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

• DOI: 10.1097/aln.0b013e3181c5e28f
• Publication Date: 2009-12-17T15:35:02Z
• Authors: Bradley J. Hindman; Emine O. Bayman; Wolfgang K. Pfist...; James C. Torner; Michael M. Todd
• Keywords: Male; Glasgow Outcome Scale; Anesthesia, General; Aneurysm, Ruptured; Neuropsychological Tests; Protective Agents; Neurosurgical Procedures; Intraoperative Hypothermia; Supplemental Protective Drug; Neurologic; Temporary clipping; Cerebral Aneurysm Surgery; Body Temperature; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Double-Blind Method; Hypothermia, Induced; Humans; Hypnotics and Sedatives; Prospective Studies; Aged; Intracranial Aneurysm; Middle Aged; 3. Good health; Logistic Models; Female; Nervous System Diseases

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.