thiopental and Cross-Infection

Clinical strategy to maximize effectiveness and to minimize adverse influences remains to be determined for mild hypothermia therapy for traumatic brain injury. This study was conducted to evaluate the clinical feasibility of the titration method of mild hypothermia in severely head-injured patients in whom a reduction in intracranial pressure was regarded as the target effect.. Nine consecutive patients with severe head injury were studied. Patient age ranged between 18 and 66 years, Glasgow Coma Scale scores were equal to or less than 8, and intracranial pressures were equal to or greater than 20 mm Hg despite removal of intracranial hematoma and drugs, including glycerol and thiopental. During a maximum of 6 days of hypothermia therapy, jugular venous blood or cerebrospinal fluid temperature was titrated to reduce intracranial pressure to less than 20 mm Hg by means of repeated intragastric cooling with our nasoduodenal tube and surface cooling. The feasibility and the effects on systemic complications of this titration method of mild hypothermia were evaluated.. Intracranial pressure variably decreased from before to 3 hours after the beginning of all procedures of cooling. The mean intracranial pressure significantly decreased from 24 to 15 mm Hg with cooling, while temperature reduced an average of 2.0 degrees C. Four patients had systemic infection complications. Increased C-reactive protein and decreased platelet count were observed in all patients during hypothermia. The incidence of good recovery and moderate disability according to the Glasgow Outcome Scale was seven of nine patients.. The titration method of mild hypothermia to control intracranial hypertension in severely head-injured patients is clinically feasible. However, the method failed to reduce the incidence of infectious and hematological complications.

Topics: Adolescent; Adult; Aged; Brain Damage, Chronic; Brain Injuries; Combined Modality Therapy; Cross Infection; Cryotherapy; Dobutamine; Dopamine; Feasibility Studies; Female; Glasgow Coma Scale; Glycerol; Humans; Hypothermia, Induced; Intracranial Hypertension; Intubation, Gastrointestinal; Male; Middle Aged; Thiopental; Thrombocytopenia; Treatment Outcome

Specific aseptic precautions have been recommended for preventing infectious complications of propofol because its lipid base can support bacterial growth if contaminated. To study whether the precautions used at our institution prevent propofol-related infections, we retrospectively analysed the data covering 1 January, 1995 until 30 June, 1996 held in our quality-assurance database. The database contains prospectively collected, detailed and standardized information of each patient's risk factors, anaesthetic and surgical data, and postoperative outcome. Surgical patients who had received propofol for anaesthesia did not have a higher incidence of postoperative infection, thus demonstrating the efficacy of our aseptic precautions.

Topics: Adult; Anesthesia, General; Anesthetics, Intravenous; Bacterial Infections; Cross Infection; Drug Contamination; Female; Humans; Incidence; Infection Control; Male; Middle Aged; Postoperative Complications; Propofol; Quality Assurance, Health Care; Retrospective Studies; Risk Factors; Thiopental

Topics: Anesthesia; Anesthetics; Anti-Bacterial Agents; Cresols; Cross Infection; Decamethonium Compounds; Escherichia coli; Halothane; Lidocaine; Methoxyflurane; Parabens; Pharmacology; Postoperative Complications; Pseudomonas aeruginosa; Research; Staphylococcus; Succinylcholine; Thiopental