Hypothermia and Cerebral Ischemia: Mechanisms and Clinical Applications.

Abstract

Wake Forest University School of Medicine, Winston-Salem, North Carolina. petrozza@wfubmc.eduHypothermia and Cerebral Ischemia: Mechanisms and Clinical Applications. By Carolina M. Maier, Ph.D., and Gary K. Steinberg, M.D., Ph.D. Totowa, New Jersey, Humana Press, 2003. Pages: 192. Price: $99.50.Hypothermia as a protective therapy and a treatment for cerebral ischemia in multiple settings has a long and storied history. Many anesthesiologists and intensivists have seen the prominence, the waning, and now the resurgence of therapeutic hypothermia within their professional lifetimes. Hypothermia and Cerebral Ischemia: Mechanisms and Clinical Applications is intended to provide a comprehensive review of mild hypothermia, including the therapeutic potential of the methodology, limitations, and recent developments in both basic and clinical research.One of the pleasures of reading this book is the evident effort which the editors Carolina A. Maier, Ph.D., and Gary K Steinberg, M.D., Ph.D., both from Stanford University, Stanford, California, expended on organizing the multiauthored text. The initial chapters contain a review of moderate hypothermia in experimental animal models primarily, and the middle chapters discuss current clinical practice and clinical trials. The third section of the book summarizes several studies performed primarily at single European centers in stroke patients. The summative chapter attempts to highlight future directions for the therapeutic applications of moderate hypothermia. Each chapter is organized with a concise historical view of hypothermia in the relevant experimental or clinical context, followed by presentations of important research studies and then a discussion of possible mechanisms of action, with a final concluding section on future directions for research.While the text is multiauthored with several international contributors, repetition of information is kept to a minimum, particularly in the initial chapters discussing experimental models of moderate hypothermia. Evidence of careful editing throughout the text is apparent by references to material or discussion in previous chapters where appropriate. In addition, the book is nicely illustrated with appropriate tables and images from experimental trials, which serve to highlight the teaching points within each chapter.Perhaps because a busy clinician has little time to explore the experimental basis for common therapies, this reader found the initial five chapters of this text to be most enjoyable. The concise discussions of the experimental rationale for moderate hypothermia followed by exploration of its application for the prevention and treatment of focal cerebral ischemia, traumatic brain injury, and postischemic injury were excellent. In contrast, the latter chapters of the text, which highlighted clinical trials and clinical methods of application of moderate hypothermia, were occasionally uneven in the amount of detail provided about clinical trials, research protocols, and patient groups.An obvious issue with a text that attempts to provide a comprehensive review of multiple applications of a technique in diverse groups of patients with many clinical scenarios is the issue of the current relevance of the information. The best asset of this text is its use to provide a foundation from which a clinician can best interpret new data. There are many practitioners, particularly those who specialize in neuroanesthesia and critical care, who are undoubtedly familiar with the myriad of mechanisms now identified as having a role in patient outcome after cerebral ischemia. However, a significant group of clinicians still exists who believe that an individual therapy such as hypothermia or a particular anesthetic might be the next “magic bullet.” Useful reading of the text such as Hypothermia and Cerebral Ischemia: Mechanisms and Clinical Applications at the point where one is initially exposed to the concepts of cerebral protection or neurosurgical anesthesia or professional interest is aroused through a clinical scenario might prove to be extremely valuable in broadening the knowledge base of many practitioners.This eminently readable text would be a valuable edition to the library of anesthesiology trainees who develop an interest in “cerebral protection” as they become familiar with concepts of neurosurgical anesthesia, critical care, and cerebral preservation within the operating room. In addition, this text serves as a strong foundation for those involved in the care of patients with devastating neurosurgical and neurologic disease as well the general practitioner of anesthesiology whose intellectual curiosity propels one to understand the background, limitations, and methodologies of current highly publicized clinical trials using therapeutic moderate hypothermia and other cerebral protection modalities.Wake Forest University School of Medicine, Winston-Salem, North Carolina. petrozza@wfubmc.edu