thiopental and Bradycardia

(1) To investigate changes in arterial oxygen saturation via pulse oximeter (SpO2) during apnea and after reinstitution of manual ventilation at SpO2 of 95% or 90% following rapid sequence induction of anesthesia in children after 2-minute preoxygenation; (2) to determine whether the setting of a safe threshold of apneic period to an SpO2 of 95% is appropriate in children during anesthetic induction; and (3) to evaluate the influences of age, body weight, and height on the time from the start of apnea to SpO2 of 95%.. A clinical study of random design and comparison among groups.. Operating room of a plastic surgery hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College.. 152 infants and children, ASA physical status 1, aged 3 months to 12 years, scheduled for elective plastic surgery.. Patients were divided into three age groups: Group 1-infants 3 months to 1 year (n = 39); Group 2 children 1 to 3 years (n = 41); and Group 3-children 3 to 12 years (n = 72). Patients in each age group were randomly allocated again to Subgroups A and B. After a 2-minute preoxygenation, anesthesia was induced with thiopental 5 mg/kg, fentanyl 5 micrograms/kg and suxamethonium 1.5 mg/kg. Patients were manually ventilated when SpO2 decreased to 90% in Subgroups A and 95% in Subgroups B, respectively, during apnea.. SpO2 was measured continuously with a Datex pulse oximeter applied to the right index finger. During apnea, the times for SpO2 to decrease to 09% (T99) and 95% (T99) in all children, and 90% (T90) in Subgroups A were recorded. The time for SpO2 to decrease from 95% to 90% (T95-90) in Subgroups A was also measured. After reinstitution of manual ventilation, the time when SpO2 continued to decrease (T1) and the time from the end of apnea to recovery of SpO2 baseline (T2) were determined. In addition, the lowest value of SpO2 after apnea was also recorded. The results showed that younger children were more susceptible than older children to the risk of hypoxemia during apnea. There were significant differences in T99, T95, T90, and T95-90 between the three age groups T1 and T2 were significantly longer in Group 3 than in Groups 1 and 2. There were significant differences in the lowest values of SpO2 following apnea among the three Subgroups A and between Subgroups A and B of each age group. During apnea, heart rate decreased gradually as SpO2 decreased, showing a significant decrease at SpO2 of 95%. Bradycardia was found in three children in Subgroups A. The apnea time to SpO2 of 95% correlated well with age, weight, and height by linear regression analysis.. The safe threshold of an apneic period setting to an SpO2 of 95% was appropriate in children during anesthesia induction. Despite the same duration of preoxygenation, younger children were more susceptible than elder ones to the risk of hypoxemia during apnea. The apnea time to SpO2 of 95% correlated with age, body weight, and height using linear regression analysis.

Topics: Age Factors; Anesthesia, Intravenous; Anesthetics, Intravenous; Apnea; Body Height; Body Weight; Bradycardia; Child; Child, Preschool; Disease Susceptibility; Elective Surgical Procedures; Fentanyl; Heart Rate; Humans; Hypoxia; Infant; Linear Models; Neuromuscular Depolarizing Agents; Oximetry; Oxygen; Respiration, Artificial; Risk Factors; Safety; Succinylcholine; Surgery, Plastic; Thiopental; Time Factors

It is common practice at the Hospital for Sick Children, Toronto, to administer atropine 20 micrograms.kg-1 prior to succinylcholine in infants and children. It is unclear whether "prophylactic" administration of this dose of atropine to older children (6-16 yr) is necessary. This study was designed to compare the changes in heart rate, rhythm and mean arterial pressure after administration of either atropine 10 or 20 micrograms.kg-1 with succinylcholine or vecuronium (control group) to older children anaesthetized with thiopentone. Thirty-six ASA I or II patients (6-16 yr) were studied. Anaesthesia was induced with thiopentone 5 mg.kg-1. Patients were randomly assigned to receive: (a) atropine 10 micrograms.kg-1 and succinylcholine 1.5 mg.kg-1 (n = 12), (b) atropine 20 micrograms.kg-1 and succinylcholine 1.5 mg.kg-1 (n = 13) or (c) vecuronium 0.1 mg.kg-1 (n = 11) to facilitate tracheal intubation. Heart rate and rhythm were recorded continuously using a computerised analogue interface whereas blood pressure was monitored non-invasively before induction of anaesthesia, immediately before and at one and three minutes after laryngoscopy. No difference was observed between patients who received atropine 10 or 20 micrograms.kg-1 prior to succinylcholine. No episode of sinus bradycardia occurred. Premature atrial contractions were observed in two patients (one succinylcholine/atropine 20 micrograms.kg-1, one vecuronium). Administration of atropine 20 micrograms.kg-1 prior to succinylcholine provides no advantage over atropine 10 micrograms.kg-1 in older children in terms of cardiovascular stability.

