Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA.
Adv Ther. 2019 Sep;36(9):2223-2232. doi: 10.1007/s12325-019-01019-z. Epub 2019 Jul 12.
Normal thermal regulation is a result of the integration of afferent sensory, central control, and efferent responses to temperature change. Therapeutic hypothermia (TH) is a technique utilized during surgery to protect vital organs from ischemia; however, in doing so leads to other physiological changes. Indications for inducing hypothermia have been described for neuroprotection, coronary artery bypass graft (CABG) surgery, surgical repair of thoracoabdominal and intracranial aneurysms, pulmonary thromboendarterectomy, and arterial switch operations in neonates. Initially it was thought that induced hypothermia worked exclusively by a temperature-dependent reduction in metabolism causing a decreased demand for oxygen and glucose. Induced hypothermia exerts its neuroprotective effects through multiple underlying mechanisms including preservation of the integrity and survival of neurons through a reduction of extracellular levels of excitatory neurotransmitters dopamine and glutamate, therefore reducing central nervous system hyperexcitability. Risks of hypothermia include increased infection risk, altered drug pharmacokinetics, and systemic cardiovascular changes. Indications for TH include ischemia-inducing surgeries and diseases. Two commonly used methods are used to induce TH, surface cooling and endovascular cooling. Core body temperature monitoring is essential during induction of TH and rewarming, with central venous temperature as the gold standard. The aim of this review is to highlight current literature discussing perioperative considerations of TH including risks, benefits, indications, methods, and monitoring.
正常的体温调节是传入感觉、中枢控制和对温度变化的传出反应整合的结果。治疗性低温（TH）是一种在手术中用于保护重要器官免受缺血的技术；然而，这样做会导致其他生理变化。已经描述了诱导低温的适应症，用于神经保护、冠状动脉旁路移植术（CABG）、胸腹部和颅内动脉瘤的手术修复、肺动脉血栓内膜切除术以及新生儿的动脉切换手术。最初认为，诱导低温通过仅依赖温度的代谢降低起作用，导致对氧气和葡萄糖的需求减少。诱导低温通过多种潜在机制发挥其神经保护作用，包括通过减少兴奋性神经递质多巴胺和谷氨酸的细胞外水平来维持神经元的完整性和存活，从而降低中枢神经系统的过度兴奋。低温的风险包括增加感染风险、改变药物药代动力学和全身心血管变化。TH 的适应症包括引起缺血的手术和疾病。有两种常用的方法可用于诱导 TH，即体表冷却和血管内冷却。在诱导 TH 和复温期间，核心体温监测至关重要，中心静脉温度是金标准。本综述旨在强调目前讨论围手术期 TH 的注意事项的文献，包括风险、益处、适应症、方法和监测。
