thiopental and Acute-Disease

Transcranial Doppler and, if possible, measurement of intracranial pressure (ICP) allow preoperative diagnosis of acute intracranial hypertension (ICH) after brain trauma. The main goal of the anaesthesiologist is to prevent the occurrence of secondary brain injuries and to avoid cerebral ischaemia. Treatment of high ICP is mainly achieved with osmotherapy. High-dose mannitol administration (1.4 to 2 g/kg given in bolus doses) may be considered a better option than conventional doses, especially before emergency evacuation of a cerebral mass lesion. Hypertonic saline seems as effective as mannitol without rebound effect and without diuresis increase. Haemostasis should be normalized before neurosurgery and invasive blood pressure monitoring is mandatory. For anaesthesia induction, thiopental or etomidate may be used. In case of ICH, halogenated and nitrous oxide should be avoided. Until the dura is open, mean arterial pressure should be maintained around 90 mmHg (or cerebral perfusion pressure around 70 mmHg). If a long-lasting (several hours) extracranial surgery is necessary, ICP should be monitored and treatment of ICH should have been instituted before.

Topics: Acute Disease; Anesthesia, General; Blood Pressure; Brain Injuries; Brain Ischemia; Case Management; Combined Modality Therapy; Comorbidity; Contraindications; Diuretics, Osmotic; Etomidate; Humans; Hyperventilation; Intracranial Hypertension; Jugular Veins; Mannitol; Monitoring, Intraoperative; Monitoring, Physiologic; Nitrous Oxide; Oxygen; Preoperative Care; Saline Solution, Hypertonic; Thiopental; Tomography, X-Ray Computed; Ultrasonography, Doppler, Transcranial; Wounds and Injuries

Topics: Acute Disease; Anesthesia; Animals; Blood Circulation; Chronic Disease; Endorphins; Halothane; Humans; Ketamine; Naloxone; Pain; Receptors, Opioid; Shock; Sleep; Thiopental

Over the past several decades, psychopharmacological treatments in psychiatry have been subjected to intensive methodological scrutiny in the continual assessment of their efficacy and safety. Although one of the most dramatic and controversial therapeutic approaches in psychiatry, electroconvulsive therapy (ECT) has not received the same concentrated, systematic attention. Through a comprehensive literature search, the present authors have attempted to provide answers relating to the efficacy and the safety of conventional ECT and some of its more prominent variations. Although specific discernible trends are reported in the text, results of the survey are too disparate for a simplistic summary statement to be made regarding efficacy in all diagnostic categories. As with most somatic treatments in psychiatry, bilateral ECT does present some apparent risk, reduced but not entirely eliminated by precautionary techniques, which must be weighed against the possible benefits to be derived in a given case. Other variations of ECT offer promise of fewer side effects but must be accepted as standard clinical practice.

Topics: Acute Disease; Anesthesia; Anesthesia, Inhalation; Anesthesia, Intravenous; Chronic Disease; Clinical Trials as Topic; Depression; Electric Stimulation; Electroconvulsive Therapy; Histamine; Humans; Insulin; Length of Stay; Mental Disorders; Nitrous Oxide; Psychotherapy; Safety; Schizophrenia; Succinylcholine; Thiopental; Tranquilizing Agents

We have performed a randomized, cross over study in 22 children suffering from acute leukaemia, who underwent repeated anaesthesia for bone marrow aspiration and lumbar puncture. For their first anaesthetic, the children (aged 3-10 years old) received, either a thiopentone/isoflurane anaesthetic or intravenous propofol, both supplemented with nitrous oxide. On a second occasion they received the alternative technique. Of those children receiving thiopentone/isoflurane, 32% had significant coughing during anaesthesia, two progressing to laryngospasm requiring 100% oxygen. None of the patients receiving propofol had a respiratory disturbance (P = 0.016). 68% of the children preferred the propofol anaesthetic. Only one child in the thiopentone/isoflurane group preferred this technique. Twenty-seven per cent had no preference. There was no significant difference in length of anaesthetic time (P = 0.07) or the time taken for recovery (P = 0.17) between the two groups. There was a large individual variation in propofol requirements and movement was common during stimulation of patients in this group, though this did not adversely affect the surgical procedure.

