination (home versus other) remained independently associated with fever. CONCLUSION: These findings suggest that fever is associated with worsened outcome in surgical subarachnoid hemorrhage patients, although, because the association between fever and the primary outcome measure for the trial is dependent on the covariates used in the analysis (particularly operative events and delayed ischemic neurological deficits), we cannot rule out the possibility that fever is a marker for other events. Only a formal trial of fever treatment or prevention can address this issue.

Published
2009

4. Preservation of antigen-specific responses in cryopreserved CD4 + and CD8 + T cells expanded with IL-2 and IL-7.

Author

Clarkson BD, Johnson RK, Bingel C, Lothaller C, and Howe CL

Abstract

Objectives: We sought to develop medium throughput standard operating procedures for screening cryopreserved human peripheral blood mononuclear cells (PBMCs) for CD4 + and CD8 + T cell responses to potential autoantigens., Methods: Dendritic cells were loaded with a peptide cocktail from ubiquitous viruses or full-length viral protein antigens and cocultured with autologous T cells. We measured expression of surface activation markers on T cells by flow cytometry and cytometry by time of flight 24-72 h later. We tested responses among T cells freshly isolated from healthy control PBMCs, cryopreserved T cells, and T cells derived from a variety of T cell expansion protocols. We also compared the transcriptional profile of CD8 + T cells rested with interleukin (IL)7 for 48 h after 1) initial thawing, 2) expansion, and 3) secondary cryopreservation/thawing of expanded cells. To generate competent antigen presenting cells from PBMCs, we promoted differentiation of PBMCs into dendritic cells with granulocyte macrophage colony stimulating factor and IL-4., Results: We observed robust dendritic cell differentiation from human PBMCs treated with 50 ng/mL GM-CSF and 20 ng/mL IL-4 in as little as 3 days. Dendritic cell purity was substantially increased by magnetically enriching for CD14 + monocytes prior to differentiation. We also measured antigen-dependent T cell activation in DC-T cell cocultures. However, polyclonal expansion of T cells with anti-CD3/antiCD28 abolished antigen-dependent upregulation of CD69 in our assay despite minimal transcriptional differences between rested CD8 + T cells before and after expansion. Furthermore, resting these expanded T cells in IL-2, IL-7 or IL-15 did not restore the antigen dependent responses. In contrast, T cells that were initially expanded with IL-2 + IL-7 rather than plate bound anti-CD3 + anti-CD28 retained responsiveness to antigen stimulation and these responses strongly correlated with responses measured at initial thawing., Significance: While screening techniques for potential pathological autoantibodies have come a long way, comparable full-length protein target assays for screening patient T cells at medium throughput are noticeably lacking due to technical hurdles. Here we advance techniques that should have broad applicability to translational studies investigating cell mediated immunity in infectious or autoimmune diseases. Future studies are aimed at investigating possible CD8 + T cell autoantigens in MS and other CNS autoimmune diseases., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors. Published by Elsevier B.V.)

Published
2022
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5. Frameless neuronavigation using the ISG-system in practice: from craniotomy to delineation of lesion.

Author

Kleinpeter G and Lothaller C

Subjects
Adult, Aged, Brain Neoplasms pathology, Brain Neoplasms surgery, Cerebrovascular Disorders pathology, Female, Glioma pathology, Glioma surgery, Humans, Male, Meningioma pathology, Meningioma surgery, Middle Aged, Reproducibility of Results, Cerebrovascular Disorders surgery, Craniotomy instrumentation, Neuronavigation instrumentation
Abstract

The overall performance of a "pointer" neuronavigation system (the ISG ALLEGRO Viewing Wand) in everyday surgical use was evaluated by investigating the practical utility of the technical set-up for one particular surgical task. The basis of the analysis was the numerical evaluation of four areas of fundamental importance for most brain surgery: site and size of craniotomy, localisation of lesion, the trajectory through the brain, and the delineation of the lesion. In a protocol of 65 patients we based our examination on a subjective 4-point rating scale ranging from 0 (= no help) to 3 (= very helpful) for each of the four above categories. We investigated the potential influence of three factors: the lesions histology (4 groups), its size (3 categories) and the depth from the cortical surface (3 levels). Our experience is that the histology of the lesions has significant influence on the relative usefulness of neuronavigation for craniotomy (P < 0.017) and for delineation of the lesion (P < 0.003). We found neuronavigation most helpful for removing gliomas. Second, this system was found to be very helpful in locating small, hitherto hard-to-find, lesions (P < 0.01). Lesion's depth had no effect on the ratings (P > 0.2). Overall, the use of this system led to more precise skin incisions, better site and size of craniotomies tailored to the pathology, the trajectory through the brain, and to more precise delineation of the lesion.

Published
2003
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