thiopental and Cough

To evaluate and compare the efficacy and related side effects of alfentanil and remifentanil in preventing the withdrawal movement associated with rocuronium injection.. Prospective, randomized, blinded, placebo-controlled clinical trial.. Operating room of a university hospital.. 115 ASA physical status I and II adult patients.. Patients were randomly allocated to one of three study groups. Group C received saline, Group A received alfentanil 10 microg/kg, and Group R received remifentanil one microg/kg, each in a volume of three mL. Treatments were injected over 30 seconds, followed by thiopental sodium. At 90 seconds after the start of the study drug injection, rocuronium 0.6 mg/kg was injected over 10 seconds.. Cough, breathholding, and thoracic muscle rigidity were observed while injecting the study drug. Each patient's response to the rocuronium injection was graded on a 4-point scale in a blinded manner.. During injection of the study drug, Group R showed a significantly higher frequency of cough than Group A (24% vs. 2%; P < 0.05). One Group R patient presented with apnea. Frequency of withdrawal movement in Groups A and R were significantly lower than that in Group C (6% and 0% vs. 63%; P < 0.0001) but there was no significant difference between the two groups.. When administered 90 seconds before rocuronium injection, alfentanil showed a comparable effect to that of remifentanil in attenuating rocuronium-associated withdrawal movement, and a lower frequency of side effects such as cough.

Topics: Adult; Alfentanil; Androstanols; Anesthetics, Intravenous; Cough; Double-Blind Method; Female; Hospitals, University; Humans; Male; Middle Aged; Movement; Neuromuscular Nondepolarizing Agents; Piperidines; Prospective Studies; Remifentanil; Rocuronium; Thiopental

Airway irritation is a major drawback of desflurane anesthesia. This study was designed to evaluate the effect of intravenous fentanyl given before thiopental induction on airway irritation caused by a stepwise increase in desflurane in children.. Eighty children (2-8 years) were enrolled in a randomized, double-blind study. Forty received saline and 40 received 2 microg/kg of fentanyl intravenously; this was followed by thiopental sodium 5 mg/kg in both groups. Patients were assistant-ventilated with desflurane 1%, which was then increased by 1% every six breaths up to 10%. During this period, cough, secretion, excitation and apnea were graded and the desflurane concentration at which airway irritation symptoms first occurred was recorded. The results were analyzed using Pearson's chi-squared test.. The incidence of typical airway irritation events was lower with fentanyl than with saline (cough, 2.5% vs. 42.5%; secretion, 27.5% vs. 82.5%; excitation, 10% vs. 82.5%; apnea, 20% vs. 65%; P < 0.05). The mean expired desflurane concentration at which the first airway irritation symptom occurred was greater with fentanyl than with saline (7.3% vs. 5.5%, P < 0.05).. Intravenous fentanyl in children reduces airway complications caused by desflurane.

Topics: Analgesics, Opioid; Anesthesia, General; Anesthetics, Inhalation; Apnea; Blood Pressure; Child; Child, Preschool; Cough; Desflurane; Double-Blind Method; Electrocardiography; Female; Fentanyl; Heart Rate; Humans; Hypnotics and Sedatives; Injections, Intravenous; Irritants; Isoflurane; Male; Mucus; Thiopental

Foreign body aspiration may be a life-threatening emergency in children requiring immediate bronchoscopy under general anesthesia. Both controlled and spontaneous ventilation techniques have been used during anesthesia for bronchoscopic foreign body removal. There is no prospective study in the literature comparing these two techniques. This prospective randomized clinical trial was undertaken to compare spontaneous and controlled ventilation during anesthesia for removal of inhaled foreign bodies in children.. Thirty-six children posted for rigid bronchoscopy for removal of airway foreign bodies over a period of 2 years and 2 months in our institution were studied. After induction with sleep dose of thiopentone or halothane, they were randomly allocated to one of the two groups. In group I, 17 children were ventilated after obtaining paralysis with suxamethonium. In group II, 19 children were breathing halothane spontaneously in 100% oxygen.. All the patients in the spontaneous ventilation group had to be converted to assisted ventilation because of either desaturation or inadequate depth of anesthesia. There was a significantly higher incidence of coughing and bucking in the spontaneous ventilation group compared with the controlled ventilation group (P = 0.0012).. Use of controlled ventilation with muscle relaxants and inhalation anesthesia provides an even and adequate depth of anesthesia for rigid bronchoscopy.