Topics: Acute Disease; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Biopsy, Needle; Bone Marrow; Child; Child, Preschool; Cough; Cross-Over Studies; Humans; Isoflurane; Laryngismus; Leukemia; Nitrous Oxide; Patient Satisfaction; Propofol; Spinal Puncture; Thiopental

The acute effects of thiopentone on plasma glucose concentration and regulation in humans have not been well described. We therefore examined the effect of a single dose (6 mg/kg) of thiopentone on plasma glucose, insulin, glucagon, adrenaline and noradrenaline in 16 healthy women undergoing elective abdominal surgery. To assess involvement of the neuroendocrine system in the response to thiopentone, half of the patients received labetalol prior to induction of anaesthesia. Thiopentone injection resulted in a 50% increase in plasma glucose levels (P < 0.001) in both labetalol-treated and non-treated patients 90 s following its administration. This was associated neither with significant increases in plasma glucagon, adrenaline and noradrenaline nor with a decline in plasma insulin. We conclude that acute hyperglycaemia following thiopentone is most likely the consequence of a non-adrenergically-mediated increase in hepatic glucose release.

Topics: Acute Disease; Anesthesia, Intravenous; Blood Glucose; Epinephrine; Female; Glucagon; Humans; Hyperglycemia; Insulin; Labetalol; Neurosecretory Systems; Norepinephrine; Placebos; Thiopental

Subhypnotic doses of thiopentone are considered to have a hyperalgesic effect, while propofol has a hypoalgesic effect. We investigated the effect of these drugs on the nociceptive system by measuring the pain threshold to laser stimulation and the pain evoked potential (power and latency). Nineteen patients (ASA group I) participated. Twelve patients received thiopentone 0.5 mg kg-1 and propofol 0.25 mg kg-1 in random order separated by an interval of 14 h, and seven patients received saline. Immediately after the injection of both agents, the pain threshold was increased significantly (P less than 0.001) and the amplitude of the evoked potential was reduced significantly (P less than 0.05), while the latency of the evoked potential remained constant. It is concluded that, in subhypnotic doses, both thiopentone and propofol decrease the acute pain evoked by argon laser stimulation.

Topics: Acute Disease; Adult; Female; Humans; Lasers; Male; Middle Aged; Pain; Propofol; Thiopental

Over the past several decades, psychopharmacological treatments in psychiatry have been subjected to intensive methodological scrutiny in the continual assessment of their efficacy and safety. Although one of the most dramatic and controversial therapeutic approaches in psychiatry, electroconvulsive therapy (ECT) has not received the same concentrated, systematic attention. Through a comprehensive literature search, the present authors have attempted to provide answers relating to the efficacy and the safety of conventional ECT and some of its more prominent variations. Although specific discernible trends are reported in the text, results of the survey are too disparate for a simplistic summary statement to be made regarding efficacy in all diagnostic categories. As with most somatic treatments in psychiatry, bilateral ECT does present some apparent risk, reduced but not entirely eliminated by precautionary techniques, which must be weighed against the possible benefits to be derived in a given case. Other variations of ECT offer promise of fewer side effects but must be accepted as standard clinical practice.

Topics: Acute Disease; Anesthesia; Anesthesia, Inhalation; Anesthesia, Intravenous; Chronic Disease; Clinical Trials as Topic; Depression; Electric Stimulation; Electroconvulsive Therapy; Histamine; Humans; Insulin; Length of Stay; Mental Disorders; Nitrous Oxide; Psychotherapy; Safety; Schizophrenia; Succinylcholine; Thiopental; Tranquilizing Agents

