Cooling in Surgical Patients: Two Case Reports

Moderate induced hypothermia has become standard of care for children with peripartum hypoxic ischaemic encephalopathy. However, children with congenital abnormalities and conditions requiring surgical intervention have been excluded from randomised controlled trials investigating this, in view of concerns regarding the potential side effects of cooling that can affect surgery. We report two cases of children, born with congenital conditions requiring surgery, who were successfully cooled and stabilised medically before undergoing surgery. Our first patient was diagnosed after birth with duodenal atresia after prolonged resuscitation, while the second had an antenatal diagnosis of left-sided congenital diaphragmatic hernia and suffered an episode of hypoxia at birth. They both met the criteria for cooling and after weighing the pros and cons, this was initiated. Both patients were medically stabilised and successfully underwent therapeutic hypothermia. Potential complications were investigated for and treated as required before they both underwent surgery successfully. We review the potential side effects of cooling, especially regarding coagulation defects. We conclude that newborns with conditions requiring surgery need not be excluded from therapeutic hypothermia if they might benefit from it. 1. Introduction Moderate induced hypothermia to 33-34°C via total body or selective head cooling has become standard care for term infants who have suffered peripartum hypoxic ischaemic encephalopathy (HIE), following the publication of randomised controlled trials (RCTs) [1] and meta-analyses [2] demonstrating its effectiveness in reducing the composite outcome of death or disability in these neonates. However, these RCTs excluded patients with significant congenital abnormalities or conditions requiring surgery [1, 2]. This was partly because of the possibility of skewing data if these children also had congenital brain abnormalities, but also because of concerns regarding the systemic effects of hypothermia that could potentially affect surgery in these neonates [3, 4]. We report two cases of children born with congenital conditions requiring surgery who were successfully cooled, stabilised medically, and then rewarmed before surgery. 2. Case Report 1 AB was born at term in a district general hospital in poor condition, requiring full cardiopulmonary resuscitation including adrenaline and bicarbonate boluses, before responding at 12 minutes of life. Her first blood gas was as follows: pH 6.8, pCO2 4.2？kPa (31？mm？Hg), bicarbonate 5.5, and base excess ？28. She