Case 78 - Therapeutic hypothermia using an endovascular approach in the neurocritical care patient

Summary

Therapeutic hypothermia has been shown to improve outcome in patients after cardiopulmonary resuscitation and might prove helpful for other circumstances in which a compromise of neurologic function is expected. Cooling a patient to mild or moderate hypothermia is usually performed by conductive, convective surface cooling, cold infusions, gastric lavage, passive cooling by leaving the anesthetized patient uncovered in a cool environment, or through a combination of these methods. Endovascular cooling techniques seem to be superior for rapid induction of hypothermia and for maintenance of stable temperature as compared with surface-cooling techniques. The majority of therapeutic hypothermia trials for brain protection have involved surface-cooling techniques that require mechanical ventilation in intubated and paralyzed patients. Drugs such as meperidine, dexmedetomidine, clonidine, nefopam, and buspirone alone, as well as in various combinations, reduce the shivering threshold and thus complement external and internal cooling.