Author: neuraxis_editor

ANAESTHESIA FOR LAMINECTOMY AND LOCALIZED CORD COOLING IN ACUTE CERVICAL SPINE INJURY
Y. K. DEMIAN, R. J. WHITE, D. YASHON AND H. E. KRETCHMER
Brit. J. Anaesth, 1971

Three patients received anesthesia and cooling after spinal cord injury. Localized cooling of the spinal cord prolonged the duration of anesthesia for a few hours. No changes in systemic blood pressure, pulse rate or e.c.g., that could be ascribed to the cooling effect on the cervical cord, were observed during the management of these three patients. Over a 2-year period a significant recovery of function in the lower cervical segments was observed in all three patients. Resumption of motor function in the lower extremities was found in one of the patients who should not have demonstrated neurological recovery in the lower extremities.

Motor Recovery, Functional Status, and Health-Related Quality of Life in Patients With Complete Spinal Cord Injuries
Charles G. Fisher, Vanessa K. Noonan, Donna E. Smith, Peter C. Wing, Marcel F. Dvorak, and Brian Kwon
Spine, 2005

All patients admitted to Vancouver Hospital with a complete spinal cord injury (SCI) between 1994 and 2001 were identified and included in the study if they remained complete following the resolution of spinal shock. Minimum 2-year follow-up consisted of an ASIA motor score, an FIM, and the SF-36. Of 133 patients identified, 94 were eligible and 70 completed follow-up. For the tetraplegic patients, the average ASIA motor score was 11.9 +/- 10.7 on admission and 20.1 +/- 10.8 at follow-up, a change reflecting local recovery only. For the paraplegic patients, the average ASIA motor score was 49.3 +/- 2.4 on admission and 50.6 +/- 1.7 at follow-up.Motor recovery does not occur below the zone of injury for patients with complete SCI. 

Regional hypothermia with epidural cooling for prevention of spinal cord ischemic complications after thoracoabdominal aortic surgery
JH Black, JK Davison, RP Cambria
Seminars in Thoracic and Cardiovascular Surgery, 2003

Harvard Medical School has employed regional hypothermia by epidural cooling to ameliorate SCI during TAA repair in over 300 patients. According to Harvard Medical School, hypothermia is known to reduce oxygen requirements in central nervous tissue and has been successfully applied in the arena of central cardioaortic surgery.

Epidural cooling for regional spinal cord hypothermia during thoracoabdominal aneurysm repair
DJ Vierra, MA Columbia, G Koustas, JK Davison, RP Cambria
Journal of Vascular Surgery, 1994

Eight patients undergoing thoracic or thoracoabdominal aneurysm resection received regional hypothermia of the spinal cord with an infusion of iced saline solution 30 minutes before aortic cross-clamping. During cross-clamping and aortic replacement the mean cerebral spinal fluid temperature was maintained between 25.2 degrees to 27.6ºC. Epidural cooling appears to be a satisfactory method of achieving regional spinal cord hypothermia in patients requiring resection of thoracic or thoracoabdominal aortic aneurysms.

Use of Selective Hypothermia to Protect the Spinal Cord
Denton A. Cooley, Bruce A. Jones
Surgical Technique, 2000

Selective hypothermia during repairs of thoracoabdominal thoracic aneurysms was used in seven patients. None of the patients who received hypothermia had neurologic complications.

Moderate Hypothermia as Treatment for Spinal Cord Injury
Andrew Cappuccino
Spine, 2008

Dr Andrew Cappuccino, assistant team orthopedic surgeon for the NFL Buffalo Bills and the supervising and operating surgeon of Bills player Kevin Everett, discusses the use of moderate systemic hypothermia to treat spinal cord injuries. Kevin Everett sustained a fracture dislocation of C3-C4 while making a tackle in a professional football game. On the field, he was immediately stabilized and received intravenous fluids, oxygen by mask, systemic hypothermic interventions, and intravenous steroid boluses. He was then able to recover in just a few months which is rare with this type of injury.

Microglia inhibition is a target of mild hypothermic treatment after the spinal cord injury
T Morino, T Ogata, J Takeba and H Yamamoto
Spinal Cord, 2008

Rats were separated into normothermic and hypothermic groups after spinal cord injury. Motor function was evaluated by measuring the frequency of standing and microglia were observed in the compressed portion of the spinal cord. The amount of tumor necrosis factor-alpha (TNF-alpha) in the compressed spinal cord was measured by the ELISA method. In normothermic rats, microglia rapidly increased up to 72 h was, while the increase of microglia was substantially inhibited at 48 and 72 h after compression in the hypothermic rats. The motor function of the hypothermic rats improved at 48 and 72 h after the compression, whereas no improvement was seen in the normothermic rats. The amount of TNF-alpha in the compressed portion of the spinal cord was lower in hypothermic rats compared with normothermic rats throughout the experiment.

Therapeutic Moderate Hypothermia for Severe Traumatic Brain Injury: A Review
DONALD W. MARION
Senior Research Fellow, The Brain Trauma Foundation

There have been at least 14 prospective randomized clinical trials of the use of hypothermia to improve outcomes following severe traumatic brain injury. Combined, these trials found that the likelihood of a good outcome was 15% higher in those who were treated with hypothermia. At least 12 studies also have evaluated the effect of hypothermia on elevated intracranial pressure (ICP) and, with a single exception, have all found a significant reduction in ICP during the period of cooling. Laboratory investigations have defined several mechanisms whereby hypothermia may reduce secondary brain injury.

HYPOTHERMIC PROCEDURES: ACUTE SCI
Hypothermia, 2008

Intravascular hypothermia will be initiated within 24 hours post-injury and 33 degrees Celsius will be maintained for 48 hours. Neurological improvement on American Spinal Injury Association (ASIA) and Functional improvement in Functional Independence Measure (FIM) will be measured and compared to those who didn’t receive hypothermia. Results for this study are not yet posted.

The Cooling Effects of Therapeutic Hypothermia
The Cooling Effects of Therapeutic Hypothermia, 2007

Therapeutic hypothermia is considered to improve survival with favorable neurological outcome in the case of global cerebral ischemia after cardiac arrest and perinatal asphyxia. The efficacy of hypothermia in acute ischemic stroke and traumatic brain injury, however, is not well studied. However, cooling therapy still has the potential to become a valuable neuroprotective intervention. Among the various methods for hypothermia induction, intravascular cooling may have the most promise in the awake patient in terms of clinical outcomes. This method of intravascular cooling is capable of a more rapid target temperature and more precise control of temperature.