We report on three acute encephalitis patients with refractory, repetitive partial seizures (AERRPS). All three suffered acute febrile episodes associated with status epilepticus, which necessitated high-dose barbiturate therapy under artificial ventilation for several weeks. Electroencephalography (EEG) revealed a predominance of diffuse epileptiform discharges initially, subsequently developing into periodic bursts of these discharges. Reduction of the barbiturate dosage resulted in clinical and subclinical partial seizures appearing repetitively in clusters. Prolonged fever persisted for 2-3 months, even several weeks after normalization of cell counts in the cerebrospinal fluid. The EEG showed an improvement after resolution of this fever, and seizures became less frequent, although still intractable. Oral administration of high-dose barbiturate and benzodiazepines were partially effective during the acute phase, and a barbiturate dependency, lasting for years, was noted in one patient. Steroid administration was effective in stopping the febrile episodes in one patient, with concurrent improvement in seizure control. Magnetic resonance imaging showed enhancement of bitemporal cortical areas in one patient, and high signal intensity on T2 weighted image in the bilateral claustrum in another patient. Diffuse cortical atrophy appeared within two months after the onset of encephalitis in all patients. The evolution of the seizures and EEG findings suggested a high degree of cortical excitability in AERRPS. In this report, we propose a tentative therapeutic regimen for seizure control in this condition. We also hypothesize that a prolonged inflammatory process exists in the cerebral cortex with AERRPS, and may be pivotal in the epileptogenesis.

Topics: Acute Disease; Anti-Inflammatory Agents; Anticonvulsants; Brain; Cell Count; Cerebrospinal Fluid; Child; Delirium; Drug Resistance; Electroencephalography; Encephalitis; Epilepsies, Partial; Female; Fever; Humans; Magnetic Resonance Imaging; Male; Midazolam; Pneumonia; Status Epilepticus; Thiopental; Tomography, X-Ray Computed; Treatment Outcome; Unconsciousness

We describe a 30-year-old parturient with acute generalised pustular psoriasis who presented for urgent caesarean section. A multidisciplinary team was involved and general anaesthesia was used successfully. Management of this condition is discussed and the literature reviewed. While generalised pustular psoriasis or impetigo herpetiformis is well recognised in pregnancy, it has not hitherto been reported in obstetric anaesthesia literature. The purpose of this article is to delineate the clinical picture of this disease, its treatment, and the effect on the mother and the fetus.

Topics: Acetaminophen; Acute Disease; Adult; Analgesics, Non-Narcotic; Analgesics, Opioid; Anesthesia, General; Anesthesia, Obstetrical; Anesthetics, Intravenous; Anti-Allergic Agents; Anti-Bacterial Agents; Anti-Infective Agents; Cesarean Section; Chlorpheniramine; Female; Gentamicins; Humans; Metronidazole; Morphine; Neuromuscular Depolarizing Agents; Pregnancy; Psoriasis; Succinylcholine; Thiopental

We report the case of a 57-year-old man who experienced life-threatening myoclonic status after the administration of gabapentin. Based on familial data, the patient was determined to be a member of a previously described family with benign adult familial myoclonic epilepsy (BAFME). The myoclonic status did not respond to benzodiazepines, but resolved after discontinuing the gabapentin. As for other idiopathic generalized epilepsies, gabapentin may precipitate myoclonic status in a benign syndrome, such as BAFME, as is reported herein for the first time. A correct diagnosis and prompt discontinuation of the drug may reverse a potentially severe, life-threatening condition.

Topics: Acute Disease; Amines; Anticonvulsants; Benzodiazepines; Cyclohexanecarboxylic Acids; Drug Resistance; Electroencephalography; Epilepsies, Myoclonic; Gabapentin; gamma-Aminobutyric Acid; Haplotypes; Humans; Male; Middle Aged; Pedigree; Severity of Illness Index; Status Epilepticus; Thiopental; Tremor

