Induced hypothermia as a therapeutic measure in neurology; a clinical study of a hopeless case.

ALTHOUGH hypothermia has only recently been introduced as a therapeutic agent in surgery and anaesthesia, it is already proving of value because of the reduction in tissue oxygen consumption that occurs when the temperature is lowered (Bigelow, Lindsay, Harrison, Gordon and Greenwood, 1950). Recent reports concern its application to cardiac surgery (Lewis and Tuffic, 1953; Swan, Zeavin, Blount and Virtue, 1953) and to general surgery for poor risk cases (Dundee, Gray, Mesham and Scott, 1953; Dundee and Mesham, 1954). Its application in acute head injuries with mid-brain lesions has been reported by Woringer, Schneider, Baumgarter and Thomalske (1954). In a previous communication we have drawn attention to the value of combining hypothermia with hypotension during major neurosurgical operations (Dundee, Francis and Sedzimir, 1954). The present report deals with a neurosurgical case in which hypothermia was employed, first to increase the safety of hypotension at operation, and later, on two occasions, as 93 a therapeutic measure. The patient survived for twenty-eight days following a massive intracerebral haemorrhage from a saccular aneurysm which was operated upon during the bleeding phase. The artificial reduction in cerebral metabolism is thought to be the main factor responsible for the prolonged survival and the astonishing preservation of function in areas of brain devoid of their main blood supply. The method of producing hypothermia will not be discussed in detail, but surface cooling was used throughout. Chlorpromazine and hexamethonium were given to produce peripheral vasodilatation. Shivering was prevented by analgesic drugs (pethidine and levorphan) and chlorpromazine (Dundee, Mesham and Scott, 1954).