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NEUROSURGICAL ANESTHESIA

Initial Experience with a Novel Heat-Exchanging Catheter in Neurosurgical Patients

Anthony G. Doufas, MD PhD^*, Ozan Akça, MD^*, Atul Barry, MD, David A. Petrusca, MD, Mohammad-Irfan Suleman, MD^*, Nobutada Morioka, MD^*, John J. Guarnaschelli, MD, and Daniel I. Sessler, MD^*

*Outcomes Research^® Institute and Department of Anesthesiology, University of Louisville; Department of Anesthesiology, Jewish Hospital Health Care Services, Louisville; Neurosurgical Group of Greater Louisville and Southern Indiana, Louisville, Kentucky; and Ludwig Boltzmann Institute, University of Vienna, Austria

Address correspondence and reprint requests to Anthony G. Doufas, MD, PhD, Department of Anesthesiology, University of Louisville Hospital, 530 South Jackson St., Louisville, KY 40202. Address e-mail to agdoufas{at}Louisville.edu

Even mild hypothermia provides marked protection against cerebral ischemia in animal models. Hypothermia may be of therapeutic value during neurosurgical procedures. However, current cooling systems often fail to induce sufficient hypothermia before the dura is opened. Furthermore, they usually fail to restore normothermia by the end of surgery, thus delaying extubation. We evaluated a new internal heat-exchanging catheter. Eight ASA physical status II–IV patients (29–72 yr) undergoing craniotomy were enrolled. After the induction of general anesthesia, we introduced the SetPoint^® catheter into the inferior vena cava via a femoral vein. The target core body temperature was 34°C–34.5°C. After reaching the target, core temperature was maintained until the dura was closed. Target core temperature was then set to 37.0°C, and the patient was rewarmed as quickly as possible. Seven patients had a tumor resection, and one had an aneurysm clipped. The core-cooling rate was 3.9°C ± 1.6°C/h, and the rewarming rate was 2.0°C ± 0.5°C/h; core temperature was 35.9°C ± 0.2°C by the end of surgery. Patients were subsequently kept normothermic for 3 h before the catheter was removed. No thrombus or other particulate material was identified on the extracted catheters. None of the patients suffered any complications that could be attributed to the SetPoint^® system or thermal management.

IMPLICATIONS: Because current systems for inducing therapeutic hypothermia are too slow, we tested an internal counter-current thermal management system during hypothermic neurosurgery. The SetPoint^® catheter cooled at 3.9°C ± 1.6°C/h and rewarmed at 2.0°C ± 0.5°C/h. Catheter-based internal thermal management thus seems to be rapid and effective.

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