Christian K. Spiss

Changes in oxygenation variables during progressive hypothermia in anesthetized patients.

Summary Because deliberate hypothermia is becoming commonly used during neurosurgery, this study was performed to investigate the effects of a progressive reduction of body core temperature (T) on whole body oxygenation variables in patients undergoing elective intracranial surgery. In 13 patients (Hypothermic Group), T was reduced to 32.0°C using convective-based surface cooling. In six patients (Control Group), T was maintained at 35.5°C during the entire study period. The cardiac index (CI) was determined with a pulmonary artery catheter by thermodilution. Whole body oxygen delivery (DO2) was calculated from CI and arterial oxygen content. Whole body oxygen consumption (VO2), carbon dioxide production (VCO2), and energy expenditure (EE) were determined by ventilation gas analysis (indirect calorimetry). Mixed venous oxygen tension at 50% saturated hemoglobin (P50), and whole body oxygen extraction ratio (O2ER) were calculated. Repeated-measures analysis of variance and the Mann-Whitney test were used for statistical analysis. Data are expressed as means ± SD. VO2 (from 100 ± 13 to 77 ± 11 ml · min-1 ± m-2), VCO2 (from 75 ± 7 to 57 ± 7 ml min-1 ± m-2), EE (from 667 ± 67 to 509 ± 66 kcal ± d-1 · m-2), P50 (from 23.8 ± 1.7 to 20 ± 0.9 mm Hg), and O2ER (from 0.29 ± 0.05 to 0.22 ± 0.03%) decreased significantly in the Hypothermic Group between 35.5 and 32.0°C (p < 0.05). None of these variables changed in the Control Group and at 32.0°C VO2, VCO2, EE, P50, and O2ER were significantly lower in the Hypothermie Group than in the Control Group. DO2 remained unchanged in both groups. We conclude that progressive hypothermia in anesthetized patients reduces metabolic rate but does not change DO2. The significant decrease in O2ER may partly be related to a leftward shift of the oxyhemoglobin dissociation curve, as evidenced by the decrease in P50.