Topics: Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Blood Gas Analysis; Bronchoscopy; Child; Cough; Foreign Bodies; Halothane; Humans; Inhalation; Neuromuscular Depolarizing Agents; Oxygen; Prospective Studies; Respiration, Artificial; Succinylcholine; Thiopental; Trachea

Administration of remifentanil followed by propofol provides adequate conditions for tracheal intubation without muscle relaxants. Other hypnotic drugs have not been thoroughly investigated in this regard. Intubating conditions with remifentanil followed by propofol, thiopentone or etomidate are compared in this study.. In a randomized, double-blind study 45 healthy males were assigned to one of three groups (n = 15). After iv atropine, remifentanil 3 microg x kg(-1) were injected over 90 sec followed by propofol 2 mg x kg(-1) (Group I), thiopentone 6 mg x kg(-1) (Group II) or etomidate 0.3 mg x kg(-1) (Group III). Ninety seconds after the administration of the hypnotic agent, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good or poor on the basis of ease of ventilation, jaw relaxation, position of the vocal cords, and patient response to intubation and slow inflation of the endotracheal tube cuff.. One patient in Group I, three patients in Group II and five patients in Group III could not be intubated on the first attempt. Clinically acceptable intubating conditions were observed in 93.3%, 66.7%, 40.0% of patients in Groups I, II and III, respectively. Overall conditions at intubation were significantly (P < 0.05) better, and the frequency of excellent conditions was significantly (P < 0.05) higher in the propofol group compared with the thiopentone and etomidate groups. No patient was treated for hypotension or bradycardia.. Propofol 2 mg x kg(-1) was superior to thiopentone 6 mg x kg(-1) and etomidate 0.3 mg x kg(-1) for tracheal intubation when combined with remifentanil 3 microg x kg(-1) and no muscle relaxant.

Topics: Adolescent; Adult; Analgesics, Opioid; Anesthetics, Intravenous; Blood Pressure; Cough; Double-Blind Method; Etomidate; Female; Heart Rate; Humans; Intubation, Intratracheal; Jaw; Laryngoscopy; Male; Midazolam; Middle Aged; Movement; Muscle, Skeletal; Neuromuscular Blockade; Piperidines; Preanesthetic Medication; Propofol; Remifentanil; Thiopental; Vocal Cords

We have performed a randomized, cross over study in 22 children suffering from acute leukaemia, who underwent repeated anaesthesia for bone marrow aspiration and lumbar puncture. For their first anaesthetic, the children (aged 3-10 years old) received, either a thiopentone/isoflurane anaesthetic or intravenous propofol, both supplemented with nitrous oxide. On a second occasion they received the alternative technique. Of those children receiving thiopentone/isoflurane, 32% had significant coughing during anaesthesia, two progressing to laryngospasm requiring 100% oxygen. None of the patients receiving propofol had a respiratory disturbance (P = 0.016). 68% of the children preferred the propofol anaesthetic. Only one child in the thiopentone/isoflurane group preferred this technique. Twenty-seven per cent had no preference. There was no significant difference in length of anaesthetic time (P = 0.07) or the time taken for recovery (P = 0.17) between the two groups. There was a large individual variation in propofol requirements and movement was common during stimulation of patients in this group, though this did not adversely affect the surgical procedure.

