No association between intraoperative hypothermia or supplemental protective drug and neurologic outcomes in patients undergoing temporary clipping during cerebral aneurysm surgery: Findings from the intraoperative hypothermia for aneurysm surgery trial

Bradley J. Hindman, Emine O. Bayman, Wolfgang K. Pfisterer, James C. Torner, Michael M. Todd, IHAST Investigators

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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° ± 0.8°C, n = 208) or normothermia (36.7° ± 0.5°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.

Original languageEnglish
Pages (from-to)86-101
Number of pages16
JournalAnesthesiology
Volume112
Issue number1
DOIs
Publication statusPublished - Jan 2010

Cite this

@article{571e172b42e54b7599c589c63cc42d03,
title = "No association between intraoperative hypothermia or supplemental protective drug and neurologic outcomes in patients undergoing temporary clipping during cerebral aneurysm surgery: Findings from the intraoperative hypothermia for aneurysm surgery trial",
abstract = "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° ± 0.8°C, n = 208) or normothermia (36.7° ± 0.5°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.",
author = "Hindman, {Bradley J.} and Bayman, {Emine O.} and Pfisterer, {Wolfgang K.} and Torner, {James C.} and Todd, {Michael M.} and {IHAST Investigators} and S. Jones and J. Haartsen and J. Kruger and P. Myles and J. Rosenfeld and J. Hunt and J. McMahon and G. Malham and S. Cairo and A. Konstantatos and J. Smart and H. Machlin and M. Buckland and A. Silvers and G. Downey and M. Langley and D. McIlroy and D. Daly and M. Angliss and G. Davis and T. Phan and S. Micallef",
year = "2010",
month = "1",
doi = "10.1097/ALN.0b013e3181c5e28f",
language = "English",
volume = "112",
pages = "86--101",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "American Society of Anesthesiologists",
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No association between intraoperative hypothermia or supplemental protective drug and neurologic outcomes in patients undergoing temporary clipping during cerebral aneurysm surgery : Findings from the intraoperative hypothermia for aneurysm surgery trial. / Hindman, Bradley J.; Bayman, Emine O.; Pfisterer, Wolfgang K.; Torner, James C.; Todd, Michael M.; IHAST Investigators.

In: Anesthesiology, Vol. 112, No. 1, 01.2010, p. 86-101.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - No association between intraoperative hypothermia or supplemental protective drug and neurologic outcomes in patients undergoing temporary clipping during cerebral aneurysm surgery

T2 - Findings from the intraoperative hypothermia for aneurysm surgery trial

AU - Hindman, Bradley J.

AU - Bayman, Emine O.

AU - Pfisterer, Wolfgang K.

AU - Torner, James C.

AU - Todd, Michael M.

AU - IHAST Investigators

AU - Jones, S.

AU - Haartsen, J.

AU - Kruger, J.

AU - Myles, P.

AU - Rosenfeld, J.

AU - Hunt, J.

AU - McMahon, J.

AU - Malham, G.

AU - Cairo, S.

AU - Konstantatos, A.

AU - Smart, J.

AU - Machlin, H.

AU - Buckland, M.

AU - Silvers, A.

AU - Downey, G.

AU - Langley, M.

AU - McIlroy, D.

AU - Daly, D.

AU - Angliss, M.

AU - Davis, G.

AU - Phan, T.

AU - Micallef, S.

PY - 2010/1

Y1 - 2010/1

N2 - 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° ± 0.8°C, n = 208) or normothermia (36.7° ± 0.5°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.

AB - 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° ± 0.8°C, n = 208) or normothermia (36.7° ± 0.5°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.

UR - http://www.scopus.com/inward/record.url?scp=74049151086&partnerID=8YFLogxK

U2 - 10.1097/ALN.0b013e3181c5e28f

DO - 10.1097/ALN.0b013e3181c5e28f

M3 - Article

VL - 112

SP - 86

EP - 101

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 1

ER -