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Previous Volume 352:135-145 January 13, 2005 Number 2 Next

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ABSTRACT

Background Surgery for intracranial aneurysm often results in postoperative neurologic deficits. We conducted a randomized trial at 30 centers to determine whether intraoperative cooling during open craniotomy would improve the outcome among patients with acute aneurysmal subarachnoid hemorrhage.

Methods A total of 1001 patients with a preoperative World Federation of Neurological Surgeons score of I, II, or III ("good-grade patients"), who had had a subarachnoid hemorrhage no more than 14 days before planned surgical aneurysm clipping, were randomly assigned to intraoperative hypothermia (target temperature, 33°C, with the use of surface cooling techniques) or normothermia (target temperature, 36.5°C). Patients were followed closely postoperatively and examined approximately 90 days after surgery, at which time a Glasgow Outcome Score was assigned.

Results There were no significant differences between the group assigned to intraoperative hypothermia and the group assigned to normothermia in the duration of stay in the intensive care unit, the total length of hospitalization, the rates of death at follow-up (6 percent in both groups), or the destination at discharge (home or another hospital, among surviving patients). At the final follow-up, 329 of 499 patients in the hypothermia group had a Glasgow Outcome Score of 1 (good outcome), as compared with 314 of 501 patients in the normothermia group (66 percent vs. 63 percent; odds ratio, 1.14; 95 percent confidence interval, 0.88 to 1.48; P=0.32). Postoperative bacteremia was more common in the hypothermia group than in the normothermia group (5 percent vs. 3 percent, P=0.05).

Conclusions Intraoperative hypothermia did not improve the neurologic outcome after craniotomy among good-grade patients with aneurysmal subarachnoid hemorrhage.

Source Information

From the Department of Anesthesia, Roy J. and Lucille A. Carver College of Medicine, University of Iowa (M.M.T., B.J.H.); and the Departments of Biostatistics (W.R.C.) and Epidemiology (J.C.T.) and the Data Management Center (W.R.C.), University of Iowa College of Public Health — both in Iowa City.

Address reprint requests to Dr. Todd at the Department of Anesthesia, University of Iowa, 200 Hawkins Dr., 6546 JCP, Iowa City, IA 52242, or at michael-todd{at}uiowa.edu.

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