Topics: Acute Disease; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Biopsy, Needle; Bone Marrow; Child; Child, Preschool; Cough; Cross-Over Studies; Humans; Isoflurane; Laryngismus; Leukemia; Nitrous Oxide; Patient Satisfaction; Propofol; Spinal Puncture; Thiopental

To assess the ease of insertion of laryngeal mask airway (LMA) comparing propofol with lidocaine or midazolam followed by thiopentone and compare the costs with each technique.. One hundred and fifty ASA 1 or 2 patients equally divided into three groups scheduled for elective surgery were recruited into this prospective, single blind, randomized, parallel groups study. Anaesthetic induction was achieved with 1 microgram.kg-1 fentanyl i.v. followed by either 2.5 mg.kg-1 propofol (group P), or a sequence of 1.5 mg.kg-1 lidocaine and 5 mg.kg-1 thiopentone (group LT), or midazolam 0.1 mg.kg-1 and, three minutes later, 5 mg.kg-1 thiopentone (group MT). The LMA was inserted by the blinded anaesthetist who assessed and graded the conditions for LMA insertion and noted any adverse responses (i.e., inadequate jaw relaxation, gagging, coughing, limb or head movement, hiccough and laryngospasm). Conditions were considered "excellent" if there were no adverse responses, and "satisfactory" if such a response was mild and transient.. Excellent or satisfactory conditions were observed in 48 (96%) patients in the midazolam-thiopentone group, 46 (92%) in the propofol group, and 34 (68%) in the lidocaine-thiopentone group (P = 0.0001). The incidence of gagging (P = 0.042), limb movement (P = 0.031), and laryngospasm (P = 0.0001) was higher in the lidocaine-thiopentone group.. With the above doses, a fentanyl-midazolam-thiopentone combination which is about 35% less expensive than fentanyl-propofol, provides equally good conditions for the insertion of LMA.

Topics: Adult; Anesthetics, Intravenous; Anesthetics, Local; Cough; Drug Costs; Elective Surgical Procedures; Female; Fentanyl; Gagging; Hiccup; Humans; Laryngeal Masks; Laryngismus; Lidocaine; Logistic Models; Male; Midazolam; Middle Aged; Movement; Propofol; Prospective Studies; Sex Factors; Single-Blind Method; Thiopental; Treatment Outcome

Disappearance of response to single twitch stimulation (STS) or train-of-four stimulation (TOF) of the ulnar nerve is insufficient as predictive guide for intubating conditions during onset of non-depolarizing neuromuscular block. Double burst stimulation (DBS) appears to be a more reliable indicator of the optimal time for intubation. In the present study, the disappearance of tactile detectable response to 0.1 Hz single twitch stimulation (STS) of the ulnar nerve was compared with disappearance of response to 0.1 Hz single burst stimulation (three stimuli at 50 Hz = SBS) as predictor for optimal intubating conditions during onset of block induced by 0.08 mg.kg-1 of vecuronium in 100 patients under light general anaesthesia where thiopentone was used as the sole anaesthetic. Intubation was performed immediately after disappearance of the twitch response. Likewise 0.05 Hz STS and 0.05 Hz SBS stimulation were compared under identical circumstances in another 100 patients. Intubating conditions were unacceptable in 10%, 14%, 8% and 10% of the patients in the 0.1 Hz STS, 0.1 Hz SBS, 0.05 Hz STS and 0.05 Hz SBS groups, respectively. There were no significant differences between the groups. In conclusion, neither absence of response to STS stimulation nor absence of response to SBS stimulation of the ulnar nerve at either 0.1 Hz or 0.05 Hz frequency does guarantee acceptable intubating conditions during onset of neuromuscular block induced by vecuronium 0.08 mg.kg-1 when thiopentone is used as the sole anaesthetic.

