thiopental and Cerebral-Infarction

In a review of 147 patients with intracranial aneurysms surgically treated by one surgeon (FAD) between 1980 and 1987, 36 selected patients received intraoperative barbiturate protection with sodium thiopental during temporary arterial occlusion. Thiopental doses of 5 to 15 mg/kg were used. Twenty-nine of 36 (81%) had ruptured aneurysms. Occlusion times ranged from 3 to 93 minutes, with a mean of 16.2 minutes. Seven patients had new neurological deficit in the immediate postoperative period, but in only two did these persist. Twenty-one patients (72%) with subarachnoid hemorrhage and 6 with incidental aneurysms made a good recovery. Of the 9 patients with significant permanent deficit, all but 2 were related to either the severity of the initial hemorrhage or to delayed vasospasm. In only one instance might temporary arterial occlusion have led to permanent neurological sequelae. Temporary arterial occlusion with barbiturate protection is a safe technique. For aneurysms that are more surgically complex, it allows for complete dissection of the aneurysm neck and identification and preservation of the surrounding vascular anatomy, while reducing the risk of intraoperative rupture and postoperative stroke.

Topics: Adult; Aged; Cerebral Arteries; Cerebral Infarction; Constriction; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Neurosurgery; Radiography; Subarachnoid Hemorrhage; Thiopental; Time Factors

Topics: Anesthetics, Intravenous; Animals; Barbiturates; Brain; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Cerebral Infarction; Dose-Response Relationship, Drug; Humans; Neuroprotective Agents; Postoperative Complications; Thiopental

Topics: Anesthetics, Intravenous; Barbiturates; Brain; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Cerebral Infarction; Humans; Neuroprotective Agents; Postoperative Complications; Reproducibility of Results; Thiopental

In an attempt to determine whether one anesthetic might be clearly advantageous over another in clinical situations of temporary focal ischemia, isoflurane or thiopental (in concentrations producing equal suppression of cerebral function as measured by the electroencephalogram) were studied for their effects on neurologic outcome and cerebral infarct size in pigtailed monkeys exposed to temporary focal ischemia produced by 5 h of middle cerebral artery occlusion (MCAo). Burst suppression was produced for 15 min before MCAo and maintained throughout the ischemic period by 2.18 +/- 0.11% (mean +/- SE) end-expired isoflurane or 135 +/- 18 mg.kg-1 thiopental. Mean arterial pressure was supported with phenylephrine and maintained at approximately 90 mmHg in both groups throughout the ischemic period. At the end of the ischemic period, the isoflurane or thiopental was discontinued, allowing the animals to awaken. Intensive care was provided as needed. Neurologic function was scored for 8 days at the end of which surviving animals were killed and the brains were fixed in formalin and then examined for infarct size. There was no significant difference in final neurologic outcome between the animals receiving isoflurane and those receiving thiopental as determined by the Mann-Whitney rank sum test. Neurologic deficit scores ranged from normal (one of eight in the group receiving isoflurane and three of nine in the group receiving thiopental) to death resulting from brain injury (three in the isoflurane group and five in the thiopental-treated group). There also was no significant difference in infarct size between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Blood Gas Analysis; Blood Glucose; Blood Pressure; Brain; Cerebral Infarction; Electroencephalography; Female; Ischemic Attack, Transient; Isoflurane; Male; Pilot Projects; Thiopental

Barbiturate coma is still recommended for brain protection during periods of temporary focal ischaemia such as during carotid endarterectomy. We tested the hypothesis that a single dose of barbiturate given before a period of protracted severe focal ischaemia would protect against focal cerebral infarction. Sixteen cats had the proximal left middle cerebral artery (MCA) occluded. Eight cats received halothane alone titrated to keep their pulse and blood pressure within the normal range. Eight cats received, in addition to halothane, a bolus of thiopentone sufficient to produce an isoelectric EEG immediately prior to MCA occlusion. Six hours after the occlusions the animals were sacrificed and the brains scored histologically to assess both size and severity of ischaemia. There was no statistically significant difference in the size or severity of the infarcts between the groups. We conclude from this study that the extent of the histological injury was not reduced by a single prophylactic bolus of thiopentone given before prolonged focal cerebral ischaemia.

Topics: Animals; Brain; Cats; Cerebral Infarction; Drug Therapy, Combination; Electroencephalography; Halothane; Hemodynamics; Ischemic Attack, Transient; 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

A review of 45 cerebral vasospasm cases for cerebral infarct under computer tomography (CT) scanner and based on activities of daily living (ADL) resulted in the finding that, of 19 cases with vasospasm of "diffuse, severe" grade, 14 cases were rated "poor (disabled)" to "dead": CT-diagnosed cerebral infarct was found in 4 out of 6 cases. From this, it was believed that indication for B-therapy was clinically significant vasospasm (diffuse, severe), which falls under the clinical grade of III or IV by Hunt and Kosnik without considering such incidental condition as severe vasospasm. After B-therapy, 45% showed ADL of at least "fair". CT-diagnosed cerebral infarct was found in 4 out of 10 cases. None died from complications as a result of B-therapy. The examination of ineffectual cases pointed to the importance of the first choice application of B-therapy, the continuation of the therapy as long as vasospasm continues, and the sustenance of cerebral perfusion pressure by the use of vasopressor (Dopamine) to offset the hypotensive effect of barbiturate. With these points of care exercised, the B-therapy is believed to achieve good results.