Pentoxifylline exhibits rheological properties that improve microvascular flow and it is widely used in vascular perfusion disorders. It also exhibits marked anti-inflammatory properties by inhibiting tumour necrosis factor alpha production. Thiopental is one of the most widely used drugs for rapid induction of anaesthesia. During experimental studies on the treatment of acute pancreatitis, we observed that when pentoxifylline was administered after anaesthesia with thiopental, most of the rats exhibited dyspnea, signs of pulmonary oedema and died. The aim of the work described here was to investigate the cause of the unexpected toxic effect of the combined treatment with thiopental and pentoxifylline.. Pulmonary vascular permeability and arterial blood gases were measured, and a histological analysis was performed. The possible role of haemodynamic changes in the formation of pulmonary oedema was also assessed.. Co-administration of pentoxifylline and thiopental increased pulmonary vascular permeability and markedly decreased arterial pO2, with one third of rats suffering from hypoxemia. This combined treatment caused death by acute pulmonary oedema in 27% of normal rats and aggravated the respiratory insufficiency associated with acute pancreatitis in which the mortality rate increased to 60%. This pulmonary oedema was not mediated by cardiac failure or by pulmonary hypertension.. Co-administration of pharmacological doses of pentoxifylline and thiopental caused pulmonary oedema and death in rats. Consequently, pentoxifylline should not be administered when anaesthesia is induced with thiopental to avoid any possible risk of acute pulmonary oedema and death in humans.

Topics: Acute Disease; Anesthetics, Intravenous; Animals; Drug Interactions; Injections, Intraperitoneal; Male; Pancreatitis; Pentoxifylline; Pulmonary Edema; Rats; Rats, Wistar; Thiopental; Vasodilator Agents

Isoniazid is an anti-tuberculosis drug, used commonly for treatment and prophylaxis of tuberculosis. Acute isoniazid intoxication is characterized by a clinical triad consisting of metabolic acidosis resistant to treatment with sodium bicarbonate, seizures which may be fatal and refractory to standard anticonvulsant therapy, and coma. Treatment requires admission to the intensive care unit for ventilatory support, management of seizures and metabolic acidosis. Pyridoxine, in a dose equivalent to the amount of isoniazid ingested, is the only effective antidote. We report the successful treatment of two isoniazid intoxication cases: the case of a child developing an accidental acute isoniazid intoxication and an adult case of isoniazid intoxication with the intent of suicide.

Topics: Acidosis; Acute Disease; Adolescent; Anticonvulsants; Antitubercular Agents; Charcoal; Child; Coma; Diazepam; Female; Gastric Lavage; Humans; Intubation, Intratracheal; Isoniazid; Pyridoxine; Seizures; Sodium Bicarbonate; Suicide, Attempted; Thiopental; Vitamin B Complex

The main rationale behind the continuous analgesia/sedation currently practiced in the treatment of neonates with severe respiratory failure in intensive care is an attempt at shielding the sick newborn from exogenous stress and pain caused by diagnostic and therapeutic interventions. Until now, however, the factors which influence endogenous, disease-related distress have been largely ignored.. We retrospectively studied the daily need for analgesics and sedatives (fentanyl, midazolam, pentobarbital, thiopental) of 40 full-term newborns with severe respiratory failure who had been ventilated for at least 48 h over an observational period of 2-5 days. Dosing of the analgesics and sedatives was based on a neonatal sedation score for ventilated infants. These daily amounts were converted to a normative comparative dose (analgesic/sedative need = ASN) and compared with the oxygenation index (OI) as a measure of the degree of pulmonary insufficiency.. Depending on the duration of ventilation, an increasingly close correlation between the ASN and the OI was detected: the index of correlation (r) was detected to be 0.65 on the second day, but increased up to 0.94 after 5 days. The subgroup of patients who had been ventilated for more than 3 days (n = 8) consistently showed a very high correlation, ranging from r = 0.86 to r = 0.94.. Our results indicate a direct relationship between severity of pulmonary failure (expressed as OI) and degree of disease-related distress (reflected by ASN). This supports the hypothesis that in full-term neonates under mandatory intensive care for severe respiratory failure, endogenous distress caused by the primary disease itself, in addition to exogenous distress caused by therapeutic and diagnostic interventions, is key factor for the determination of the required amount of analgesic and sedative drugs.

