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January 1960

Portacaval Shunts: Use of Hypothermia During Anesthesia

Author Affiliations

Durham, N.C.
From the Duke Medical Center and Veterans Administration Hospital.

AMA Arch Surg. 1960;80(1):125-130. doi:10.1001/archsurg.1960.01290180127015

The patient with cirrhosis of the liver and bleeding esophageal varices presents a number of serious problems. Diagnosis may occasionally be difficult and the treatment hazardous whether by balloon tamponade or transesophageal ligation. If the patient survives the acute bleeding episode, a period of intensive treatment is necessary to attain a maximum return toward normal liver function. Having accomplished this, an operation of considerable magnitude, frequently under prolonged anesthesia, must be performed. The postoperative period is endangered, in addition to the usual complications, by those untoward events peculiar to this disease, such as liver failure, coma, ammonia intoxication, and hemorrhage. Therefore, any treatment or technique which will enhance the possibility of recovery assumes a degree of importance. This discussion concerns the utilization of hypothermia during anesthesia for portacaval shunt.

The Rationale of Hypothermia  Linton (1958), one of the pioneers in shunt surgery, has described on several occasions his preference for

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