thiopental and Emergencies

Rapid sequence intubation is an essential bullet in the maintenance of patency of the airway during intubation in emergency. It is a valid method in all those situations where you can not determine whether the patient is fasting or not. But RSI is not applicable in all critically ill patients. The presence of severe acidosis, depletion of intravascular volume, heart failure and severe pulmonary disease may complicate the pre-induction period as the induction, leading to the onset of vasodilatation and hypotension. Another complication is represented by Hypoxemia during the manoeuvre. The algorithm of RSI consists in six steps: pre-oxygenation, premedication, myo-relaxation and induction, intubation, primary and secondary confirmation, post-intubation patient management. Propofol has replaced Thiopental as the most common intravenous ipnotic. In hypotensive patients Ketamine represents a viable alternative. Succinylcholine is the most common neuromuscular relaxant used in the RSI. The not depolarizing NMBAs are an alternative to Succinylcholine. Among these, the most important is the Rocuronium. This drug is characterized by a fairly rapid onset (1-2 min) and an intermediate half-life (45-70 min). The onset depends on the dosage used. The problem that limits the use of Rocuronium is the fact that its duration of action is much longer than that of Succinylcholine, especially when used at higher doses. This problem can be solved through the use of Sugammadex. As a muscle relaxant chelating Sugammadex antagonizes the effects induced by Rocuronium on muscle tissue and quickly resolve the blockade.

Topics: Algorithms; Androstanols; Anesthetics, Dissociative; Clinical Trials as Topic; Emergencies; gamma-Cyclodextrins; Humans; Hypnotics and Sedatives; Intubation, Intratracheal; Ketamine; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Premedication; Propofol; Rocuronium; Succinylcholine; Sugammadex; Thiopental

A number of clinical studies have reported poor clinical outcomes for patients treated with barbiturate therapy in acute neurological and neurosurgical emergencies. Barbiturate therapy, as currently practised with thiopentone and pentobarbitone at least, is also associated with a prolonged post-infusion period of clinical unresponsiveness. Hence, the popularity of barbiturate therapy for sedation of critically ill neurological and neurosurgical patients has declined over the past decade. A retrospective study of traumatic brain injury patients treated at the Royal North Shore Hospital, Sydney, with high-dose thiopentone therapy between 1987 and 1997 has found disappointing results with a 1-month mortality outcome of 50% (14 of 28 patients). Nevertheless, barbiturate therapy remains a consideration for patients with severe cranial trauma in whom preferred treatments have failed to control intracranial or cerebral perfusion pressures. More favourable results ( approximately 10% 1-month mortality rate) were encountered for patients with refractory vasospasm complicating subarachnoid haemorrhage or intracerebral haemorrhage complicating supratentorial arteriovenous malformation resection. A well designed, prospective and randomised controlled trial may be of value in further determining the role of barbiturate therapy in acute neurovascular emergencies refractory to standard therapy.

Topics: Barbiturates; Brain Injuries; Craniocerebral Trauma; Emergencies; Humans; Hypnotics and Sedatives; Intracranial Pressure; Neurosurgery; Randomized Controlled Trials as Topic; Retrospective Studies; Status Epilepticus; Thiopental; Treatment Outcome; Vasospasm, Intracranial

To evaluate a protocol for rapid sequence intubation (RSI) for pediatric patients in a Level 1 trauma center.. Retrospective review of prospectively gathered Continuing Quality Improvement (CQI) data at an inner city Level 1 trauma center with an emergency medicine residency program. Protocols for RSI were established prior to initiating the study. All pediatric intubations at the center from February 1996 to February 2000 were included. Statistical analysis included descriptive statistics for categorical data and Chi-square for comparisons between groups.. Over the 4-year study period there were 83 pediatric intubations ranging in age from 18 months to 17 years; mean age 8.6. All had data collected at the time of intubation. There were 20 (24%) females and 62 (76%) males (p<0.001). Reasons for intubation were related to trauma in 71 (86%) and medical reasons in 12 (14%) (p<0.001). Of the trauma intubations 7 (10%) were for gunshot wounds, 39 (55%) were secondary to MVCs, and the remainder (25; 35%) were from assaults, falls, and closed head injuries. The non-trauma intubations were for smoke inhalation, overdose, seizure, HIV related complications, eclampsia, and near drowning. Intubations were successful with one attempt in 65 (78%) cases. No surgical airways were necessary. Rocuronium was used in 4 cases. Protocol deviations did not lead to complications.. This protocol based pediatric rapid sequence intubation method worked well in an EM residency program. More intubations were in males and more were necessary due to trauma in this group.

Topics: Adolescent; Androstanols; Atropine; Child; Child, Preschool; Clinical Protocols; Diagnosis-Related Groups; Drug Administration Schedule; Emergencies; Emergency Treatment; Etomidate; Female; Forms and Records Control; Humans; Hypnotics and Sedatives; Infant; Intubation, Intratracheal; Lidocaine; Louisiana; Male; Medical Records; Neuromuscular Nondepolarizing Agents; Retrospective Studies; Rocuronium; Succinylcholine; Thiopental; Trauma Centers

The practice of emergency medicine is a constant onslaught of decision making and challenges and the issues of airway management are no exception. Obtaining proper airway control requires thoughtful organization and planning, and necessitates a thorough working knowledge of the drugs or medications employed. Because there are so many agents available, expertise in airway pharmacology has become essential. The emergency physician who is well versed in the uses, and the physiologic effects, contraindications, and alternatives of drugs administered is both providing immediate intervention and positively affecting patient outcome, which is certainly a goal worth achieving.

