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Lower temperatures improve outcomes after bypass surgery

HONOLULU -- Duke University Medical Center researchers are urging their colleagues in the field to spend an extra 10 to 15 minutes slowly rewarming their patients after cardiac bypass surgery, which they have found reduces the likelihood of cognitive decline after surgery. In a new study, they present data from Duke as an example of an institution that was able to change long-standing practice, instituting slower rewarming rates in such patients.

Rapid rewarming can lead to an overshoot in brain temperature, the researchers said. By allowing patients to return to normal temperatures at a slower rate, physicians can also reduce the potential of temperatures spiking high enough to harm the brain. Over a seven-year period, the maximum temperatures of patients being rewarmed after undergoing coronary artery bypass surgery at Duke University Hospital dropped an average of more than 1.5 degrees Celsius.

In order to protect the brain and other organs from damage while the heart is stopped during surgery, physicians cool a patient's blood as it passes through a heart-lung machine. However, toward the end of the operation, this blood needs to be rewarmed. While the current study demonstrates that the results of past studies have been incorporated into clinical practice at Duke and other centers, the researchers said that slower rewarming has not yet become the standard of care nationally.

"There are still many surgical teams that are unaware of the importance of temperature in effecting outcomes after bypass surgery," said Duke cardiothoracic anesthesiologist Hilary Grocott, M.D., who presented the results of the Duke analysis April 26, 2004, at the annual scientific sessions of the Society of Cardiovascular Anesthesiologists.

"The reasons why slower rewarming has not become more widespread are numerous, ranging from the inherent resistance to changing long-standing medical practices, to not wanting to spend the additional time in the operatin
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Contact: Richard Merritt
merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
26-Apr-2004


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