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CARDIOVASCULAR ANESTHESIA

Prevention of Cerebral Hyperthermia During Cardiac Surgery by Limiting On-Bypass Rewarming in Combination with Post-Bypass Body Surface Warming: A Feasibility Study

Shahar Bar-Yosef, MD^*, Joseph P. Mathew, MD^*, Mark F. Newman, MD^*, Kevin P. Landolfo, MD, Hilary P. Grocott, MD FRCPC^*, and The Neurological Outcome Research Group and C.A.R.E. Investigators of the Duke Heart Center

Departments of *Anesthesiology (Division of Cardiothoracic Anesthesiology and Critical Care Medicine) and Surgery (Division of Cardiothoracic Surgery), Duke University Medical Center, Durham, North Carolina

Address correspondence and reprint requests to Hilary P. Grocott, MD, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710. Address e-mail to h.grocott{at}duke.edu

Cerebral hyperthermia is common during the rewarming phase of cardiopulmonary bypass (CPB) and is implicated in CPB-associated neurocognitive dysfunction. Limiting rewarming may prevent cerebral hyperthermia but risks postoperative hypothermia. In a prospective, controlled study, we tested whether using a surface-warming device could allow limited rewarming from hypothermic CPB while avoiding prolonged postoperative hypothermia (core body temperature <36°C). Thirteen patients undergoing primary elective coronary artery bypass grafting surgery were randomized to either a surface-rewarming group (using the Arctic Sun® thermoregulatory system; n = 7) or a control standard rewarming group (n = 6). During rewarming from CPB, the control group was warmed to a nasopharyngeal temperature of 37°C, whereas the surface-warming group was warmed to 35°C, and then slowly rewarmed to 36.8°C over the ensuing 4 h. Cerebral temperature was measured using a jugular bulb thermistor. Nasopharyngeal temperatures were lower in the surface-rewarming group at the end of CPB but not 4 h after surgery. Peak jugular bulb temperatures during the rewarming phase were significantly lower in the surface-rewarming group (36.4°C ± 1°C) compared with controls (37.7°C ± 0.5°C; P = 0.024). We conclude that limiting rewarming during CPB, when used in combination with surface warming, can prevent cerebral hypothermia while minimizing the risk of postoperative hypothermia.

IMPLICATIONS: Cerebral hyperthermia during rewarming from cardiopulmonary bypass is associated with increased neurological injury. In this randomized, controlled study, we have shown that limiting the target rewarming temperature on bypass to 35°C, combined with continuous surface warming, can prevent cerebral hyperthermia without risking prolonged postoperative hypothermia.

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