Topics: Adolescent; Anesthesia, Intravenous; Arrhythmia, Sinus; Atrial Function; Atropine; Blood Pressure; Bradycardia; Cardiac Complexes, Premature; Child; Female; Heart Rate; Humans; Infant; Intubation, Intratracheal; Laryngoscopy; Male; Succinylcholine; Thiopental; Vecuronium Bromide

It is common practice to administer atropine before a first dose of succinylcholine in infants and children. However, the administration of succinylcholine without atropine has not been investigated in children. This study was designed to compare cardiovascular changes after the administration of either atropine with succinylcholine or succinylcholine alone. In 41 ASA I or II patients aged from 1 to 12 yr anaesthesia was induced with thiopentone 5 mg.kg-1. Patients were randomly allocated to receive either atropine 20 micrograms.kg-1 and succinylcholine 1.5 mg.kg-1 (n = 20) or succinylcholine 1.5 mg.kg-1 alone (n = 21). Heart rate and rhythm were recorded continuously from two minutes before induction until two minutes after tracheal intubation. Blood pressure was measured non-invasively before and after induction of anaesthesia and both immediately and two minutes after laryngoscopy. One self-limiting episode of bradycardia was recorded during laryngoscopy in a child who received atropine. Heart rate increased in both groups compared with baseline values (108 +/- 25), with a greater increase in patients who had received atropine (150 +/- 13) than in those who had not (128 +/- 18) (P < 0.05). There was no difference in mean arterial pressure or incidence of arrythmias between the two groups. No recorded arrythmias were judged to be clinically important by a cardiologist. The incidence of bradycardia after succinylcholine in the absence of atropine in children aged from 1 to 12 yr appears to be lower than previously estimated. The use of atropine before a single dose of succinylcholine in children deserves to be reconsidered.

Topics: Adjuvants, Anesthesia; Anesthesia, Intravenous; Anesthetics, Intravenous; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atropine; Blood Pressure; Bradycardia; Child; Child, Preschool; Female; Heart Rate; Humans; Incidence; Infant; Intubation, Intratracheal; Laryngoscopy; Male; Neuromuscular Nondepolarizing Agents; Succinylcholine; Thiopental

The purpose of this double-blind randomized work was to study the effect of alfentanil and esmolol and their half-dose combination on the increases of heart rate and arterial pressure and on the prolongation of the QTc interval of the ECG occurring during anaesthetic induction. Sixty ASA class I-II patient with mean age ranging from 26 to 32 yr among the groups. Patients were allocated to one of four equal groups to receive saline, esmolol 2 mg.kg-1, alfentanil 0.03 mg.kg-1 and alfentanil 0.015 mg.kg-1+esmolol 1 mg.kg-1. Anaesthesia was induced with thiopentone. Succinylcholine was used to facilitate tracheal intubation. Haemodynamic variables were measured non-invasively and the QTc interval with the aid of a microcomputer. Comparisons between the groups were performed using two-way analysis of variance with repeated measures. Both alfentanil and alfentanil-esmolol prevented the increase of heart rate and arterial pressure caused by intubation whereas esmolol prevented only the increase of the heart rate. None of the treatments prevented prolongation of the QTc interval after intubation and only alfentanil prevented that after succinylcholine. The present results suggest that in the prevention of the haemodynamic responses to tracheal intubation, the half-dose combination of alfentanil and esmolol is as effective as alfentanil and superior to esmolol. The combination is preferable to relatively large doses of either drug in circumstances where side effects, such as respiratory depression due to alfentanil or bradycardia due to both drugs should be minimized.