Topics: Adult; Anesthesia, Intravenous; Cough; Electric Stimulation; Female; Forecasting; Humans; Intubation, Intratracheal; Laryngoscopy; Middle Aged; Muscle Contraction; Nerve Block; Single-Blind Method; Thiopental; Touch; Ulnar Nerve; Vecuronium Bromide; Vocal Cords

The "Timing Principle" utilises a single bolus of non-depolarising neuromuscular blocking drug followed by thiopentone given at the onset of clinical weakness. The purpose of this study was to compare the intubating conditions after succinylcholine and after atracurium used according to the "timing principle." Eighty patients were randomly assigned to four groups of 20. Three study groups were given atracurium 0.5, 0.75 or 1 mg.kg-1 (Groups I, II and III respectively) and the control group (Group IV) received succinylcholine 1.5 mg.kg-1. The study groups received fentanyl 1 microgram.kg-1, atracurium three minutes later, followed by thiopentone 4-6 mg.kg-1 at the onset of ptosis. The control group had a defasciculating dose of atracurium (0.025 mg.kg-1) and fentanyl (1 microgram.kg-1) followed by thiopentone (4-6 mg.kg-1) and succinylcholine three minutes later. The trachea was intubated one minute after thiopentone was given. The intubating conditions were then graded by a laryngoscopist who was unaware of the induction sequence. All patients were interviewed on the day after surgery. Intubation scores of patients in Group I were worse than in Groups II, III and IV (P < 0.005) but there were no differences between Groups II, III and IV. The technique was not associated with severe haemodynamic changes. All patients, except one were able to cough well after administration of atracurium, before induction of anaesthesia with thiopentone. Patients were generally satisfied with this method of induction. It is concluded that atracurium, when used according to the timing principle, can be an alternative to succinylcholine during rapid-sequence induction.

Topics: Adult; Anesthesia, Intravenous; Atracurium; Blood Pressure; Cough; Female; Fentanyl; Flushing; Heart Rate; Humans; Intubation, Intratracheal; Laryngoscopy; Male; Middle Aged; Patient Satisfaction; Succinylcholine; Thiopental; Time Factors

The response to insertion of the laryngeal mask airway (LMA) following either propofol 2.5 mg.kg-1 or thiopentone 5 mg.kg-1 was assessed in two groups of patients. The purpose of the study was to ascertain which of these two induction agents provided the better conditions for insertion of the LMA. Anaesthesia was induced by propofol in 35 patients and by thiopentone in 37. Following induction, ventilation was assisted for two minutes using 50% oxygen and nitrous oxide and 2% isoflurane, before insertion of the LMA. The presence of gagging, coughing, laryngospasm and movement was noted and graded. Thiopentone was associated with an adverse response in 76% of patients, compared with propofol in 26% (P < 0.01). Gagging, laryngospasm and head movement were more common using thiopentone (P < 0.01, P < 0.05 and P < 0.05 respectively) and in 11% (P < 0.05) of the thiopentone group insertion of the LMA was impossible due to inadequate relaxation. We conclude that, using these doses, propofol is superior to thiopentone as an induction agent for insertion of the laryngeal mask airway.

Topics: Adult; Anesthesia, Inhalation; Anesthesia, Intravenous; Cough; Extremities; Female; Gagging; Head; Humans; Isoflurane; Laryngeal Masks; Laryngismus; Larynx; Male; Movement; Muscle Relaxation; Nitrous Oxide; Propofol; Reflex; Thiopental

The authors compared tracheal intubating conditions using three techniques for rapid-sequence orotracheal intubation. Sixty patients were randomly assigned to one of three groups: priming with vecuronium (0.01 mg/kg priming dose, 4-min priming interval, 0.14-mg/kg intubating dose along with thiopental 4-6 mg iv); timing with vecuronium (0.15-mg/kg intubating dose given before thiopental and timed to weakness of hand grip); and succinylcholine (1.5 mg/kg). Blinded intubators graded intubating conditions 60 s after the induction of anesthesia with thiopental. Intubation scores in the succinylcholine group were significantly better than in the priming group (P = 0.009). Intubation scores of the succinylcholine and the timing groups were not significantly different. Use of the timing principle for rapid-sequence orotracheal intubation is a reliable alternative in cases where succinylcholine is contraindicated.