Topics: Acute Disease; Analgesia; Female; Fentanyl; Humans; Hypnotics and Sedatives; Infant, Newborn; Intensive Care, Neonatal; Male; Midazolam; Pentobarbital; Respiration, Artificial; Respiratory Insufficiency; Retrospective Studies; Stress, Physiological; Thiopental

The acute porphyria is an autosomal dominant disorder of the héme biosynthesis enzyme. The aim of this work is to determin a diagnostic step in order to anticipate porphyric crises. We report the observation of a child which was hospitalized in the pédiatric service three years ago for peripheric arthralgies and myalgies where the diagnosis of an acute porphyria was not posed. He wase admitted in our service for appendicitis, he was operated, the anesthesie was carried out by the thiopenthal and the succinylcholine. At the first post-operative day, a respiratory insufficiency was the cause of death. The rate of coproporphyrines and of uroporphyrines in the urine had confirmed the diagnosis of acute porphyria. The positive diagnostic of acute porphyria is difficult, the association of abdominal, psychological and neurologic signs must suggest the diagnostic, all the more, if the urines have a dark colour. The presence of uroporphyrines and coproporphyrines and certain precursors in the urines or in the high-rated stools confirm the diagnostic. The family survey and dosage of porphyric compounds in the sickness-bearing patient's family members allow to reveal certain asymptomatic forms of the heriditary acute porphyria, it is caused by certain products used in neuropsychiatry, in aneasthesic or in certain circunstances, such as, the infection or the trauma. The treatment of the acute porphyria is an emergency wich requires the transfert of the patient to a unit of intensive care.

Topics: Acute Disease; Anesthetics, Inhalation; Anesthetics, Intravenous; Appendicitis; Child; Diagnosis, Differential; Fatal Outcome; Halothane; Humans; Pedigree; Porphyria, Acute Intermittent; Postoperative Complications; Prognosis; Respiratory Insufficiency; Thiopental

From 1992 to July 1996, 19 patients (aged 39 to 78 years) were operated on for type A acute aortic dissection. Our operative strategy is that all patients in whom aortic dissection involves the segment of transverse aortic arch should undergo simultaneous replacement or repair of the aortic arch and ascending aorta. Among these 19 patients, 17 were operated on within 24 hours after onset. In 13 patients, graft replacement extended from the ascending aorta to the transverse portion of the arch. The aortic stumps were prepared with the Teflon left both inside and outside of the aortic wall. Recently these were reconstructed with the aid of the Gelatin-Resorcin-Formaling glue, instilled into the false lumen. Cerebral protection was achieved by hypothermic circulatory arrest associated with the cerebroplegia (thiopental, nicradipine and mannitol). In one patient associated with severe aortic regurgitation, a valved conduit was implanted and the coronary arteries were reimplanted. CABG was performed concomitantly in two patients for involvement of the proximal coronary arteries by the dissection process. The hospital mortality rate was 26% (5/19). However, in two of them, death was not directly related to the operative procedure. One patient died of graft versus host disease (GVHD), another patient died of acute epidural hemorrhage which was undetected until the repair was completed. During the postoperative course, in all but two patients, the false lumens of the aortic arch and/or descending thoracic aorta were confirmed to be totally thrombosed by the examination of CT scan and/or aortography. It is concluded that the surgical treatment of type A acute aortic dissection can be successfully performed, even if the graft replacement extended to the transverse aortic arch.

Topics: Acute Disease; Adult; Aged; Aortic Aneurysm, Thoracic; Aortic Dissection; Blood Vessel Prosthesis; Cerebrovascular Circulation; Female; Heart Arrest, Induced; Humans; Hypothermia, Induced; Male; Mannitol; Middle Aged; Nicardipine; Perfusion; Potassium Compounds; Thiopental

Topics: Acute Disease; Adjuvants, Anesthesia; Adult; Airway Obstruction; Anesthesia, General; Anesthetics, Intravenous; Atropine; Female; Humans; Intubation, Intratracheal; Neuromuscular Depolarizing Agents; Salivary Gland Diseases; Succinylcholine; Thiopental; Tracheostomy