Topics: Adult; Aged; Anesthesia, Endotracheal; Cerebral Infarction; Dopamine; Drug Therapy, Combination; Female; Humans; Hypotension; Intracranial Aneurysm; Ischemic Attack, Transient; Male; Middle Aged; Thiopental

Sodium thiopental was administered to 10 dogs following embolization of the middle cerebral artery. Its effect on the "grace period" for revascularization was investigated by performing embolectomies 6 hours later. We observed a striking reduction in the size of infarction in the animals treated with thiopental at moderate and prolonged dosage levels. The control animals treated with pentobarbital received less protection against ischemia although blood levels were similar to those of the experimental groups during the period of vascular occlusion.

Topics: Animals; Barbiturates; Brain Ischemia; Cerebral Infarction; Cerebral Revascularization; Dogs; Dose-Response Relationship, Drug; Pentobarbital; Thiopental; Time Factors

This report describes a 25-month-old child with an internal carotid artery injury that was caused by a fall upon the sharp end of a comb held in the mouth. The initial injury appeared trivial, but 24 hours later a right cerebral hemispheric infarct occurred. Delayed deterioration was caused by increased intracranial pressure and transtentorial herniation. Aggressive medical therapy was instituted for the control of intracranial pressure. The clinical and radiographic features are described in detail and the pertinent literature is reviewed. This is the first reported patient with this condition who survived once transtentorial herniation was present.

Topics: Adolescent; Carotid Artery Injuries; Cerebral Angiography; Cerebral Infarction; Child; Child, Preschool; Dura Mater; Female; Hernia; Humans; Infant; Intracranial Pressure; Male; Mannitol; Palate, Soft; Respiration, Artificial; Thiopental; Tomography, X-Ray Computed

Topics: Animals; Barbiturates; Brain Ischemia; Cats; Cerebral Infarction; Dogs; Haplorhini; Humans; Hypoxia, Brain; Intracranial Pressure; Pentobarbital; Postoperative Complications; Pseudotumor Cerebri; Rats; Thiopental

Thiopentone (20 mg/kg/bolus and 20 mg/kg/three hours) was effective in preventing infarction in five dogs with six hours of middle cerebral occlusion. Nine control animals sustained massive to large infarctions. Utilizing this regime therapeutic blood levels were rapidly attained for over 12 hours without side effects. From the experimental and human experience with focal cerebral ischaemia, there appears to be a finite grace period in which cerebral revascularization can be undertaken. In canine and primate models this time has been about five hours, following which the infarction process may not be reversible (Sundt et al. 1977, Laha et al. 1978). Seeking to prolong this grace period, thiopentone was selected as an ideal drug for this purpose, and its effect on the revascularized canine middle cerebral distribution was evaluated at six hours following embolectomy.

Topics: Animals; Cerebral Infarction; Cerebral Revascularization; Cerebrovascular Circulation; Dogs; Intracranial Embolism and Thrombosis; Postoperative Complications; Thiopental

The effect of a barbiturate, Sodium thiopental (Nesdonal), on the cerebral circulation in 13 patients with a cerebral ischemic attack is studied. Its action is compared to the action of other intravenous anesthetics (Alfatésine - Etomidate - diazanalgésie) used in neuro-anesthésia. The study is on a total of thirty patients. The regional cerebral blood flow (RCBF) is measured by the intra-carotid injection of Xe133. The anesthetics studied acted like vasoconstrictive agents on the healthy brain. They diminish the RCBF. At the leel of ischemic lesions the response is abolished, even inversed : the flow remains unchanged, even increases. It is the inverse steal syndrome. This action, comparable to the action of hypocapnia, has both a diagnostic and a prognostic value.

Topics: Alfaxalone Alfadolone Mixture; Anesthetics; Brain; Carbon Dioxide; Cerebral Infarction; Cerebrovascular Circulation; Diazepam; Etomidate; Fentanyl; Humans; Oxygen Consumption; Thiopental; Vasoconstriction

Topics: Blood Gas Analysis; Brain Ischemia; Carbon Dioxide; Cats; Cerebral Angiography; Cerebral Infarction; Ethanol; Ischemic Attack, Transient; Mannitol; Oxygen; Pentobarbital; Pharmacology; Research; Thiopental; Trypan Blue; Urea

Topics: Animals; Brain; Brain Ischemia; Cerebral Infarction; Cyanides; Guinea Pigs; Histological Techniques; Hypoxia, Brain; Ischemic Attack, Transient; Nitrogen; Nitrous Oxide; Pathology; Research; Thiopental; Toxicology

Topics: Anesthesia; Anesthesia, Inhalation; Atmosphere; Bis-Trimethylammonium Compounds; Blood Flow Velocity; Blood Gas Analysis; Cerebral Infarction; Cerebrovascular Circulation; Cerebrovascular Disorders; Dogs; Halothane; Hyperbaric Oxygenation; Hypothermia; Hypothermia, Induced; Infarction; Neurosurgery; Oxygen; Research; Thiopental