thiopental and Acidosis--Respiratory

In rats with experimental thiopental coma rectal temperature decreased by 9.4 degrees C, oxygen consumption 5-fold, and arteriovenous Po(2)gradient decreased 2-fold within 3 h; CO(2)accumulated in the blood and mixed type acidosis developed. Administration of sodium succinate under these conditions increased arteriovenous Po(2)gradient and reduced manifestations of metabolic acidosis. Maintenance of normal body temperature (warming) corrected primarily manifestations of respiratory acidosis. Each therapeutic agent reduced inhibition of O(2)consumption by 1/4; animal survival tended to increase from 42 to 50%. Combined use of these treatments potentiated the antiacidotic effect and increased survival to 92%. The authors conclude that hypothermia inhibits the therapeutic effect of succinate in barbiturate coma.

Topics: Acidosis, Respiratory; Animals; Body Temperature; Carbon Dioxide; Coma; Female; Oxygen; Oxygen Consumption; Rats; Succinates; Thiopental; Time Factors

We report the case of a 31-year-old man with Graves' disease who manifested malignant hyperthermia during subtotal thyroidectomy. His past medical history and family history were unremarkable. Before surgery, his condition was well controlled with propylthiouracil, beta-adrenergic blocker and iodine. During the operation, anesthesia was induced by intravenous injection of vecuronium and thiopental, followed by suxamethonium for endotracheal intubation. Anesthesia was maintained with nitrous oxide and sevoflurane. One hour after induction of anesthesia, his end tidal carbon dioxide concentration (ET(CO2)) increased from 40 to 50 mmHg, heart rate increased from 90 to 100 beats per min and body temperature began to rise at a rate of 0.3 degrees C per 15 min. Suspecting thyroid storm, propranolol 0.4 mg and methylprednisolone 1,500 mg were administered, which, however, had little effect. Despite the lack of muscular rigidity, the diagnosis of malignant hyperthermia was made based on respiratory acidosis. Sevoflurane was discontinued and dantrolene was given by intravenous bolus. Soon after the treatment, ET(CO2), heart rate and body temperature started to fall to normal levels. His laboratory findings showed abnormally elevated serum creatine phosphokinase and myoglobin but normal thyroid hormone levels. Since dantrolene is efficacious in thyrotoxic crisis and malignant hyperthermia, an immediate intravenous administration of dantrolene should be considered when a hypermetabolic state occurs during anesthesia in surgical treatment for a patient with Graves' disease.

Topics: Acidosis, Respiratory; Adult; Anesthetics; Antithyroid Agents; Carbon Dioxide; Creatine Kinase; Dantrolene; Diagnosis, Differential; Goiter; Graves Disease; Heart Rate; Humans; Male; Malignant Hyperthermia; Methimazole; Methyl Ethers; Muscle Relaxants, Central; Myoglobin; Nitrous Oxide; Propylthiouracil; Sevoflurane; Succinylcholine; Thiopental; Thyroidectomy; Thyroxine; Triiodothyronine; Vecuronium Bromide

Hydrochloric acid was instilled into the bronchial tree in anaesthetized dogs. A severe respiratory acidosis resulted. The metabolic component of acid-base balance was little affected.

Topics: Acidosis, Respiratory; Anesthesia, General; Animals; Carbon Dioxide; Disease Models, Animal; Dogs; Female; Halothane; Hematocrit; Hydrochloric Acid; Hydrogen-Ion Concentration; Lung; Male; Nitrous Oxide; Organ Size; Oxygen; Pneumonia, Aspiration; Respiration; Thiopental

Topics: Acidosis, Respiratory; Analgesia; Anesthesia, Conduction; Anesthesia, Epidural; Anesthesia, Obstetrical; Bradycardia; Delivery, Obstetric; Drug Therapy, Combination; Extraction, Obstetrical; Female; Humans; Infant, Newborn; Injections, Intravenous; Labor, Obstetric; Meperidine; Naloxone; Pain; Pregnancy; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Thiopental; Tranquilizing Agents; Vasoconstrictor Agents

Topics: Acid-Base Equilibrium; Acidosis, Respiratory; Adult; Anesthesia, Intravenous; Blood; Carbon Dioxide; Cesarean Section; Female; Fetus; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Maternal-Fetal Exchange; Nitrous Oxide; Partial Pressure; Placenta Diseases; Pregnancy; Succinylcholine; Thiopental

Topics: Acidosis, Respiratory; Anesthesia, General; Anesthesia, Obstetrical; Carbon Dioxide; Cesarean Section; Female; Fetus; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Intubation, Intratracheal; Maternal-Fetal Exchange; Oxygen; Pregnancy; Succinylcholine; Thiopental; Umbilical Arteries; Umbilical Veins

Topics: Acid-Base Equilibrium; Acidosis; Acidosis, Respiratory; Anesthesia, Inhalation; Anesthesia, Obstetrical; Anesthesia, Spinal; Carbon Dioxide; Cesarean Section; Female; Humans; Hypotension; Infant, Newborn; Infant, Newborn, Diseases; Lidocaine; Nitrous Oxide; Oxygen; Physical Examination; Pregnancy; Succinylcholine; Thiopental

Topics: Acidosis, Respiratory; Adult; Aged; Anesthesia, General; Apnea; Bronchiectasis; Bronchoscopy; Carbon Dioxide; Female; Humans; Male; Methods; Middle Aged; Pressure; Succinylcholine; Thiopental