thiopental and Bronchial-Spasm

To compare the effects of propofol and thiopentone on tracheal intubation-induced bronchoconstriction, 37 patients were allocated randomly to anaesthesia with either thiopentone 4 mg kg-1 followed by a 15-mg kg-1 h-1 continuous infusion or propofol 3 mg kg-1 followed by a 9-mg kg-1 h-1 continuous infusion. Intubation was facilitated by vecuronium 0.1-0.2 mg kg-1. Respiratory system resistance (Rrs) was measured by a CP-100 pulmonary function monitor, 5 min after intubation. The 5-min post-intubation Rrs values were significantly lower in the propofol group (8.5 (SD 1.5) cm H2O litre-1 S-1) than in the thiopentone group (10.9 (3.2) cm H2O litre-1 S-1). Thirty minutes after commencing isoflurane-nitrous oxide anaesthesia, Rrs declined by 17.5 (SEM 3.6)% from baseline in the thiopentone group, but by only 1.6 (2.6)% in the propofol group. We conclude that the dose of propofol administered provided more protection against tracheal intubation-induced bronchoconstriction than an induction dose of thiopentone.

Topics: Adult; Airway Resistance; Anesthetics, Inhalation; Anesthetics, Intravenous; Bronchial Spasm; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Mucus; Propofol; Thiopental; Trachea

A 6-year-old boy presented for surgery for phimosis. The anaesthetic technique included intravenous induction with thiopentone and neuromuscular blockade with cisatracurium. Severe persistent bronchospasm and central cyanosis followed the administration of these drugs. A continuous i.v. infusion of epinephrine at 0.2 microg. kg(-1) x min(-1) was necessary to break the severe refractory bronchial hyperresponsiveness. There was no previous exposure to anaesthetic drugs and no definite family history of allergy. Through increased serum eosinophil cationic protein, tryptase and histamine levels and IgE levels specific to cisatracurium, we demonstrated an IgE-mediated anaphylactic reaction to cisatracurium in the child's first exposure to this new neuromuscular blocking agent. Anaphylactic reactions to new anaesthetic drugs may be challenging to recognize and treat during general anaesthesia in children. The pathogenesis, diagnosis and management of life threatening persistent allergic reactions to intravenous anaesthetics are discussed.

Topics: Adrenergic Agonists; Anaphylaxis; Anesthetics, Intravenous; Atracurium; Blood Proteins; Bronchial Hyperreactivity; Bronchial Spasm; Child; Chymases; Cyanosis; Eosinophil Granule Proteins; Epinephrine; Histamine; Humans; Immunoglobulin E; Inflammation Mediators; Male; Mast Cells; Neuromuscular Blockade; Neuromuscular Blocking Agents; Phimosis; Ribonucleases; Serine Endopeptidases; Thiopental; Tryptases

Topics: Aged; Anaphylaxis; Anesthesia, Intravenous; Anesthetics, Intravenous; Bronchial Spasm; Humans; Hypotension; Male; Neuromuscular Nondepolarizing Agents; Pancuronium; Propofol; Tachycardia; Thiopental

