Deep hypothermia is now employed for open heart surgery in infants. The method of surface cooling infants to 25° C and then by-pass cooling down to 15–20° C prior to exsanguination is described. This provides a still heart and ideal operating conditions. The infants are re-warmed on by-pass. Some of the physiological effects of hypothermia and the methods employed to counteract these are discussed. The aims are to reduce temperature gradients, improve cerebral oxygen supply, avoid arrhythmias and secure haemostasis.
The experience in 33 operations is outlined. Seventeen patients were under one year of age.
References
1.
BigelowE. A., LindsayW. K., and GreenwoodW. F. (1950): “Hypothermia, its possible role in cardiac surgery: An investigation of factors governing survival in dogs at low body temperatures”, Ann. Surg., 132, 849.
2.
BrewinE. G. (1904): “Physiology of hypothermia”, Int. Anaesthesiology Clin., 2, 803.
3.
BrownT. C. K., JohnstonA. E., and ConnA. W. (1966): “Respiratory insufficiency and its treatment following paediatric cardiac surgery”, Canad. Anaes. Soc. J., 13, 342.
4.
BrownT. C. K., DunlopM., and StevensB. J. (1972): “Biochemical studies during deep hypothermia”. (Unpublished data.)
5.
ClarkeC. P., BrownT. C. K., McKieB. D., JonesP. G., and VenablesA. W. (1971): “Open heart surgery in infants using deep hypothermia and partial heart lung bypass”, Med. J. Aust.2, 710.
6.
DrewC. E., and AndersonI. M. (1959): “Profound hypothermia in cardiac surgery”, Lancet, 1, 748.
7.
EkertH., GilchristG. S., StantonR., and HammondD. (1970): “Haemostasis in cyanotic congenital heart disease”, J. Pediatrics, 76, 221.
8.
EngleM. A., AdamsF. H., BotsonC., DuShaneJ. W., ElliottL. P., McNamaraD. G., RashkindW. J., and TalnerN. S. (1971): “Resources for the optimal acute care of patients with congenital heart disease”, Circulation, 43, A123.
9.
GoodmanI. S., and OilmanA. (1970): Pharmacological Basis of Therapeutics, Macmillan Co., New York.
10.
HewerA. J. H. (1964): “Hypothermia for neurosurgery”, Int. Anesthesiology Clin., 2, 919.
11.
HikasiY., ShirotaniH., SatomuraK., MuraokaR., AbeK., TsushimiK., YokotaY., MikiS., KawaiJ., MoriA., OkamotoY., KoieH., BanT., KanzakiY., YokataM., MoriC., NamiyaT., TamuraT., TishiiA., and AsawaY. (1967): “Open heart surgery in infants with an aid of hypothermic anaesthesia”, Archiv. fur Japanische Chirurgie, 36, 495.
12.
HoriuchiT., KoyamadaK., MatamoJ., MohriH., KomatsuT., HondaT., AbeT., IshitoyaT., SagawaY., MatsuzawaK., MotsumuraM., TsudaT., IshizawaE., IshikawaS., SuzukiH., and SaitoY. (1903): “Radical operation for ventricular septal defect in infancy”, J. Thorac. Cardiovasc. Surg., 46, 180.
13.
MohriH., DillardD. H., CrawfordE. H., MartinW. E., and MerendineK. A. (1969): “Method of surface-induced deep hypothermia for open-heart surgery in infants”, J. Thorac. Cardiovasc. Surg., 58, 262.
14.
OsborneJ. J., GerbodeF., JohnstonJ. B., RossJ. K., OgataT., and KerthW. J. (1901): “Blood chemical changes in perfusion hypothermia for cardiac surgery”, J. Thorac. Cardiovasc. Surg., 42, 462.
15.
RichardsM. R., MerrittK. K., SamuelsM. H., and PangmannA. G. (1955): “Congenital malformations of the cardiovascular system in a series of 0,053 infants”, Pediatrics, 15, 12.
16.
RosenhainF. R., and PenrodR. E. (1951): “Blood gas studies in the hypothermic dog”, Amer. J. Physiol., 166, 55.
