thiopental and Cognition-Disorders

Electroconvulsive therapy (ECT) is among the most effective treatments of several life-threatening psychiatric disorder. Despite effective therapy, ECT-induced seizure could cause several adverse effects including cognitive disorders and memory impairment. Drugs such as thiopental, which have been prescribed for anesthesia required for ECT, are known as drugs with cognitive effects. This pilot randomized clinical trial tried to assess the feasibility of using a lower dose of thiopental in combination with remifentanil instead of a higher challenging dose of a single drug with cognitive side effects such as thiopental. We evaluated post-ECT cognitive impairment in patients who received remifentanil-thiopental compared with thiopental-placebo group.. One hundred twenty patients with psychiatric disorders between the ages of 18 and 60 years were enrolled. The patients were randomized into 2 groups who received either thiopental sodium (4 mg/kg) and remifentanil (1 μg/kg) or thiopental sodium (3 mg/kg, placebo). The psychiatric patients were examined using mini-mental state examination in terms of the cognitive deficits before ECT as well as 5 and 24 hours after ECT. Statistical analyses were done using Statistical Package for the Social Sciences version 16. Unpaired t test, χ2 test, and analysis of variance were used to determine the association of variables.. All the patients completed the trial. There were no reports of adverse effects. In terms of depth of anesthesia measured by bispectral index, no significant difference was observed. Regarding mini-mental state examination scores, the difference was not statistically significant.. Depth of anesthesia was similar between the groups.

Topics: Adolescent; Adult; Anesthesia; Anesthetics, Intravenous; Cognition Disorders; Consciousness Monitors; Double-Blind Method; Electroconvulsive Therapy; Female; Hemodynamics; Humans; Male; Mental Disorders; Middle Aged; Neuropsychological Tests; Pilot Projects; Piperidines; Remifentanil; Thiopental; Young Adult

Preliminary evidence suggests that the use of ketamine during electroconvulsive therapy (ECT) may be neuroprotective against cognitive impairment and have synergistic antidepressant effects. This study tested whether the addition of ketamine reduced cognitive impairment and enhanced efficacy over a course of ECT, in a randomised, placebo-controlled, double-blind study.. Fifty-one depressed patients treated with ultrabrief pulse-width right unilateral ECT were randomised to receive either ketamine (0.5mg/kg) or placebo (saline) in addition to thiopentone during anaesthesia for ECT. Neuropsychological outcomes (measured before ECT, after six treatments, and after the final ECT treatment) and mood outcomes (measured before ECT, and weekly after every three ECT treatments) were measured by a rater blinded to treatment condition.. Neuropsychological outcomes did not differ between groups. The ECT-ketamine group had a slightly greater improvement in depressive symptoms over the first week of treatment and at one-week follow up, though there was no overall difference in efficacy at the end of the ECT course. No psychomimetic effects were detected.. The study was conducted in a clinical setting, so not all aspects of ECT treatment were fully controlled. Thiopentone doses differed slightly between groups, in order to accommodate the addition of ketamine to the anaesthetic.. The addition of ketamine did not decrease cognitive impairment in patients having ultrabrief pulse-width right unilateral ECT, but was safe and slightly improved efficacy in the first week of treatment and at one-week follow up.. Clinicaltrials.gov ID: NCT00680433. Ketamine as an anaesthetic agent in electroconvulsive therapy (ECT). www.clinicaltrials.gov.

Topics: Adult; Affect; Bipolar Disorder; Cognition; Cognition Disorders; Depressive Disorder, Major; Double-Blind Method; Electroconvulsive Therapy; Electroencephalography; Female; Follow-Up Studies; Humans; Ketamine; Male; Middle Aged; Mood Disorders; Neuroprotective Agents; Neuropsychological Tests; Thiopental; Treatment Outcome

To compare propofol and thiopental as anesthetic agents for electroconvulsive therapy (ECT) with respect to seizure duration, stimulus charge, clinical effect, and cognitive side effects.. Randomized, blinded study of 62 depressed patients treated with bilateral ECT. Algorithm-based charge dosing was used.. The mean seizure duration of the patients in the thiopental group was 36.3 seconds versus 25.7 seconds in the propofol group (P = 0.001). The charge per treatment was 79.5 mC in the thiopental group versus 109.8 mC in the propofol group (P = 0.026). Sixteen patients in the propofol group (52%) reached the highest electrical dose versus 8 patients (26%) in the thiopental group (P = 0.014). No difference in response to treatment or number of treatments was observed. The mean score on Mini-Mental State Examination (MMSE) was 28.9 in the thiopental group versus 26.8 in the propofol group (P = 0.014). However, age distribution of patients completing the study differed between the groups.. Propofol significantly decreases seizure duration without significant difference in the clinical outcome. Using the employed treatment algorithm, patients anesthetised with propofol received higher electrical charge. Mini-Mental State Examination scores suggest that this results in more severe cognitive side effects. Results, however, might be confounded by the differences in age distribution in the groups.