Topics: Abdomen; Adolescent; Adult; Aged; Cough; Electric Stimulation; Humans; Intubation, Intratracheal; Midazolam; Middle Aged; Muscles; Preanesthetic Medication; Random Allocation; Single-Blind Method; Succinylcholine; Thiopental; Time Factors; Vecuronium Bromide

Topics: Adolescent; Adult; Aged; Anesthesia, Inhalation; Anesthesia, Intravenous; Antitussive Agents; Atropine; Clinical Trials as Topic; Cough; Dextromoramide; Dose-Response Relationship, Drug; Double-Blind Method; Female; Fentanyl; Humans; Intubation, Intratracheal; Male; Meperidine; Middle Aged; Morphine; Nitrous Oxide; Pentazocine; Preanesthetic Medication; Respiration; Succinylcholine; Thiopental

To determine the success rate, safety and complications using a standard protocol and trained nurses to provide sedation for MRI under the supervision of a radiologist.. Nurses were trained to provide sedation via a standard protocol for pediatric patients undergoing diagnostic MRI. Oral chloral hydrate (80-100 mg x kg(-1)) was used for children less than 18 mo of age. Older children received either 1-6 mg x kg(-1) pentobarbital i.v., with or without 1-2 microg x kg x hr(-1) fentanyl, or 25 mg x kg(-1) thiopental pr. Sedation was defined as successful if it allowed completion of the MRI without image distorting patient movement. The records of 572 MRIs performed on 488 pediatric patients (mean age 5+/-4 yr; age 2 mo-14 yr) from 1991 to July 1995 were reviewed to determine the success rate and complications using the sedation program.. Most, 91.8% (525/572), of the MRIs were successfully completed in 445 patients. The reasons for failure were inadequate sedation (45, 95.7%) and coughing (2, 4.2%). The failure rate was much higher before 1994 (38/272, 14%) than after (9/300, 3%; P<0.0001). Failure was more common if rectal thiopental was used (23/172, 14%) than intravenous pentobarbital (19/256, 7.4%; P<0.05). The failure rate was also high in patients with a history of a behavioural disorder (10/59, 17%). There were no deaths or unexpected admissions as a result of the sedation program.. A high success rate can be achieved as experience is gained using a standard protocol and trained nurses to sedate children for MRI.

Topics: Administration, Rectal; Adolescent; Age Factors; Anesthesia, General; Anesthesiology; Anesthetics, Intravenous; Child; Child Behavior Disorders; Child, Preschool; Chloral Hydrate; Cough; Education, Nursing; Fentanyl; Humans; Hypnotics and Sedatives; Infant; Magnetic Resonance Imaging; Movement; Phenobarbital; Prognosis; Safety; Thiopental

Conditions for insertion of the laryngeal mask were assessed following induction of anaesthesia with either propofol 2.5 mg/kg or thiopentone 4.0 mg/kg in 80 patients premedicated with diazepam 10 mg. Insertion following induction with thiopentone resulted in a greater incidence of gagging (p less than 0.01). The use of additional induction agent, where necessary, resulted in no ultimate significant difference between the groups for the provision of satisfactory conditions.

Topics: Adult; Aged; Anesthesia, General; Cough; Female; Gagging; Humans; Intubation; Larynx; Male; Masks; Middle Aged; Propofol; Thiopental

Topics: Adolescent; Aging; Anesthesia, General; Child; Child, Preschool; Cough; Dose-Response Relationship, Drug; Humans; Infant; Infant, Newborn; Thiopental

Topics: Adolescent; Adult; Aged; Anesthesia; Cough; Diazepam; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Muscle Cramp; Succinylcholine; Thiopental