Induction of anaesthesia with thiopental sometimes causes bronchospasm. Although the mechanism by which thiopental induces bronchospasm may involve cholinergic stimulation, direct spastic effect and histamine release, the spastic effects of thiopental have not been comprehensively defined. In this study, we have assessed the effect of thiopental on in vivo airway smooth muscle tone using direct visualization method with a superfine fibreoptic bronchoscope as previously reported. Twenty-one mongrel dogs were anaesthetized with pentobarbital (30 mg kg-1) and paralysed with pancuronium (200 micrograms kg-1 h-1). The trachea was intubated with a tube that had a second lumen for insertion of the bronchoscope (od: 2.2 mm) to continuously measure bronchial cross-sectional area. The tip of the bronchoscope was placed between the second and third bronchial bifurcation of the right lung. The dogs were allocated to three groups of seven: group T, A+T, H+T. In group T, thiopental 0 (saline), 0.1, 1.0 and 10 mg kg-1 was given i.v. In group A+T, saline i.v., 5 min later atropine 0.1 mg kg-1 i.v., and 5 min later thiopental 10 mg kg-1 was administered. In group H+T, bronchoconstriction was produced with histamine 10 micrograms kg-1 i.v. followed by infusion at 500 micrograms kg-1 h-1. Thirty minutes later, thiopental 0, 1.0 and 10 mg kg-1 were given. Arterial blood sampling was performed for measurement of plasma catecholamines and histamine. In group T, thiopental significantly reduced bronchial cross-sectional area (maximally by 28.7 (5.6% at 0.5 min after thiopental 10 mg kg-1), which returned to the baseline in 3 min, while any changes in plasma concentrations of catecholamines and histamine were not observed except norepinephrine level at 1 min following thiopental 10 mg kg-1 i.v. Atropine pretreatment completely prevented thiopental-induced bronchospasm in group A+T. In group H+T, thiopental 10 mg kg-1 transiently but significantly decreases bronchial cross-sectional area. Therefore, the present study indicates that the mechanism of thiopental bronchospasm may result from cholinergic nerve stimulation.

Topics: Anesthetics, Intravenous; Animals; Atropine; Bronchi; Bronchial Spasm; Bronchoconstriction; Bronchoscopy; Dogs; Dose-Response Relationship, Drug; Epinephrine; Fiber Optic Technology; Histamine; Norepinephrine; Thiopental

The effects of aminophylline on the release of endogenous catecholamines and on airway reactivity to aerosol histamine challenge were evaluated during halothane and thiopental/fentanyl anesthesia in basenji-greyhound dogs. Responses to histamine aerosol challenge (0.01, 0.03, 0.1, 0.3, 1.0, and 3.0 mg/ml) were measured during six conditions: 1) thiopental/fentanyl anesthesia (control), 2) thiopental/fentanyl with aminophylline infusion, 3) halothane anesthesia (1.5 MAC), 4) halothane anesthesia with aminophylline infusion, 5) thiopental/fentanyl anesthesia after pretreatment with iv propranolol, and 6) thiopental/fentanyl anesthesia with aminophylline infusion after pretreatment with iv propranolol. Prior to aerosol challenge baseline pulmonary resistance (RL) did not differ in the six groups. Aminophylline significantly attenuated the pulmonary response to histamine and increased catecholamine concentrations during thiopental/fentanyl anesthesia. Although halothane itself significantly attenuated the pulmonary response to histamine, the administration of aminophylline during halothane anesthesia produced no additional protective effect and no increases in catecholamines were noted. Moreover, no protective effect was seen after aminophylline administration during thiopental/fentanyl anesthesia in the same dogs pretreated with propranolol. These data suggest that the protective effect of aminophylline on histamine reactivity results from release of endogenous catecholamines and that the use of aminophylline during halothane anesthesia, which blocks this release, is not warranted.

Topics: Aminophylline; Anesthesia, General; Animals; Bronchial Spasm; Dogs; Epinephrine; Fentanyl; Halothane; Hemodynamics; Histamine; Lung Compliance; Norepinephrine; Thiopental