Topics: Adult; Aged; Algorithms; Anesthesia, Intravenous; Anesthetics, Intravenous; Cognition Disorders; Double-Blind Method; Electroconvulsive Therapy; Female; Humans; Male; Middle Aged; Monitoring, Physiologic; Neuropsychological Tests; Propofol; Seizures; Thiopental; Young Adult

Cognitive impairments are the main complication after electroconvulsive therapy (ECT). Modification of treatment parameters has been shown to affect the magnitude of these impairments, but the role of anesthetic type remains unclear. This study tested whether there is a difference in cognitive impairments immediately after ECT with propofol compared to thiopental anesthesia.. This randomized, double-blind, crossover study included 15 patients receiving right unilateral ECT for depression. Patients received propofol or thiopental on alternating ECTs up to 6 treatments. Immediate and delayed verbal memory, motor speed, reaction speed, visuospatial, and executive functions were assessed 45 minutes after each ECT. Differences were assessed with repeated measures analysis of variance.. Cognitive impairments were reduced after ECT with propofol compared to thiopental. Time to emergence was quicker and EEG seizure duration was shorter after propofol treatments. There was no significant correlation between seizure duration and neuropsychological test performance.. Our results indicate that cognitive impairments in the early recovery period after ECT are reduced with propofol compared to thiopental anesthesia. We suggest that, in addition to ECT parameters, the type of anesthetic agent should be considered to reduce cognitive impairments after ECT.

Topics: Adult; Anesthetics, Intravenous; Cognition Disorders; Cross-Over Studies; Depressive Disorder; Double-Blind Method; Electroconvulsive Therapy; Female; Humans; Male; Memory; Middle Aged; Propofol; Reaction Time; Thiopental

In a double-blind study, 57 patients were anaesthetized with either Althesin, thiopentone, or fentanyl combined with diazepam for cystoscopies. One and a half and four hours after the administration of anaesthesia, the patients were investigated with an objective neuropsychological method, continuous Reaction Time, and with a subjective rating scale. Beecher's Mood Scale. One week later the patients answered a questionnaire about side-effects experienced during the days following anaesthesia. At the 1 1/2 h investigation, the patients were cerebrally affected, both subjectively and objectively. The CNS-dysfunction was different for the three anaesthetics. After administration of thiopentone, the patients experienced the highest degree of subjective effects but had the smallest reaction time prolongation. Fentanyl-diazepam gave the least subjective effects, but the highest degree of cerebral affection in the reaction time measurements. The effects of Althesin were intermediate. Four hours after anaesthesia, the reaction time prolongations had disappeared, except for Althesin, and only patients who had thiopentone registered subjective effects. The number of side-effects was greatest and most prolonged following thiopentone. About 25% of the patients reported that side-effects had persisted more than 1 day after anaesthesia.

Topics: Adult; Aged; Alfaxalone Alfadolone Mixture; Anesthetics; Clinical Trials as Topic; Cognition Disorders; Diazepam; Double-Blind Method; Female; Fentanyl; Humans; Male; Middle Aged; Mood Disorders; Postoperative Period; Pregnanediones; Thiopental

Topics: Anesthesia, General; Anesthesia, Intravenous; Anesthesia, Obstetrical; Cesarean Section; Cognition; Cognition Disorders; Delirium; Diazepam; Dreams; Female; Hallucinations; Humans; Ketamine; Nitrous Oxide; Pregnancy; Thiopental

A variety of cardiovascular and cerebrovascular diseases are associated with alterations in cholesterol levels and metabolism. Moreover, convincing evidence shows that high cholesterol diet can lead to learning and memory impairments. On the other hand, a significant body of research has also demonstrated that learning is improved by elevated dietary cholesterol. Despite these conflicting findings, it is clear that cholesterol plays an important role in these cognitive properties. However, it remains unclear how this blood-brain barrier (BBB)-impenetrable molecule affects the brain and under what circumstances it provides either detrimental or beneficial effects to learning and memory. The aim of this study was to characterize the effects of 5% cholesterol diet on six-month-old inbred Brown Norway rats. More important, we sought to examine the role that cholesterol can play when repeated anesthesia and intravenous infusion disrupts cognitive function. This present study supports previous work showing that enriched cholesterol diet leads to significant alterations in neuroinflammation and BBB disruption. Following repeated anesthesia and intravenous infusion of saline we observe that animals under normal diet conditions exhibit significant deficiencies in spatial learning and cholinergic neuron populations compared to animals under enriched cholesterol diet, which do not show such deficiencies. These findings indicate that cholesterol diet can protect against or counteract anesthesia/infusion-induced cognitive deficits. Ultimately, these results suggest that cholesterol homeostasis serves an important functional role in the brain and that altering this homeostasis can either exert positive or negative effects on cognitive properties.