1. Whole cell patch-clamp and extracellular field recordings were obtained from granule cells of the dentate gyrus in 400-microns-thick brain slices of the adult rat to determine the actions of the intravenous general anesthetic 2,6-diisopropylphenol (propofol) on acute neuronal survival and preservation of synaptic integrity after amputation of dendrites (dendrotomy), and to determine the role of gamma-aminobutyric acid-A (GABAA)-receptor-mediated inhibition in the neuroprotective effects of propofol. The actions of propofol were compared with those exerted by another widely used intravenous general anesthetic, 5-ethyl-5-[1-methylbutyl]-2-thiobarbituric acid (thiopental). 2. Propofol (10 microM) increased the frequency (control: 5.9 +/- 0.9 Hz, mean +/- SE; propofol: 10.5 +/- 1.3 Hz) and the single-exponential decay time constant (tau D) (control: 4.5 +/- 0.2 ms; propofol: 15.3 +/- 1.5 ms) of miniature inhibitory postsynaptic currents (mIPSCs) recorded in control neurons. Thiopental (25 microM) also increased the tau D (14.3 +/- 0.9 ms) of mISPCs, but had no effect on mIPSC frequency. Both anesthetics potentiated mIPSCs at low concentrations (propofol: 5 microM; thiopental: 1 microM). Propofol and thiopental did not change the peak amplitude and rise times of mIPSCs. 3. Propofol (10 microM) was able to depress the excitability of control granule cells, as determined by the reduction in the amplitude of the orthodromic population spikes. This depression could be prevented by the GABAA receptor antagonist bicuculline (50 microM), indicating that propofol reduces excitability via GABAA receptor functions. 4. Propofol and thiopental were neuroprotectant (assessed by antidromic population responses 2-5 h after injury) if present before and during the amputation of the granule cell dendrites. The protective actions were dose dependent, and at high doses (propofol: 200 microM; thiopental: 400 microM) the anesthetics were as neuroprotective against dendrotomy-induced cell death as 2-amino 5-phosphovaleric acid (APV) and 6-cyano-7-nitroquinoxaline-2,3 dione (CNQX). The protective effects of the anesthetics were completely blocked with the GABAA receptor antagonists picrotoxin or bicuculline, and were mimicked by the GABAA receptor agonist muscimol (100 microM). 5. Propofol, in contrast to APV and CNQX, could not prevent the dendrotomy-induced Ca(2+)-dependent and long-lasting changes in mIPSC decay kinetics (appearance of a double-exponential, prolonged decay). 6

Topics: Acute Disease; Anesthetics, Intravenous; Animals; Brain Injuries; Dendrites; gamma-Aminobutyric Acid; In Vitro Techniques; Kinetics; Male; Neural Inhibition; Neurons; Neuroprotective Agents; Patch-Clamp Techniques; Propofol; Rats; Rats, Wistar; Synaptic Transmission; Thiopental

We present two cases of acute isoniazid poisoning in patients who ingested 7.5 g and 5.0 g of isoniazid respectively, with the intention of committing suicide. Both were admitted unconscious, with ventilatory insufficiency and convulsions. Hepatic dysfunction and peripheral neuropathy were notable complications.

Topics: Acute Disease; Adult; Diazepam; Female; Humans; Intermittent Positive-Pressure Ventilation; Isoniazid; Male; Pyridoxine; Suicide, Attempted; Thiopental

The anaesthetic management of two patients with severe muscle weakness--one suffering from acute dermatomyositis, the other from acute polymyositis--is described. Both patients presented for surgery for malignancy. Anaesthesia was induced with etomidate in one, thiopentone in the other. Alfentanil was used for analgesia and atracurium for muscle paralysis in both. Neuromuscular blockade was monitored using a peripheral nerve stimulator and no problems were experienced. Recovery of neuromuscular transmission and ventilatory function after operation were normal.

Topics: Acute Disease; Aged; Alfentanil; Anesthesia, General; Atracurium; Dermatomyositis; Etomidate; Fentanyl; Humans; Male; Middle Aged; Myositis; Neoplasms; Preanesthetic Medication; Thiopental

Topics: Acute Disease; Adolescent; Adult; Aged; Brain Injuries; Female; Hemodynamics; Humans; Intracranial Pressure; Male; Middle Aged; Thiopental; Wounds and Injuries

