thiopental and Cerebral-Hemorrhage

Topics: Adult; Anesthesia, Intravenous; Anesthetics, Intravenous; Cerebral Hemorrhage; Child; Craniotomy; Fentanyl; Humans; Ischemic Attack, Transient; Male; Moyamoya Disease; Subarachnoid Hemorrhage; Thiopental

Topics: Barbiturates; Cerebral Hemorrhage; Glycerol; Hematoma; Humans; Intracranial Pressure; Mannitol; Thiopental

The effects of antihypertensive drugs, such as nifedipine, chlorpromazine, reserpine and thiopental on mean arterial blood pressure (ABP), mean intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were studied in 43 patients with systemic hypertension and intracranial hypertension due to hemorrhagic cerebrovascular diseases and other causes. These drugs are commonly used in neurosurgical practice for the treatment of systemic hypertension. Nifedipine, chlorpromazine and reserpine reduced the mean ABP, raised the mean ICP and decreased the CPP. The effects of these drugs on mean ICP and CPP were more pronounced in patients with severely increased ICP (more than 40 mmHg) than in patients with moderately increased ICP (20-40 mmHg). Thiopental reduced both mean ABP and ICP, whereas the CPP was unchanged from the preadministration level. During thiopental administration, however, respiratory depression was observed, and hence, intubation and ventilation were required. We suggest that, in the treatment of systemic hypertension in patients with increased ICP, barbiturates are more desirable than agents with calcium channel or alpha-adrenergic blocking actions, despite the problem of respiratory control.

Topics: Adult; Aged; Antihypertensive Agents; Blood Pressure; Brain Edema; Cerebral Hemorrhage; Cerebrospinal Fluid Pressure; Chlorpromazine; Female; Humans; Hypertension; Intracranial Pressure; Male; Middle Aged; Nifedipine; Pseudotumor Cerebri; Reserpine; Thiopental

The effects and indications of barbiturate therapy for brain protection, and prevention and reduction of the intracranial hypertension were investigated using an ultrashort acting barbiturate, thiamylal, in sixteen cases with intracranial lesions. Final outcome of the treatment revealed 8 good recoveries which were actively administered thiamylal during operation or immediately after. On the other hand, four cases, whose intracranial pressures (ICPS) of over 40 mmHg could not be controlled suffered brain death. Barbiturate therapy was not effective for brain protection of primary damaged lesions. It is concluded that barbiturate therapy may provide a satisfactory reduction of the intracranial hypertension in cases during the early postoperative stage or of under 40 mmHg initial ICP.

Topics: Adolescent; Adult; Aged; Brain Edema; Brain Injuries; Brain Neoplasms; Cerebral Hemorrhage; Child, Preschool; Female; Humans; Intracranial Aneurysm; Intracranial Arteriovenous Malformations; Male; Middle Aged; Postoperative Complications; Pseudotumor Cerebri; Thiamylal; Thiopental

Efficacy and limitation of barbiturate therapy employed as postoperative treatment for acute traumatic intracranial hematomas were studied in 20 patients. The clinical cases in this series included 15 males and 5 females with mean age of 41.8 years who all were operated on for intracranial hematomas within 3 days after injury. Glasgow Coma Scale (GCS) score was less than 7 in all instances and intracranial pressure (ICP) as well as arterial pressure was monitored postoperatively with Gaeltec and Gould transducers. Barbiturate therapy (5 mg/kg of thiopental as an initial dose and loading dose of 2-3 mg/kg/hour) was given when ICP rose above 20 mmHg and maintained for 3 days after operation. The outcome of the patients was assessed by Glasgow Outcome Scale 3 months after injury. The response of barbiturate on ICP and the changes of cerebral perfusion pressure (CPP) during the therapy in relation to the outcome were studied. Final outcome of the patients revealed 5 of good (good recovery and moderate disability), 3 of poor (severe disability and vegetative state) outcomes and 60% of mortality rate. Eleven out of 20 patients responded to barbiturate therapy and 0-20 mmHg of ICP reduction (mean reduction of 10 mmHg) was obtained in these cases. Among these cases, 2 out of 3 dead patients were older than 60 years. There were no responses of barbiturate in 7 patients to whom the therapy was started when ICP rose above 40 mmHg. No response of the therapy on ICP was also observed in the patients with GCS score of 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Cerebral Hemorrhage; Craniocerebral Trauma; Female; Hematoma; Humans; Intracranial Pressure; Male; Middle Aged; Postoperative Complications; Prognosis; Thiopental

We present an extremely rare case of an arteriovenous malformation (AVM) in the territory of the middle cerebral artery, the main trunk of which was occluded asymptomatically. Immediately after an uneventful excision of the entire AVM, massive brain swelling occurred unexpectedly and was treated successfully with high dose barbiturate therapy associated with other standard measures of controlling increased intracranial pressure. The underlying pathophysiological mechanisms leading to the massive intraoperative brain swelling in this case are discussed.

Topics: Adult; Brain Edema; Cerebral Angiography; Cerebral Arterial Diseases; Cerebral Hemorrhage; Cerebral Infarction; Constriction, Pathologic; Humans; Intracranial Arteriovenous Malformations; Intracranial Pressure; Male; Microsurgery; Postoperative Complications; Thiopental

Topics: Anesthesia; Cerebral Hemorrhage; Cerebrospinal Fluid Shunts; Emergencies; Female; Humans; Intracranial Pressure; Lidocaine; Male; Middle Aged; Thiopental

Topics: Adult; Anesthesia, Intravenous; Anesthesia, Obstetrical; Cerebral Hemorrhage; Cesarean Section; Eclampsia; Female; Humans; Obstetric Labor Complications; Oxygen Inhalation Therapy; Pregnancy; Succinylcholine; Thiopental

We report two cases of children, 7 and 14 yr old, in whom prolonged infusion of thiopental sodium (TS) was used to control intracranial hypertension previously unresponsive to conventional therapy. Intracranial hypertension followed removal of a large tumor in 1 case, and trauma in the other. TS was administered at a rate of up to 7 mg/kg . h for 8 days in 1 patient, and up to 12 mg/kg . h for 10 days in the other. Both children regained consciousness and made significant recovery of neurological function. The advantage and the side-effects of the prolonged use of TS for intracranial hypertension are discussed.

Topics: Adolescent; Brain Neoplasms; Cerebral Hemorrhage; Child; Female; Hematoma, Subdural; Humans; Infusions, Parenteral; Lymphoma; Male; Postoperative Complications; Pseudotumor Cerebri; Thiopental; Time Factors

Topics: Amphetamine; Ataxia; Bone Marrow; Cerebral Hemorrhage; Depression, Chemical; Dicumarol; Dihydroxyphenylalanine; Disulfiram; Drug Antagonism; Ephedrine; Humans; Hypertension; Hypotension; Isoniazid; Mercaptopurine; Methamphetamine; Microsomes, Liver; Monoamine Oxidase Inhibitors; Norepinephrine; Phenethylamines; Phenytoin; Reserpine; Stimulation, Chemical; Thiazines; Thiopental; Tyramine