Topics: Adrenergic beta-Antagonists; Adult; Alfentanil; Analysis of Variance; Anesthesia, Intravenous; Blood Pressure; Bradycardia; Double-Blind Method; Drug Combinations; Electrocardiography; Heart Rate; Humans; Intubation, Intratracheal; Propanolamines; Respiration; Succinylcholine; Thiopental

The effects on corrected QT interval (QTc), heart rate and arterial pressure were studied after induction with propofol 1.5, 2 or 2.5 mg.kg-1, thiopentone 5 mg.kg-1 or methohexitone 2 mg.kg-1 in 123 ASA class I or II children undergoing outpatient otolaryngological surgery. Premedication consisted of oral midazolam and atropine. The children were randomly allocated to one of the three propofol groups or to the thiopentone or methohexitone group. After injection of the intravenous anaesthetic, the QTc interval was significantly prolonged after propofol 2.5 mg.kg-1. Thirty seconds after suxamethonium 1.5 mg.kg-1, a significant prolongation of the QTc interval occurred in the thiopentone and propofol 1.5 and 2 mg.kg-1 groups. After intubation, no further prolongation of the QTc interval occurred in any of the groups. Heart rate increased significantly after the barbiturates but not after propofol. Systolic arterial pressure decreased significantly after propofol 1.5 and 2.5 mg.kg-1. In all groups a cardiovascular intubation response occurred. Bradycardia and junctional rhythm occurred in 4% of the children in both barbiturate groups and in 19-29% in the propofol groups. It is concluded that propofol causes prolongation of the QT interval and results in a higher incidence of bradycardia and junctional rhythm than the barbiturates.

Topics: Anesthesia, Intravenous; Atropine; Blood Pressure; Bradycardia; Child, Preschool; Electrocardiography; Female; Heart Rate; Humans; Intubation, Intratracheal; Male; Methohexital; Midazolam; Preanesthetic Medication; Propofol; Succinylcholine; Thiopental

Eighty healthy patients were randomly allocated to four groups. Atropine 0.01 mg kg-1 i.v. (group I), gallamine 0.3 mg kg-1 i.v. (group II), atropine 0.01 mg kg-1 i.m. and gallamine 0.3 mg kg-1 i.v. (group III), or atropine 0.01 mg kg-1 i.v. and gallamine 0.3 mg kg-1 i.v. (group IV) were given before operation. After induction of anesthesia with thiopentone, suxamethonium 1 mg kg-1 was given i.v. The lungs were ventilated with halothane in nitrous oxide in oxygen. Five minutes later the same dose of suxamethonium was repeated. E.c.g. was monitored continuously. No serious bradycardia was observed following a second injection of suxamethonium in any group. The results suggest that thiopentone protects against suxamethonium-induced bradycardia during halothane anaesthesia.

Topics: Adolescent; Adult; Anesthesia, General; Atropine; Bradycardia; Female; Gallamine Triethiodide; Halothane; Heart Rate; Humans; Intraoperative Complications; Male; Middle Aged; Premedication; Succinylcholine; Thiopental

Continuous ECG recording (Holter technique) was carried out in 25 patients undergoing similar ophtalmological surgery for retinal detachment. The patients were selected at random and divided into two groups. Premedication (alimemazine 25 mg. atropine 0.5 mg given one hour before the operation) and induction (penthiobarbital 4 mg.kg-1 and succinylcholine iodide 1 mg.kg-1) were given in the same way. General anaesthesia was maintained in Group I (n = 12) with halothane and in group II (n = 13) using neuroleptanalgesia. There was no significant difference in the percentage of arrhythmias between the two groups. There was a remarkablly high prevalence of sinus bradycardia and ventricular pauses (8/25). The respective role of atropine and of retrobulbar local anaesthesia in prevention is discussed in the light of data from the literature. If arrhythmias occurring at the time of intubation are included, the total percentage of rhythm disturbances was 80 p. 100 (20/25).

Topics: Arrhythmias, Cardiac; Atropine; Bradycardia; Electrocardiography; Humans; Retinal Detachment; Succinylcholine; Thiopental; Time Factors; Trimeprazine