Cardiac output (CO) and its distribution were studied in dehydrated (37 degrees C) anesthetized (Na thiopentone) rats prior to and following heat acclimation (at 34 degrees C), using 57Co 15 micron microspheres. In non-acclimated dehydrated rats, CO decreased while heart rate (HR) increased significantly. Following acclimation CO increased without any change in HR; during dehydration CO remained elevated together with a significant increase in HR. In non-acclimated rats at low dehydration blood perfusion to peripheral thermoregulatory areas increased while perfusion of splanchnic area decreased; at high dehydration level peripheral blood flow decreased whereas splanchnic blood flow was augmented. In acclimated dehydrated rats, CO distribution to thermoregulatory areas did not change while perfusion of the splanchnic area decreased. It is suggested that following acclimation, the increased CO contributes to maintenance of thermoregulatory peripheral blood flow; in non-acclimated rats severe dehydration leads to augmented blood flow in the permeable splanchnic vascular bed, increasing efflux of plasma protein and failure of plasma volume conservation.

Topics: Acclimatization; Acute Disease; Anesthesia; Animals; Body Temperature Regulation; Cardiac Output; Dehydration; Male; Organ Specificity; Rats; Rats, Inbred Strains; Regional Blood Flow; Thiopental

Topics: Acute Disease; Adult; Brain Diseases; Critical Care; Female; Humans; Intracranial Pressure; Male; Middle Aged; Thiopental

The effects of barbiturate administration on experimental balloon-induced spinal cord injury were tested in cats. Somatosensory evoked potentials from sciatic nerve stimulation were obtained before trauma and every 60 minutes after it up to the sixth hour, when the animals were killed. Eight cats received no barbiturate treatment. On histologic examination the traumatic lesion was found to be extensive (mean, 72.8% of total cross section of the cord area), sparing dorsal columns only in six cats. Somatosensory evoked potentials were absent in two cats and profoundly modified (that is, the late waves were absent) in six cats at the sixth hour. Eight cats were given a continuous infusion for 1 hour of intravenous thiopental sodium (total dose, 65-90 mg/kg) starting 30 minutes after trauma. In these eight cats, the extent of the traumatic lesion was significantly reduced (8.8% of the cord area). Among them, three animals presented with unaltered somatosensory evoked potentials (that is, with the presence of both primary components and late waves) at the sixth hour. It was concluded that thiopental sodium improves the response of the spinal cord to trauma, both at an anatomic and at a functional level.

Topics: Acute Disease; Animals; Cats; Evoked Potentials, Somatosensory; Female; Male; Spinal Cord Injuries; Thiopental

The hemodynamic effects of changes in PaCO2 during intermittent positive pressure ventilation (IPPV) were studied in nine dogs with acute cardiac tamponade. During steady state light thiopental anesthesia, measurements were performed during hypocarbia (24.0 +/- 2.6), normocarbia (40.4 +/- 2.4), and hypercarbia (56.8 +/- 3.1 mm Hg; mean +/- SD). The study was carried out at a standardized level of cardiac tamponade that gave a 60% reduction in cardiac output (CO) at normocarbia. Changes in airway pressure were avoided by adding CO2 to the inspiratory gas to obtain the desired PaCO2. Hypercarbia increased pericardial pressure 2-4 mm Hg and significantly decreased CO. During hypocarbia CO increased as pericardial pressure decreased 3-6 mm Hg. These findings are the reverse of changes seen when tamponade is not present. The changes in pericardial pressure most likely influence myocardial tone and cardiac volume and, thus, CO. The results suggest that patients with cardiac tamponade requiring general anesthesia should not breathe spontaneously if there is any danger of respiratory depression and hypercarbia.

Topics: Acute Disease; Anesthesia, Intravenous; Animals; Carbon Dioxide; Cardiac Tamponade; Dogs; Hemodynamics; Hypercapnia; Intermittent Positive-Pressure Ventilation; Positive-Pressure Respiration; Thiopental

Topics: Acute Disease; Barbiturates; Craniocerebral Trauma; Humans; Intracranial Pressure; Monitoring, Physiologic; Thiopental

Acute myocardial ischaemia was induced in five greyhounds by ligation of the anterior descending branch of the left main coronary artery. Changes in oxygen availability and consumption in the ischaemic area in response to thiopentone 10 mg kg-1 were compared with corresponding changes in non-ischaemic myocardium supplied by the circumflex artery. Despite a 40% reduction in arterial pressure, there were no significant changes in the oxygen availability/consumption ratio in either normal or ischaemic areas.

