thiamylal and Intracranial-Aneurysm

Mild barbiturate-moderate hypothermia therapy was established for severe head injury and cerebrovascular disease. This study was conducted on 152 patients from April 1984 through July 1995. In this study were included patients with Glagow Coma Scale score of less than 8 points but those with serious systemic complications and elderly and infantile patients were excluded. Our protocol consisted of administration of thiamylal Na 1.25-2.5 mg/kg/h and droperidol 20-40 micrograms/kg/h (mild barbiturate) while maintaining a core temperature of 32-34 degrees C (moderate hypothermia). The clinical outcome was good (GR, MD) in 58 cases, poor (SD) in 24 cases and bad (PVS, D) in 70 cases. This therapy was found to be particularly effective for preventing ischemic neurological damage in the vasospasm stage following SAH and severe head injury in young patients. However, this therapy did not prevent pneumonia, cardiac failure, arrhythmia and hypopotassemia from occurring frequently. We conclude that this therapy is contraindicated in the elderly, i.e., those older than 65 years.

Topics: Adolescent; Adult; Aged; Brain Injuries; Cerebrovascular Disorders; Child; Droperidol; Female; Glasgow Coma Scale; Humans; Hypnotics and Sedatives; Hypothermia, Induced; Intracranial Aneurysm; Male; Middle Aged; Thiamylal; Treatment Outcome

A 68-year-old female and a 47-year-old male patients underwent clipping surgery for giant basilar arterial and thrombotic internal carotid arterial aneurysms respectively with closed-chest extracorporeal circulation (femoro-femoral bypass). Profound hypothermia and continuous infusion of thiamylal were used to prevent brain damage. Blood outflow via the femoral vein was sufficient to induce profound hypothermia down to 20 degrees C. Hemodynamics were controllable without catecholamines during closed-chest extracorporeal circulation. Preoperative symptoms significantly improved and no neurological complication was observed in either case postoperatively. Right femoral phlebothrombosis was, however, observed in one case. In conclusion, profound hypothermia with closed-chest extracorporeal circulation is a safe technique to reduce the complications induced by open-chest technique, but special attention should be given to postoperative phlebothrombosis.

Topics: Aged; Anesthetics, Intravenous; Basilar Artery; Brain Damage, Chronic; Carotid Artery, Internal; Extracorporeal Circulation; Female; Humans; Hypothermia, Induced; Intracranial Aneurysm; Male; Middle Aged; Postoperative Complications; Thiamylal; Thrombophlebitis

A 52 year-old female was scheduled for clipping of giant basilar artery aneurysm. This operation needed temporary clipping of the basilar artery for 30-40 minutes, and preoperative examination suggested that some regions would become ischemic by temporary clipping. Therefore profound hypothermia using cardiopulmonary bypass (CPB) and thiamylal loading were planned to prevent cerebral damage during the operation. Anesthesia was induced with thiamylal, fentanyl, and isoflurane in nitrous oxide and oxygen. Following administration of vecuronium, trachea was intubated. Two hours after the start of surgery, thiamylal was titrated to obtain EEG patterns of burst-suppression before CPB and the infusion was continued until CPB was discontinued. With burst-suppression present, CPB was instituted. Hypothermia below 20 degrees C at pulmonary artery temperature was maintained until the aneurysm was clipped and bleeding from the operating site was controlled. Cooling and rewarming by CPB were carried out with ease and uneventfully. The patient had no neurological complications postoperatively.

Topics: Basilar Artery; Blood Loss, Surgical; Cardiopulmonary Bypass; Female; Humans; Hypothermia, Induced; Intracranial Aneurysm; Middle Aged; Thiamylal

The effects and indications of barbiturate therapy for brain protection, and prevention and reduction of the intracranial hypertension were investigated using an ultrashort acting barbiturate, thiamylal, in sixteen cases with intracranial lesions. Final outcome of the treatment revealed 8 good recoveries which were actively administered thiamylal during operation or immediately after. On the other hand, four cases, whose intracranial pressures (ICPS) of over 40 mmHg could not be controlled suffered brain death. Barbiturate therapy was not effective for brain protection of primary damaged lesions. It is concluded that barbiturate therapy may provide a satisfactory reduction of the intracranial hypertension in cases during the early postoperative stage or of under 40 mmHg initial ICP.

Topics: Adolescent; Adult; Aged; Brain Edema; Brain Injuries; Brain Neoplasms; Cerebral Hemorrhage; Child, Preschool; Female; Humans; Intracranial Aneurysm; Intracranial Arteriovenous Malformations; Male; Middle Aged; Postoperative Complications; Pseudotumor Cerebri; Thiamylal; Thiopental