This study compares the data of (modified) electroconvulsive theraphy (ECT) applications from two different inpatient clinics in Turkey: Kocaeli Derince Training and Research Hospital (Clinic-I) and Kocaeli University (Clinic-II).. Recorded files of patients from the two clinics were compared in terms of ECT indications, number and duration of seizures, and anesthetic agents used (propofol vs. thiopental). ECT applications occurring between January 2011 and January 2013 were included in the study.. A total of 86 patients (9.5% of the inpatients) received ECT in Clinic-I and 103 patients (21.1% of the inpatients) in Clinic-II during the period studied. The yearly ECT rate (treated person rate per 10,000 per year) was 0.59/10,000 for Kocaeli (Turkey) as a whole. The overall number of ECT applications was 539 in Clinic-I and 999 in Clinic-II, and the average number of ECT sessions for each patient was 6.4 ± 2.33 in Clinic-I and 9.69 ± 4.66 in Clinic-II. The majority of indications were depressive disorders and insufficient response to medicine. Patients in the clinic which utilized thiopental as the anesthetic agent experienced more cardiovascular and respiratory side effects than the one which used propofol. The number of ECT sessions required was greater for patients with schizoaffective disorder than for others.. The administration of ECT was considered to be a reliable method of treatment in these clinics. With respect to specific anesthetic agents, propofol was found to have less hemodynamic side effects and shorter seizure durations than thiopental.

Topics: Adult; Anesthesia, General; Anesthesia, Intravenous; Anesthetics, Intravenous; Bipolar Disorder; Bradycardia; Depressive Disorder; Electroconvulsive Therapy; Female; Hemodynamics; Hospital Units; Humans; Male; Medical Records; Propofol; Retrospective Studies; Schizophrenia; Seizures; Thiopental; Time Factors; Treatment Outcome; Turkey

Thiopentone sodium is one of the important drugs in the armamentarium for terminating refractory status epilepticus, a neurological emergency. We report a case of thiopentone-related bradycardia during the management of the new onset refractory status epilepticus in a young man, which was circumvented by prophylactic insertion of temporary pacemaker while thiopentone infusion was continued. A systematic approach was employed to manage the status epilepticus, including infusion of thiamine and glucose followed by antiepileptic drugs. The patient was ventilated and infused with lorazepam, phenytoin, sodium valproate, levetiracetam and midazolam followed by thiopentone sodium. With the introduction of thiopentone the seizures could be controlled but the patient developed severe bradycardia and junctional rhythm. The bradycardia disappeared when thiopentone was withdrawn and reappeared when the drug was reintroduced. Propofol infusion was tried with no respite in seizures. Later thiopentone sodium was reintroduced after inserting temporary cardiac pacemaker. Seizure was controlled and patient was weaned off the ventilator.

Topics: Adult; Anticonvulsants; Bradycardia; Brain; Electrocardiography; Humans; Male; Neuroimaging; Status Epilepticus; Thiopental; Tomography, X-Ray Computed

A 70-year-old man who had been drinking a bottle of whisky each day was scheduled for laser resection of a tongue tumor. His electrocardiogram showed sinus bradycardia (heart rate was 35-40 bpm), and transient complete heart block was observed. Echocardiography showed hypertrophic cardiomyopathy. After a temporary transvenous pacemaker had been inserted, anesthesia was induced with thiopental and vecuronium bromide, and maintained with sevoflurane and fentanyl. Heart rate was 45.min-1 before the induction of anesthesia, and after the induction increased to 70-80.min-1. Analysis of heart rate variability suggested that the increase in heart rate was due to augmentation of sympathetic nervous activity after intubation and operation stress. After the operation his bradycardia improved gradually, and after 3 months heart rate settled at about 55.min-1. Cadiomyopathy is known to be one of the complications of alcoholism. It was reported that alcoholic heart disease was improved promptly by abstinence from alcohol. During his long hospitalization, abstinence might have improved his severe bradycardia. Thiopental is useful for induction of anesthesia in a patient with severe bradycardia from alcoholic cadiomyopathy.

Topics: Aged; Alcoholism; Anesthesia; Bradycardia; Cardiomyopathy, Alcoholic; Heart Block; Humans; Intraoperative Care; Male; Pacemaker, Artificial; Thiopental; Tongue Neoplasms

Topics: Anesthesia, General; Anesthetics, General; Apnea; Bradycardia; Epilepsy, Generalized; Epilepsy, Tonic-Clonic; Hernia, Inguinal; Humans; Hyponatremia; Infant, Newborn; Isoflurane; Male; Seizures; Thiopental

Strabismus surgery in children is associated with side-effects, intraoperative oculocardiac reflexes in relation with muscular tractions and postoperative vomiting. Studies with propofol anaesthesia in this surgery have shown a lower incidence of these side-effects. So, a prospective study compared these incidences with propofol (P) versus thiopental/halothane (T+H) anaesthesia. Propofol appears to be efficient in reducing postoperative vomiting but might be associated with more frequent OCR.

