thiamylal and Heart-Arrest

A 59-year-old man presented with severe dyspnea caused by advanced laryngeal cancer. As he had disregarded the dyspnea for a month, we did not have enough information about the extent of the tumor. The pulse oximeter showed 88% with oxygen inhalation. Because of severe dyspnea, he could not maintain supine position. Fiberoptic laryngoscopy showed tumor bulk obstructing airway directly. In the operating room, at first, a cricothyroid membrane puncture was attempted under local anesthesia but the procedure was abandoned when the patient became hypoxic and unconscious. Immediately tracheostomy and cardiopulmonary resuscitation were performed. Tumor bulk had displaced the trachea and surrounding structures, making a tracheostomy difficult. Nine min after loss of consciousness, a secure airway was obtained. However, he was still unconscious and developed characteristic decerebrate rigidity. Therefore the patient was treated with infusion of thiamylal and free radical scavenger and mild hypothermia therapy (bladder temperature 34 degrees C). On the fifth day of this treatment, after rewarming and discontinuation of thiamylal, the patient responded to command. He recovered with no neurological deficits. This case suggests that combined treatment with barbiturate, free radical scavenger, and mild hypothermia therapy is effective to minimize ischemic brain damage after cardiopulmonary resuscitation.

Topics: Acute Disease; Airway Obstruction; Cardiopulmonary Resuscitation; Combined Modality Therapy; Decerebrate State; Dyspnea; Free Radical Scavengers; Heart Arrest; Humans; Hypothermia, Induced; Hypoxia, Brain; Laryngeal Neoplasms; Male; Middle Aged; Thiamylal; Tracheostomy; Treatment Outcome

A 46-yr-old man with dysaesthesia (burning sensation) following herpes zoster in the left upper chest region was treated with a single thoracic (T2/T3) epidural injection (1.0% lidocaine 3 ml + 0.125% bupivacaine 3 ml) as an outpatient. Twenty minutes after the injection, a nurse noticed the patient to be unconscious with dilated pupils, apnoea and cardiac arrest. Following immediate cardiopulmonary resuscitation, the patient was treated with an i.v. infusion of thiamylal sodium 2-4 mg kg-1 h-1 and his lungs were mechanically ventilated. When the patient developed a characteristic decorticate posture, mild hypothermia (oesophageal temperature, 33-34 degrees C) was induced. On the 17th day of this treatment, after rewarming (35.5 degrees C) and discontinuation of the barbiturate, the patient responded to command. Weaning from the ventilator was successful on the 18th day. About 4 months after the incident, the patient was discharged with no apparent mental or motor disturbances. We suggest that mild hypothermia with barbiturate therapy may have contributed to the successful outcome in this case.

Topics: Analgesia, Epidural; Decerebrate State; Heart Arrest; Humans; Hypnotics and Sedatives; Hypothermia, Induced; Male; Middle Aged; Paresthesia; Thiamylal

Topics: Acepromazine; Anesthesia; Anesthesia, Intravenous; Animals; Female; Guaifenesin; Heart Arrest; Horse Diseases; Horses; Injections, Intravenous; Lethal Dose 50; Male; Muscle Relaxants, Central; Succinylcholine; Thiamylal

Topics: Analgesia; Anesthesia, Inhalation; Animals; Arrhythmia, Sinus; Blood Pressure; Dogs; Epinephrine; Ethers; Ethyl Ethers; Halothane; Heart; Heart Arrest; Injections, Intravenous; Methoxyflurane; Oxygen; Respiration; Thiamylal; Ventricular Fibrillation