Topics: Acute Disease; Animals; Blood Pressure; Coronary Circulation; Coronary Disease; Dipyridamole; Dogs; Halothane; Heart Rate; Lidoflazine; Oxygen Consumption; Thiopental

Topics: Acute Disease; Adult; Anaphylaxis; Antigen-Antibody Complex; Drug Hypersensitivity; Female; Humans; Immunoglobulin E; Radioallergosorbent Test; Thiopental; Time Factors

To evaluate the risk of inducing acute symptoms after general anesthesia in patients with "inducible " porphyrias, the authors analyzed retrospectively the effects of 78 exposure to anesthesia in 47 patients, 33 with acute intermittent porphyria and 14 with variegate porphyria. On 62 occasions, 29 involving the use of a barbiturate, anesthesia was induced in 37 patients who had no porphyric symptoms at the time. None of these patients had an acute attack postoperatively. Anesthesia was induced 16 times in 14 patients during acute episodes; 12 of these patients also received precipitating drugs other than anesthetics. Porphyric symptoms worsened in seven in the ten patients who received thiopental and in two of the four who did not. In the latent stages of acute intermittent and variegate porphyria in this patient population, the risk of incurring symptoms after exposure to thiopental and/or other anesthetics was small. During an acute episode thiopental may aggravate porphyric symptoms.

Topics: Acute Disease; Adolescent; Adult; Aged; Anesthesia, General; Barbiturates; Ether; Female; Halothane; Humans; Male; Nitrous Oxide; Porphyrias; Postoperative Complications; Succinylcholine; Thiopental; Time Factors; Tubocurarine

Topics: Acute Disease; Anesthetics; Animals; Blood-Brain Barrier; Halothane; Hypertension; Rabbits; Thiopental

A case of acute hepatic failure is described following multiple general anaesthetics administered for the treatment of cranio-facial trauma. The dangers of multiple anaesthetics within a short period is stressed. The possibility that unexplained pyrexia following a general anaesthetic may be and early warning sign is mentioned in relation to this case. The subsequent development of the Henoch-Schönlein syndrome is reported, and the occurrence of the two conditions in the same patient is thought to be possibly unique.

Topics: Acute Disease; Adult; Anesthesia, General; Facial Injuries; Halothane; Humans; IgA Vasculitis; Liver Diseases; Male; Nitrous Oxide; Skull; Succinylcholine; Thiopental

Topics: Acute Disease; Adult; Anesthesia, Intravenous; Female; Humans; Porphobilinogen; Porphyrias; Thiopental

A simplified classification of the porphyrias is given which is thought to be advantageous to the anesthesiologist in determining those patients who are predisposed to acute attacks. These acute attacks may be precipitated by the administration of barbiturates, but may also be spontaneous. The current theory for the precipitation of the acute attack is described, with the probable mechanism being a decrease in uroporphyrinogen synthetase levels and the resultant interference in heme production. Increased formation of cytochrome P-450 with barbiturates also produces increased levels of delta aminolevulinic acid, which may be a cause of the acute attack. The significance in anesthesia and suggested means of anesthetic management are discussed.

Topics: 5-Aminolevulinate Synthetase; Acute Disease; Aminolevulinic Acid; Ammonia-Lyases; Anesthesia; Anesthetics; Child; Chlordiazepoxide; Cytochrome P-450 Enzyme System; Demyelinating Diseases; Diazepam; Heme; Humans; Neostigmine; Pentazocine; Porphobilinogen; Porphyrias; Thiopental

Topics: Acute Disease; Adult; Age Factors; Aged; Anesthesia; Anesthesia, Intravenous; Anesthesia, Local; Blood Pressure; Blood Transfusion; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypotension; Intensive Care Units; Male; Middle Aged; Postoperative Complications; Prognosis; Respiration, Artificial; Retrospective Studies; Thiopental