Topics: Animals; Cerebral Cortex; Cholesterol; Cholesterol, Dietary; Choline O-Acetyltransferase; Cognition Disorders; Male; Maze Learning; Memory Disorders; Neurons; Rats; Thiopental

In a retrospective chart review, we examined the effects of ketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist, as electroconvulsive therapy (ECT) anaesthetic in patients suffering from therapy-resistant depression. We included 42 patients who received ECT treatment with either ketamine (n = 16) or the barbiturate thiopental (n = 26). We analysed the number of sessions until completion of ECT treatment (used as a surrogate parameter for outcome), psychopathology as assessed by pre- and post-ECT Mini-Mental State Examination (MMSE) and Hamilton Rating Scale for Depression (HAM-D) scores as well as ECT and seizure parameters (stimulation dose, seizure duration and concordance, urapidil dosage for post-seizure blood pressure management). The ketamine group needed significantly fewer ECT sessions and had significantly lower HAM-D and higher MMSE scores afterwards. As expected, the ketamine group needed more urapidil for blood pressure control. Taking into account the limits inherent in a retrospective study design and the rather small sample size, our results nonetheless point towards synergistic effects of ECT and ketamine anaesthesia, less cognitive side effects and good tolerability of ketamine.

Topics: Aged; Anesthetics, Dissociative; Anesthetics, Intravenous; Antihypertensive Agents; Cognition Disorders; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Inpatients; Ketamine; Male; Middle Aged; Neuropsychological Tests; Piperazines; Psychiatric Status Rating Scales; Retrospective Studies; Thiopental; Treatment Outcome

Topics: Aged; Anesthesia; Anesthetics, Intravenous; Cognition Disorders; Depressive Disorder, Major; Electroconvulsive Therapy; Etomidate; Female; Humans; Long-Term Care; Neuropsychological Tests; Thiopental

Topics: Anesthetics, Intravenous; Cognition Disorders; Depressive Disorder; Electroconvulsive Therapy; Humans; Memory; Propofol; Reaction Time; Thiopental

This study reports on clinical outcome in 38 patients with severe head injuries (posttraumatic coma for 6 hours or more) treated with barbiturate coma because of intracranial hypertension. Eighteen patients died, 4 patients remained in a severely disabled or a chronic vegetative state, and 16 patients reached the levels good recovery/moderate disability. Six of these patients returned to work or school full time, 4 for half time and 3 were in a rehabilitation program. Fourteen patients were subjected to a comprehensive neuropsychological assessment. All patients except one exhibited varying degrees of cognitive dysfunction and 6 patients had signs of personality change. The quality of life for the majority of surviving patients was relatively good but the positive effects of barbiturate coma therapy in the age groups over 40 years appeared to be limited.

Topics: Adult; Brain Damage, Chronic; Brain Injuries; Child; Cognition Disorders; Critical Care; Disability Evaluation; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Glasgow Coma Scale; Humans; Male; Neurologic Examination; Neuropsychological Tests; Quality of Life; Survival Rate; Thiopental

For many years, reports have appeared indicating cognitive deficits in elderly patients following anaesthesia. However, there is no general consensus of opinion concerning the putative relationship between these deficits and the anaesthetic process. In a prospective study, 85 patients undergoing elective surgery were assessed on a battery of standardized cognitive tests, 1 day before and 2 days after surgery. Analysis of results indicated that anaesthesia does produce post-operative cognitive deficits in both young and elderly patients, and a possible causative mechanism is discussed.

Topics: Age Factors; Aged; Anesthesia Recovery Period; Anesthesia, General; Cognition Disorders; Female; Humans; Male; Middle Aged; Postoperative Care; Preoperative Care; Prospective Studies; Psychological Tests; Thiopental

Topics: Adolescent; Adult; Cognition Disorders; Electroconvulsive Therapy; Female; Humans; Injections, Intravenous; Male; Methaqualone; Middle Aged; Respiration; Seizures; Succinylcholine; Thiopental