Topics: Adrenergic beta-Antagonists; Algorithms; Androstanols; Anesthetics, Local; Anti-Arrhythmia Agents; Emergencies; Emergency Medicine; Etomidate; Humans; Hypnotics and Sedatives; Intubation, Intratracheal; Isoquinolines; Ketamine; Lidocaine; Mivacurium; Narcotics; Neuromuscular Blocking Agents; Propofol; Rocuronium; Succinylcholine; Thiopental

Emergency intubations are done for a variety of reasons in the emergency department (ED). In some patients, a rapid, controlled induction of anesthesia is useful to facilitate intubation and to reduce the complications of intubation. This is referred to a rapid sequence induction (RSI) in the anesthesia literature. Atropine, thiopental, fentanyl, diazepam, ketamine, vecuronium, succinylcholine, other drugs and their applications for RSI are described. The purpose of this article is to describe the use of RSI in the airway management of ED patients. Nineteen pediatric patients requiring emergency intubation were intubated using RSI with vecuronium and thiopental. Actual intubation difficulty using RSI was significantly less than the anticipated intubation difficulty without RSI. There were no complications caused by intubation or RSI that had a significant impact on patient outcome. We feel that a sedative in combination with vecuronium represents the most optimal means of achieving RSI in the ED setting. Although the induction of general anesthesia is best done by anesthesiologists, emergency physicians are often the most experienced physicians immediately available to manage an airway in a critical emergency. An objective protocol such as that described will make it easier for emergency physicians to perform this procedure when needed.

Topics: Adolescent; Adult; Anesthesia, Intravenous; Atropine; Child; Child, Preschool; Clinical Protocols; Emergencies; Humans; Infant; Intubation, Intratracheal; Oxygen Inhalation Therapy; Thiopental; Vecuronium Bromide

Acute fetal distress requires that the anesthesiologist use his skills and knowledge to achieve a safe anesthetic effect for both mother and infant. Techniques should be individualized in a manner dictated by the situation, and those techniques that least affect the fetus and maternal-fetal interrelationships should be employed. The anesthesiologist must be able to apply regional or general techniques with equal facility and to select agents of the least toxicity and threat to the maternal-fetal relationship. The possibility of perinatal asphyxia is remote when the induction and maintenance of anesthesia are carried out efficiently and carefully. For a fetus that is already stressed, however, injudiciously managed anesthesia can be a serious problem. Finally, because the anesthesiologist administered the anesthetic, he must also be prepared to effectively institute immediate neonatal resuscitative measures in the first five to ten minutes of extrauterine life.

Topics: Abruptio Placentae; Adrenergic beta-Agonists; Anesthesia, Endotracheal; Anesthesia, Epidural; Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthesia, Obstetrical; Anesthesia, Spinal; Emergencies; Female; Fetal Diseases; Humans; Ketamine; Nitrous Oxide; Obstetric Labor Complications; Placenta Previa; Pregnancy; Prolapse; Thiopental; Umbilical Cord

The pharmacologic effects of ketamine, midazolam, and a midazolam-ketamine combination were compared with thiopental for rapid induction of general anesthesia. Thiopental, 4 mg/kg, 1.5 mg/kg ketamine, 0.3 mg/kg midazolam, or 0.15 mg/kg midazolam, and 0.75 mg/kg ketamine, were administered intravenously in a randomized fashion to 80 patients undergoing emergency surgery. Adequacy of induction, hemodynamic changes, and postoperative effects were assessed during and after a standardized induction-maintenance anesthetic technique. Midazolam had the slowest onset (15-60 s) and longest duration of action. During induction, thiopental decreased mean arterial pressure (MAP) by 11%, ketamine increased MAP by 10%, while neither midazolam nor the midazolam-ketamine combination significantly changed MAP. Heart rate (HR) increased during induction in all groups; however, the increase was significantly less in the combination group. After intubation, MAP and HR increased to the same extent in all four groups. Significantly more patients who received ketamine for induction were disoriented during emergence. Midazolam most effectively produced anxiolysis and antegrade amnesia. Significantly more patients who received thiopental felt depressed postoperatively, and 95% required parenteral opiate analgesics in the recovery room. Dreaming was highest after ketamine (55%) and lowest after midazolam (0%) and the combination (5%). Thus, midazolam effectively attenuated both the cardiostimulatory responses and unpleasant emergence reactions associated with ketamine. The author concludes that both midazolam and the midazolam-ketamine combination are safe and effective induction agents for emergency surgery, which may offer an advantage over thiopental in situations where hemodynamic stability is crucial. Furthermore, midazolam effectively attenuates the side effects of ketamine.

