Prevention and correction of hypocalaemia during systematic hypothermia in patients with aneurismal subarachnoid hemorrhages.

S. Dudukina

doi:10.26641/2307-0404.2013.3.18944

Authors

S. Dudukina Dnipropetrovs’k Regional Hospital, Ukraine

DOI:

https://doi.org/10.26641/2307-0404.2013.3.18944

Keywords:

subarachnoid hemorrhage, preventive, hypothermia hypocalaemia, cardiological complications

Abstract

The effectiveness of hypothermia as a method of neuroprotection in brain damage has been proved in many studies, but a large number of complications requires development of further protocols of its management. The article presents experience of treatment of aneurismal subarachnoid hemorrhage under conditions of preventive hypothermia. 84 patients were examined. In 56 of them the efficacy of developed method on prevention and correction of hypocalaemia developed as a result of cold diuresis has been proposed. It has been found that decrease in plasma potassium occurs in parallel with decrease in body temperature regardless the technique of potassium chloride injection. Introduction of potassium chloride solution in physiological dose of 0.2 mmol/kg prevents hypocalaemia development during preventive hypothermia. Injection of potassium chloride in the physiological dose of 0.2 mmol/kg/h and after beginning of patient’s rewarming – 0.8 mmol/kg within the period of one postsurgery day prevents the development of postoperative hypocalaemia in the postoperative period; and after patient’s rewarming– 0.8. mmol/kg within the period of one postoperative day prevents development of postoperative cardiac complications in the perioperative period by 20%.

References

Пат. Российская Федерация № 2144362 A61K33/14. Способ профилактики нарушений ритма сердца при кардиохирургических операциях / Лита¬сова Е.Е. Ломиворотов В.Н., Семаев Е.Б., Шунь¬кин А.В., Караськов А.М., Селиванов С.В. - опубл. 20.01.2000.

Пат. 74945 Україна, МПК А61P 23/00, A61K 33/14. Спосіб профілактики ускладнень гіпотермії / Дудукіна С.О. – заявл. 06.06.2012, опубл. 12.11.2012., Бюл. № 21.

Bederson J.B. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage / J.B. Bederson, R.G. Dacey, J.E. Dion // Stroke. – 2009. – Vol. 40. –P. 994-1025.

European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Suba¬rachnoid Haemorrhage / T. Steiner, S. Juvela, A. Unter¬berg [et al.] // Cerebrovasc Dis. – 2013. – Vol. 35, N 2. – P.93-112.

Gal R. Mild hypothermia for intracranial aneu¬rysm surgery / R. Gal, M. Smrcka // Bratisl Lek Listy. – 2008. – Vol.

, N 2. – P. 66-70.

Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare pro¬fessionals from the American Heart Associa¬tion / Ame¬rican Stroke Association / E.S. Connolly, A.A. Rabin¬stein, J.R. Carhuapoma, C.P. Derdeyn // Stroke. – 2012. – Vol. 43. – P. 1711–1737.

Li Bassi G. Perioperative hypothermia: the deli¬cate balance between heat gain and heat loss / Li Bassi G. // Minerva Anestesiol. – 2008. – Vol. 74, N 12. – P.683-685.

Mahaney K. Acute postoperative neurological deterioration associated with surgery for ruptured intra¬cra¬nial aneurysm: incidence, predictors, and outcomes / Ma¬haney K., Todd M., Bayman E. // J. Neurosurg. – 2012. – Vol. 116, N 6. – P. 1267-1278.

Metabolic downregulation: a key to successful neuroprotection? / M. Yenari, K. Kitagawa, P. Lyden, M. Pe¬rez-Pinzon // Stroke. – 2008. – Vol. 39, N 10. – P. 2910-2917.

Which treatment modality is more injurious to the brain in patients with subarachnoid hemorrhage? Degree of brain damage assessed by serum S100 protein after aneurysm clipping or coiling / J.H. Shim, S.M. Yoon, H.G. Bae [et al.] // Cerebrovasc Dis. – 2012. – Vol. 34. – P.38–47.

Litasova EE, Lomivorotov VN, Semaev EB, Shu¬n'kin AV, Karas'kov AM, Selivanov SV. Way of pre¬vention violations of heart rhythm during cardiac ope¬rations. Patent of Russia N 2144362. A61K33/14. 20.01.2000.

Dudukina SO. Way of prevention complications of hypothermia. Patent of Ukraine №74945, MPK А61P 23/00, A61K 33/14. 12.11.2012, N 21.

Bederson JB, Connolly ES, Hunt HB, Dacey RG, Dion JE, Diringer MN, Duldner JE, Robert JE, Aman HB. Guidelines for the Management of Aneurysmal Suba¬rachnoid Hemorrhage. Stroke. 2009;40:994-1025.

Steiner T, Juvela S, Unterberg A, Jung C, For¬sting M, Rinkel G. European Stroke Organization Guide¬lines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage .Cerebrovasc Dis. 2013;35(2):93-112.

Gal R, Smrcka M. Mild hypothermia for intrac¬ranial aneurysm surgery. Bratisl Lek Lis¬ty. 2008;109(2):66-70.

Connolly ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP. Guidelines for the management of aneury¬smal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association. Ame¬rican Stroke Association. Stroke.2012;43:1711–37.

Li Bassi G. Perioperative hypothermia: the deli¬cate balance between heat gain and heat loss. Minerva Anestesiol. 2008;74(12):683-85.

Mahaney K, Todd M, Bayman E. Acute postope¬rative neurological deterioration associated with surgery for ruptured intracranial aneurysm: incidence, predictors, and outcomes. J. Neurosurg. 2012;116(6):1267-78.

Yenari M, Kitagawa K, Lyden P, Perez-Pinzon M. Metabolic downregulation: a key to successful neuro¬protection? Stroke. 2008;39(10):2910-17.

Shim JH, Yoon SM, Bae HG, Yun IG, Shim JJ, Lee KS, Doh JW. Which treatment modality is more injurious to the brain in patients with subarachnoid hemorrhage? Degree of brain damage assessed by serum S100 protein after aneurysm clipping or coiling. Cerebrovasc Dis. 2012;34:38-47.