Topics: Bronchial Spasm; Humans; Thiopental

The influence of inhalational anesthetics on histamine released during bronchospasm induced by Ascaris antigen aerosol was studied in Basenji-Greyhound (BG) dogs. Five BG dogs were anesthetized with thiopental and halothane on separate occasions and challenged with Ascaris antigen aerosol for five minutes. Pulmonary resistance (RL), dynamic compliance (Cdyn), and arterial plasma histamine levels were measured over 30 min following antigen exposure. Prior to antigen challenge, RL, Cdyn, and histamine levels were similar in thiopental- and halothane-anesthetized dogs. The peak change in RL and Cdyn occurred 10 min after the start of antigen challenge. RL increased 3.0 +/- 0.4-fold (mean +/- SEM) in thiopental-anesthetized dogs as compared with 1.6 +/- 0.2-fold in halothane-anesthetized dogs (P less than 0.05). Cdyn decreased to a similar extent in both groups, with maximal decreases of 0.53 +/- 0.08 and 0.53 +/- 0.09 times the prechallenge value for thiopental- and halothane-anesthetized dogs, respectively. Plasma histamine levels peaked at 5 min. Plasma histamine increased to 8.0 +/- 5.0 ng/ml in thiopental-anesthetized dogs compared with 10.7 +/- 4.7 ng/ml in halothane-anesthetized dogs. Histamine levels were not significantly different during or after antigen challenge between thiopental- and halothane-anesthetized dogs. Halothane, but not thiopental, significantly attenuated the increase in RL provoked by antigen challenge. However, arterial plasma histamine levels were similar during both anesthetics. Therefore, the authors conclude that the protective effect of halothane on airways was not due to an inhibition of release of histamine from mast cells.

Topics: Anesthesia, Inhalation; Animals; Antigens; Ascaris; Bronchial Spasm; Dogs; Halothane; Histamine Release; Lung Compliance; Thiopental

Topics: Adjuvants, Anesthesia; Anesthesia, General; Anesthesia, Intravenous; Bronchial Spasm; Cardiac Output; Cardiopulmonary Bypass; Fentanyl; Halothane; Heart, Artificial; Humans; Intraoperative Complications; Lidocaine; Male; Middle Aged; Postoperative Complications; Respiration, Artificial; Suction; Thiopental

Topics: Adult; Anaphylaxis; Bronchial Spasm; Drug Eruptions; Drug Hypersensitivity; Erythema; Female; Halothane; Humans; Intubation, Intratracheal; Thiopental; Tubocurarine

Experimental asthma was induced in dogs previously sensitized to ascaris antigen by ventilation with ascaris antigen, in an aerosol, for 10 min. Before the administration of antigen, there was no significant difference in pulmonary airways resistance (RL) during thiopentone and ketamine anaesthesia. In dogs anaesthetized with thiopentone, RL increased significantly from a pre-antigen control of 0.36 +/- 0.13 (mean +/- SEM) kPa litre-1 s to 1.56 +/- 0.38 at 5 min after administration of antigen. In dogs anaesthetized with ketamine, RL before (0.30 +/- 0.10) and 5 min after antigen (0.47 +/- 0.18) was not significantly different. Beta adrenergic blockade with propranolol abolished the protective effect of ketamine so that there was no significant difference in the maximal increase (5 min after antigen) in RL in dogs anaesthetized with ketamine (2.92 +/- 0.74) or thiopentone (3.28 +/- 1.16). Beta adrenergic blockade also increased pre-antigen RL in both groups (ketamine 0.87 +/- 0.24; thiopentone 0.77 +/- 0.32).

Topics: Airway Resistance; Anesthesia, Intravenous; Animals; Antigens; Ascaris; Asthma; Bronchial Spasm; Disease Models, Animal; Dogs; Ketamine; Lung Compliance; Propranolol; Thiopental

A detailed review of drug-induced bronchospasm is presented. Four types of reactions are described. Furthermore, pathogenesis, clinical picture, treatment and prophylaxis of the "Aspirin-induced asthma" are demonstrated.

Topics: Adrenal Cortex Hormones; Aspirin; Asthma; Bronchi; Bronchial Spasm; Drug Hypersensitivity; Female; Humans; Male; Pancuronium; Peptide Hydrolases; Proteins; Tartrazine; Thiopental

Topics: Anaphylaxis; Anesthesia, Intravenous; Animals; Bronchial Spasm; Dog Diseases; Dogs; Drug Hypersensitivity; Keratitis; Male; Thiopental

One hundred consecutive reports of reactions to intravenous anaesthetics Althesin, thiopentone and Epontol are reviewed and analysed. Ten reactions are attributed to causes other than the anaesthetic drug, and four are believed to have been caused by the muscle relaxant employed. The remaining 86 reactions were grouped according to their clinical presentation: histaminoid reactions ( 19), histaminoid with bronchospasm (33), bronchospasm (12), cardiovascular collapse (uu), delayed histaminoid reactions (6), and clonic contractions (5). None of the first four reaction types was associated with only one anaesthetic. A knowledge of the sales of Althesin has allowed the incidence of reactions to be estimated as between one in 11,000 and one in 19,000.

