thiopental and Carotid-Artery-Diseases

Topics: Anesthetics; Arterial Occlusive Diseases; Carotid Artery Diseases; Fentanyl; Humans; Hypertension; Intracranial Aneurysm; Male; Middle Aged; Phenylephrine; Sufentanil; Thiopental

The thiopentone sodium surge in plasma was investigated in 15 elderly surgical patients and 10 young adults during injection, over a period of 1 minute, of 4 mg of anaesthetic per kg of fat-free body weight (in 18 patients), and 5 mg per kg of fat-free body weight (7 patients). In keeping with prolonged circulation time in old age, thiopentone sodium reached the sampling site faster in the younger patients than it did in the older patients. In the majority of cases, thiopentone sodium concentrations in plasma reached a maximum of between 60 and 80 micrograms/ml. Mean thiopentone sodium concentrations in the older patients were 10% higher, but here values differed so widely that this result must be regarded as coincidental. It was, accordingly, impossible to establish any statistically verifiable differences between young and old patients by estimating the volume of thiopentone sodium distribution shortly after the end of injection. Plasma protein binding, 85% on average, with extremes ranging from 79% to 89% did not depend on thiopentone concentration or age. In the group of patients studied, it was not possible to confirm statistically that the plasma protein concentration influenced the rate of binding. Dosage according to fat-free body weight did not diminish inter-individual differences in plasma concentration-time profiles.

Topics: Adult; Age Factors; Aged; Anesthesia, General; Carotid Artery Diseases; Constriction, Pathologic; Dose-Response Relationship, Drug; Hearing Loss; Hearing Loss, Conductive; Humans; Protein Binding; Thiopental

Topics: Aged; Anesthesia, General; Anesthesia, Inhalation; Blood Pressure; Brain; Brain Ischemia; Carbon Dioxide; Carotid Artery Diseases; Endarterectomy; Humans; Injections, Intravenous; Isoflurane; Lidocaine; Middle Aged; Monitoring, Physiologic; Nitrous Oxide; Oxygen; Oxygen Consumption; Postoperative Care; Preanesthetic Medication; Thiopental

Carotid endarterectomy was performed 28 times in 27 patients. All but one patient had symptomatic carotid artery disease, 59% had bilateral disease and 59% had associated intracranial disease. Barbiturate therapy was used as a means of cerebral protection during carotid artery cross-clamping. Neurological deficit occurred in two patients, being permanent in one patient (3.5%); both patients had bilateral carotid and intracranial disease and both had carotid stump pressures greater than 55 mmHg. No morbidity could be attributed to barbiturate usage.

Topics: Adult; Aged; Anticoagulants; Blood Pressure; Brain Diseases; Carotid Arteries; Carotid Artery Diseases; Cerebrovascular Disorders; Constriction; Endarterectomy; Female; Humans; Intraoperative Complications; Ischemic Attack, Transient; Male; Middle Aged; Postoperative Complications; Risk; Thiopental

Topics: Carotid Artery Diseases; Carotid Artery, Internal; Coronary Disease; Endarterectomy; Humans; Hypothermia, Induced; Male; Middle Aged; Myocardial Revascularization; Thiopental

Topics: Adult; Anesthesia; Arteriovenous Fistula; Atropine; Carotid Artery Diseases; Cavernous Sinus; Dexamethasone; Diazepam; Droperidol; Female; Fentanyl; Heart Arrest; Humans; Hypothermia, Induced; Naloxone; Neostigmine; Neuroleptanalgesia; Pancuronium; Preanesthetic Medication; Thiopental

Twenty patients with aneurysms of the internal carotid artery underwent temporary clamping, in turn, of the internal and then the common carotid artery. Cerebral blood flow, internal carotid artery pressure, and the EEG were recorded to assess the probability of cerebral ischaemia after permanent ligation. With this method of monitoring the cerebral circulation, 17 of the 20 patients had a permanent carotid ligation without neurological deficit; in the other three ligation was contraindicated. Although a correlation was observed between the reduction of cerebral blood flow and the fall in internal carotid artery pressure caused by temporary clamping (P<0·01), the scatter of data was too wide to predict cerebral blood flow from the change in carotid artery pressure. Similarly, EEG slowing was usually associated with low cerebral blood flow but exceptions occurred. Ligation was safe when, during temporary clamping, cerebral blood flow exceeded 40 ml/100 g/min, but was deemed unsafe when flow was less than 20 ml/100 g/min. In the range 20-40 ml/100 g/min, consideration of the internal carotid artery pressure permitted more patients to be safely ligated than if the decision had rested on changes in cerebral blood flow alone.

Topics: Adolescent; Adult; Aged; Anesthesia, General; Blood Pressure; Brain; Carotid Artery Diseases; Carotid Artery, Internal; Cerebrovascular Circulation; Electroencephalography; Humans; Hypertension; Intracranial Aneurysm; Ischemia; Middle Aged; Nitrous Oxide; Postoperative Complications; Respiration, Artificial; Subarachnoid Hemorrhage; Thiopental