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NEUROSURGICAL ANESTHESIA

The Effect of Graded Hypothermia (36°C–32°C) on Hemostasis in Anesthetized Patients Without Surgical Trauma

S. C. Kettner, MD^*,, C. Sitzwohl, MD^*, M. Zimpfer, MD MBA^*,, S. A. Kozek, MD^*, A. Holzer, MD^*, C. K. Spiss, MD^*, and U. M. Illievich, MD^*

*Department of Anesthesiology and General Intensive Care, University of Vienna, General Hospital Vienna, Vienna, Austria; and Ludwig Boltzmann Institute of Clinical Anesthesiology and Intensive Care, Vienna, Austria

Address correspondence and reprint requests to Stephan C. Kettner, MD, Department of Anesthesiology and General Intensive Care, General Hospital Vienna, 18-20 Währinger Gürtel, A-1090 Vienna, Austria. Address e-mail to stephan.kettner{at}akh-wien.ac.at

The isolated effects of hypothermia on hemostasis have not been investigated in healthy humans. We cooled 16 anesthetized patients scheduled for elective intracranial surgery to 32°C body core temperature and assessed prothrombin time (PT), activated partial thromboplastin time, thrombelastogram (TEG®), closure time, and platelet count at 36°C, 34°C, and 32°C body core temperature after the induction of anesthesia but before surgical intervention. Activated partial thromboplastin time, hematocrit, and closure time did not change, whereas PT and platelet count decreased during cooling. Platelet count decreased without a decrease in hematocrit; hence, a dilution by administered fluids seemed unlikely. The small decrease of platelet count is probably clinically irrelevant in patients with normal platelet count and function. The small decrease in PT indicates an alteration of the extrinsic pathway of coagulation. TEG® measurements showed a delay of clot formation in temperature-adjusted measurements but showed no change if the test temperature was 37°C. This indicates that hypothermia reduces plasmatic coagulation and platelet reactivity. However, the clot strength is not altered by hypothermia. All coagulation variables remained within the normal ranges. Our results may indicate that moderate short-term (4-h) hypothermia has only minor adverse effects in healthy humans. We can make no statement about the effects of hypothermia of longer duration.

IMPLICATIONS: This study investigated the isolated effects of hypothermia in healthy anesthetized humans. We found only minor effects of body temperature reduction to 32°C on assessed coagulation variables, indicating only minor effects in otherwise healthy humans.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999