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Significantly differ, but duration of catecholamine application and maximal catecholamine dosage were significantly higher in the MH group. CONCLUSIONS: In patients with severe ischemic stroke, CE results in lower mortality and lower complication rates compared with MH. Both treatment modalities, however, are associated with intensive medical treatment and a prolonged stay in the neurological intensive care unit. Level of evidence: 5, nonrandomized Level of design: Poor, N 36, no controls Endpoint: ICP, Comparison of hemicraniectomy and hypothermia Direction: None, no measure of clinical outcome was performed Comments: This was a small nonrandomized trial of 36 patients with severe more than two thirds of the MCA territory based on baseline or followup CT and NIHSS 15 ; ischemic strokes. Hypothermia was used on patients with strokes in the dominant hemisphere; hemicraniectomy was performed on patients with nondominant hemispheric strokes. The cooling method was external cooling with blankets Hico Variotherm ; in 12 patients, endovascular ICY, Alsius ; in 7 patients. The target degree of hypothermia was 33oC; time to reach temperature was 3 hours range 2-4.5 hours duration of cooling was not reported but suggested to be between 48-72 hours; rewarming was rate controlled at 1oC 8 hr. Additional interventions included intubation, thrombolysis in 2 patients, neuromuscular blockade, sedation, and analgesia. Hematologic and electrolyte assays were preformed during the cooling and rewarming phase in patients. No significant complications were attributed to the catheter, although all patients developed pulmonary infection, and all patients required catecholamines for maintenance of blood pressure. Catheter and cooling was reported as being well tolerated in all patients, except singultus was observed in all patients likely due to the cooling solution. This small study gives no measure of clinical efficacy. The authors conclude further study is warranted based on technical efficacy of the device. Georgiadis, D., S. Schwarz, et al. 2001 ; . "Endovascular cooling for moderate hypothermia in patients with acute stroke: first results of a novel approach." Stroke 32 11 ; : 2550-3. AB: BACKGROUND AND PURPOSE: We undertook this study to evaluate the feasibility of inducing and maintaining moderate hypothermia with the use of endovascular rather than surface cooling. METHODS: Six patients with severe acute ischemic stroke were treated with moderate hypothermia. This was induced and maintained by circulating temperature-adjusted normal saline in a closed-loop system entailing 3 balloons located near the tip of a central line, which dwelled in the inferior vena cava. RESULTS: The mean + -SD initial temperature of the patients was 37 + -1 degrees C range, 35.5 degrees C to 38.4 degrees C ; . The pace of cooling was 1.4 + -0.6 degrees C h, and target temperature was reached after 3 + -1 hours range, 2 to 4.5 hours ; . During hypothermia, the maximal temperature observed was 33.4 degrees C, and the minimal temperature was 32.2 degrees C. Temperature deviations 0.2 degrees C or 0.3 degrees C were observed during 21% or 10% of the hours under hypothermia, respectively. Singultus was the only device-related complication encountered. Pulmonary infection, arterial hypotension, bradycardia, arrhythmia, and thrombocytopenia were the most common side effects. CONCLUSIONS: Induction and maintenance of hypothermia with an intravenous cooling device are feasible. The safety of this approach remains to be evaluated. Level of evidence: 5, nonrandomized, no control Level of design: Poor, N 6 feasibility trial ; Endpoint: Technical efficacy of technique only Direction: None, no measure of clinical outcome was performed Comments: This was a very small nonrandomized trial of 6 patients with severe greater than a third MCA distribution strokes. The cooling method was endovascular via a catheter in the inferior vena cava. The target degree of hypothermia was 33oC; time to reach temperature was 3 hours range 2-4.5 hours duration of cooling was not reported but suggested to be between 48-72 hours; rewarming was rate controlled at 1oC 8 hr. Additional interventions included intubation, thrombolysis in 2 patients, neuromuscular blockade, sedation, and analgesia. Hematologic and electrolyte assays were preformed during the cooling and rewarming phase in patients. No significant complications were attributed to the catheter, although all patients developed pulmonary infection, and all patients required catecholamines for maintenance of blood pressure. Catheter and cooling was reported as being well tolerated in all patients, except singultus was observed in all patients likely due to the cooling solution. This small study gives no measure of clinical efficacy. The authors conclude further study is. Aspirin EC 81, 325mg tab Aspirin 600mg supp Aspirin caffeine butalbital Fiorinal ; cap Choline Mag Trilisate ; 500mg tab Diclofenac EC Voltaren ; 50mg tab Diclofenac Misopros Arthrotec ; 50mg, 75mg 0.2mg tab Etodolac Lodine ; 200, 300, 400mg Ibuprofen Motrin ; 400, 600, 800mg tab Ibuprofen 100mg 5ml susp Indomethacin Jndocin ; 25, 75mg cap Meloxicam Mobic ; 7.5, 15mg tab Naproxen Naprosyn ; 250, 500mg tab Naproxen 125mg 5ml suspension and moduretic and indocin. 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