Topics: Adolescent; Bradycardia; Child; Child, Preschool; Halothane; Humans; Infant; Postoperative Complications; Propofol; Prospective Studies; Reflex, Oculocardiac; Strabismus; Thiopental; Vomiting

To define the role of vecuronium in the occurrence of bradyarrhythmia, haemodynamic changes after the induction of anaesthesia were studied in 96 patients undergoing coronary artery bypass grafting. Patients were assigned to one of six groups according to different combinations of induction agents (etomidate 0.3 mg kg-1 or thiopentone 3 mg kg-1, with fentanyl 0.003 mg kg-1; etomidate 0.4-0.5 mg kg-1 or thiopentone 4-6 mg kg-1, without fentanyl) and neuromuscular blocking drugs (vecuronium 0.112 mg kg-1, pancuronium 0.112 mg kg-1 or suxamethonium 1 mg kg-1). Anaesthesia was maintained with enflurane and nitrous oxide in oxygen. After initial diverse changes, heart rate decreased in all groups. Thirty minutes after intubation, the reduction of heart rate showed statistically significant differences between the different combinations of drugs: fentanyl-etomidate-vecuronium (group I) (the largest reduction) greater than etomidate-vecuronium (II) = fentanyl-thiopentone-vecuronium (IV) greater than thiopentone-vecuronium (V) = fentanyl-thiopentone-suxamethonium (VI) = fentanyl-etomidate-pancuronium (III). Five patients in group I, two in group IV and one each in groups II and V had a heart rate slower than 45 beat min-1, whereas a similar value was never seen in groups III and VI. These results indicate that vecuronium has a bradycardic effect. This effect is more pronounced in association with etomidate than in association with thiopentone, and is augmented by the addition of fentanyl.

Topics: Adult; Aged; Anesthesia, Intravenous; Blood Pressure; Bradycardia; Drug Interactions; Etomidate; Female; Fentanyl; Heart Rate; Humans; Intraoperative Complications; Male; Middle Aged; Thiopental; Vecuronium Bromide

We have used immature commercial swine (13-25 kg) successfully in a variety of experimental cardiopulmonary surgical procedures in our laboratories since 1981. Multiple drug anesthetic protocols using barbiturates, narcotics, paralytic and antiarrhythmic agents have been employed in over 400 procedures per year. Complications, including fatal cardiac arrhythmias, have been greatly reduced by anesthetic protocols and surgical procedures developed through experience.

Topics: Acepromazine; Anesthesia; Animals; Arrhythmias, Cardiac; Bradycardia; Cardiopulmonary Bypass; Cardiovascular Surgical Procedures; Female; Fentanyl; Halothane; Heart Transplantation; Male; Pancuronium; Pentobarbital; Pneumonectomy; Succinylcholine; Swine; Thiamylal; Thiopental; Ventricular Fibrillation

Topics: Alfaxalone Alfadolone Mixture; Anesthetics; Animals; Bradycardia; Diazepam; Dogs; Femoral Artery; Hypotension; Injections, Intra-Arterial; Muscular Diseases; Shock; Thiopental; Vascular Diseases

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: Anesthesia, Intravenous; Atropine; Blood Pressure; Bradycardia; Cardiovascular Diseases; Depression; Dose-Response Relationship, Drug; Electrocardiography; Electroconvulsive Therapy; Heart Rate; Humans; Injections, Intravenous; Oxygen; Respiration, Artificial; Spinal Injuries; Succinylcholine; Thiopental

Topics: Adolescent; Adult; Age Factors; Aged; Anesthesia, General; Arrhythmias, Cardiac; Benperidol; Bradycardia; Coronary Disease; Cysts; Electrocardiography; Halothane; Humans; Jaw Fractures; Lidocaine; Male; Methohexital; Middle Aged; Propanidid; Propranolol; Surgery, Oral; Tachycardia; Thiopental; Tooth Extraction

Topics: Anesthesia, General; Bradycardia; Cholecystectomy; Cyanosis; Female; Humans; Hypotension; Middle Aged; Pneumothorax; Radiography; Succinylcholine; Thiopental

Topics: Animals; Arrhythmias, Cardiac; Blood Pressure; Bradycardia; Dogs; Electric Stimulation; Electrocardiography; Heart Rate; Isoproterenol; Pharmacology; Research; Tachycardia; Thiamylal; Thiopental; Vagus Nerve