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Are you having back pain with any of the following?
- Severe pain, weakness or tingling in your leg(s).
- Difficulty stopping urination or loss of control of bladder or bowels.
- Unexplained fever, nausea or vomiting.
- A history of cancer or unexplained weight loss.
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Deep Hypothermic Circulatory Arrest [Read/Print full article]
Overview
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Deep hypothermia (DH) or deep hypothermic circulatory arrest (DHCA) is a technique of radically cooling the body in preparation for surgery. Slowing metabolism in this way reduces the body's oxygen requirements. This protects the brain and other organs from the effects of oxygen deprivation during surgery.
Under normal conditions, if the brain is deprived of oxygen, cells start to die within 4 minutes and permanent brain damage may be inevitable after 5 minutes. The deep hypothermia process extends the time that the brain and other organs can go without oxygen to around 30 to 40 minutes, which allows for sufficient time to complete surgery.
We may recommend DH for certain types of heart surgery. For example, we may use this technique in order to repair a weakened, bulging area (aneurysm) in the aorta. The aorta is the large blood vessel leading from the heart that supplies the body with blood. If the aneurysm is located in an area of the aorta called the aortic arch, for example, it is not possible to isolate it from the rest of the circulatory system in order to repair it. In that case we need to stop blood from circulating, and protect the brain and other organs, while we make the repair.
Why it is Done
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We use DH most often when we are operating directly on the heart or repairing an aorta. The procedure is also known as deep hypothermic circulatory arrest (DHCA). We may recommend the procedure in order to safely repair congenital heart defects such as an atrial septic defect, also known as a hole in the heart, or an aortic aneurysm.
DHCA may also be used for some types of brain surgery, for example, to repair, or close off, a complex aneurysm in the brain.
How it is Performed
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We perform DHCA in a cooled operating room. Once you have been given general anesthetic and are no longer awake, we begin the surgery by making a chest incision to gain access to the heart. Clamps are then placed to stop the flow of blood to and from the heart and a cardiopulmonary bypass machine (heart-lung machine) is connected to the veins and arteries surrounding the heart.
The cardiopulmonary bypass (CPB) machine oxygenates the blood, performing the functions of the lungs. The machine, rather than your heart, then pumps the blood back into your body. The CPB machine is filled with ice to rapidly cool the blood that is being pumped through the body. We monitor your temperature continuously throughout the surgery. When your body has cooled sufficiently, the circulation is stopped, and the surgical repair can begin. We perform the surgery as quickly as possible to minimize the period of time that oxygen is not circulating.
Once surgery is complete, we remove the external cooling devices and packs. The CPB machine includes a heat exchanger which we use to very gradually warm the blood. Once the body has warmed sufficiently, we remove the clamps, restoring blood flow to and from the heart. The heart is restarted with a series of small electric shocks. Once your heart is beating normally, the CPB machine tubes are removed.
All of these procedures are performed under general anesthesia, so you will not be aware of the surgery and you will not feel any pain.
Risks
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As with any surgery, DHCA has some risks. These include:
- Compromised heart function
- Temporary memory loss or confusion
- Kidney damage
- Failure of the lungs to fully expand
- Stroke or seizure
- Blood clots
- Postoperative bleeding
Also, because your blood comes into contact with foreign substances (the tubing and components of the CPB machine), your body may have an inflammatory reaction. This is known as postpericardiotomy syndrome. It can include fever and swelling in different parts of the body and can potentially cause damage to other organs. We may prescribe medication, including steroids administered before and during surgery, to prevent postpericardiotomy syndrome.
For most people, the benefits of the DH approach outweigh the risk of complications. However, the risk may be greater if you have additional medical conditions or if the surgery is very complicated and takes an extended period of time.
After Your Procedure
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Because DHCA is a complex procedure, recovery time in the hospital can take several days. During that time, we may use several tubes to either drain excess fluids (or urine) or to deliver medications. We will continue to monitor your vital signs, such as blood pressure and breathing, during this time.
Once you are well enough to return home, you will be asked to limit your return to normal activity until you are stronger and completely recovered. We will talk with you about your medications, including those for pain and heart disease. We may also recommend an appropriate exercise regimen once you are strong enough to participate in regular physical activity.
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.
If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.
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