Topics: Adolescent; Adult; Aged; Alfaxalone Alfadolone Mixture; Anesthesia, Intravenous; Anesthetics; Bronchial Spasm; Cardiovascular System; Child; Child, Preschool; Drug Hypersensitivity; Female; Histamine Release; Humans; Male; Middle Aged; Muscle Contraction; Pregnanediones; Propanidid; Thiopental

Three patients with sensitivity to an intravenous anaesthetic-thiopentone, propanidid, and Althesin (alphadolone and alphaxalone)-are described. In the cases of thiopentone and Althesin the reaction was characterized by cardiovascular collapse, while bronchospasm also occurred with thiopentone. The reaction to propanidid was a direct skin sensitivity. All patients had a personal or family history of asthma and all had been previously exposed to the offending drug. A leucocyte challenge test showed an allergic response to thiopentone and Althesin in two patients but gave a negative result in the patient with the skin reaction. Allergic reactions can occur to all types of intravenous anaesthetics in a few patients.

Topics: Adult; Aminophylline; Anesthesia, Intravenous; Asthma; Bronchial Spasm; Carbon Dioxide; Cardiovascular System; Child; Drug Combinations; Drug Eruptions; Drug Hypersensitivity; Edema; Humans; Hydroxysteroids; Immunoglobulin E; Lactates; Leukocytes; Male; Oxygen; Pregnanediones; Propanidid; Skin Tests; Thiopental

Topics: Adult; Anesthesia, General; Bronchial Spasm; Female; Humans; Thiopental

Topics: Adolescent; Aminophylline; Anesthesia, Inhalation; Bronchial Spasm; Dexamethasone; Female; Humans; Succinylcholine; Thiopental; Tuberculosis, Spinal

Topics: Adult; Aminophylline; Anesthesia, General; Bronchial Spasm; Cyanosis; Cystoscopy; Drug Hypersensitivity; Female; Humans; Hydrocortisone; Hypotension; Male; Middle Aged; Tachycardia; Thiopental

Topics: Adult; Aged; Airway Resistance; Anesthesia, General; Atropine; Bronchi; Bronchial Spasm; Chronic Disease; Halothane; Humans; Lung Compliance; Lung Diseases; Male; Middle Aged; Muscle, Smooth; Nitrous Oxide; Reflex; Respiration; Respiratory Physiological Phenomena; Spirometry; Thiopental; Tubocurarine

Topics: Bronchial Spasm; Humans; Intubation, Intratracheal; Male; Middle Aged; Rectal Neoplasms; Thiopental

Topics: Adult; Anesthesia, General; Breast Neoplasms; Bronchial Spasm; Carcinoma; Carcinoma, Squamous Cell; Female; Humans; Lung Neoplasms; Male; Middle Aged; Preanesthetic Medication; Thiopental; Tubocurarine

Topics: Anesthesia, Intravenous; Bronchial Spasm; Female; Hexobarbital; Humans; Middle Aged; Procaine; Thiopental

Topics: Adult; Anesthesia, Endotracheal; Bronchial Spasm; Female; Graves Disease; Humans; Postoperative Complications; Thiopental; Thyroidectomy

Topics: Adolescent; Aminophylline; Anesthesia; Anesthesia, General; Anesthesiology; Atropine; Bronchial Spasm; Halothane; Humans; Hydrocortisone; Meperidine; Preanesthetic Medication; Promethazine; Succinylcholine; Thiopental; Toxicology