Lowering body temperature in acute ischemic stroke without artificial ventilation and heavy sedation: A feasibility study

Background and purpose: We assessed the feasibility of inducing very mild hypothermia in 8 patients with acute ischemic anterior circulation stroke, without artificial ventilation and heavy sedation, until 24 hours after onset of symptoms. Methods: Four regimes (A, B, C, and D) with increasing monitoring and treatment intensity were studied. Two patients in in regime A were monitored only. In regime B, 2 patients were treated with acetaminophen suppositoria of 1 g at 4-hour intervals. Additionally, the patients in regime C were cooled with a cooling blanket until 24 hours after the onset of symptoms. The target body temperature was 35°C to 36°C. During the cooling procedure, slight sedation was induced by continuous intravenous administration of low-dose midazolam. In regime D, sponging with 70% alcohol could be applied. Results: In these 4 patients, the mean reduction in body temperature after 8 hours of treatment amounted to 1.25°C. No clinically important changes in vital parameters occurred. Conclusions: The present study suggests that mild hypothermia in noncomatose stroke patients during a period of 24 hours after the ictus may be accomplished with a cooling blanket and light sedation with midazolam in a well-equipped stroke unit. Copyright

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