Topics: Adult; Anesthetics; Benzodiazepines; Double-Blind Method; Emergencies; Female; Hemodynamics; Humans; Infusions, Parenteral; Ketamine; Male; Memory; Midazolam; Postoperative Complications; Random Allocation; Thiopental

The aim of this study is to establish the initial safety of triple neuroprotection (TNP) in an acute stroke setting in patients presenting outside the window for systemic tissue plasminogen activator (tPA).. Over 12,000 patients were referred to our vascular services with carotid artery disease, of whom 832 had carotid intervention with a stroke rate of 0.72%. Of these, 25 patients presented (3%), between March 2015 and 2019, with acute dense stroke. These patients had either failed tPA or passed the recommended timing for acute stroke intervention. Fifteen (60%) had hemi-neglect with evidence of acute infarct on magnetic resonance imaging of the brain and a Rankin score of 4 or 5. Ninety-six percent had an 80-99% stenosis on the symptomatic side. Mean ABCD3-I score was 11.35. All patients underwent emergency carotid endarterectomy (CEA) with therapeutically induced hypothermia (32-34°C), targeted hypertension (systolic blood pressure 180-200 mm Hg), and brain suppression with barbiturate.. There were no cases of myocardial infarction, death, cranial nerve injury, wound hematoma, or procedural bleeding. Mean hospital stay was 8.4 (±9.5) days. All cases had resolution of neurological symptoms, except 3 who had failed previous thrombolysis. Eighty percent had a postoperative Rankin score of 0 on discharge and 88% of patients were discharged home with 3 requiring rehabilitation.. Positive neurological outcomes and no serious adverse events were observed using TNP during emergency CEA in patients with acute brain injury. We recommend TNP for patients who are at an increased risk of stroke perioperatively, or who have already suffered from an acute stroke beyond the recommended window of 24 hr. Certainly, the positive outcomes are not likely reproducible outside of high-volume units and patients requiring this surgery should be transferred to experienced surgeons in appropriate tertiary referral centers.

Topics: Aged; Aged, 80 and over; Carotid Stenosis; Databases, Factual; Emergencies; Endarterectomy, Carotid; Female; Humans; Hypertension; Hypothermia, Induced; Infusions, Intravenous; Length of Stay; Male; Middle Aged; Neuroprotective Agents; Pilot Projects; Retrospective Studies; Risk Factors; Stroke; Thiopental; Time Factors; Time-to-Treatment; Treatment Outcome

In 2011, the company that produced thiopental in France and in the United States stopped its marketing. Because of limited evidences, the choice of the best induction agent for caesarean section remains controversial, especially in emergency. The objective of this study was to compare the effects of propofol versus thiopental on the Apgar score of the newborn.. Newborns delivered by elective or emergency caesarean section under general anaesthesia in a university hospital were included from January 2009 to December 2013. Two periods, according to the hypnotic drug used, were compared in this before-and-after comparative study: thiopental before May 2011 and propofol after. The primary outcome was to compare the proportion of newborns with a 5-minute Apgar Score < 7 between both groups.. 367 newborns were enrolled, 178 in thiopental group and 189 in propofol group. Demographic and clinical characteristics were similar in both groups. The occurrence of a 5-minute Apgar Score less than 7 was not influenced by the use of propofol (OR 1.40 [CI 95% 0.90-2.20] P = 0.135). Blood gas analyses and admission's rate in neonatal intensive care unit were similar in both groups.. Thiopental and propofol do not appear to present significant difference in term of outcome of the newborn after caesarean section. In this situation, propofol may probably be a reliable alternative to the supply reduction of thiopental imposed by forces. Prospective studies are required to confirm the safety of propofol, particularly in the long term.

Topics: Adult; Anesthesia, General; Anesthesia, Obstetrical; Apgar Score; Cesarean Section; Elective Surgical Procedures; Emergencies; Female; Fetus; France; Hospitals, University; Humans; Infant, Newborn; Placenta; Pregnancy; Pregnancy Outcome; Propofol; Prospective Studies; Rapid Sequence Induction and Intubation; Thiopental; Young Adult

We report the anaesthetic management of a term pregnant woman with active tuberculous meningitis, who had experienced seizures, had signs of raised intracranial pressure and required emergency caesarean section. Peripartum anaesthetic management of a patient with tuberculous meningitis is a rare event.

Topics: Adult; Androstanols; Anesthesia, Obstetrical; Anesthetics, Inhalation; Anesthetics, Intravenous; Anticonvulsants; Antihypertensive Agents; Cesarean Section; Emergencies; Female; Fentanyl; Humans; Intracranial Hypertension; Isoflurane; Labetalol; Midazolam; Neuromuscular Nondepolarizing Agents; Phenytoin; Pregnancy; Pregnancy Complications, Infectious; Rocuronium; Seizures; Thiopental; Tuberculosis, Meningeal

Etomidate is often used to induce anaesthesia in sick patients owing to its relative cardiovascular stability. However, etomidate affects adrenal cortical activity, and there is concern that this could impair outcome in patients undergoing emergency surgery.. We retrospectively analysed data from 176 patients admitted to an ICU after emergency laparotomy. We retrieved ASA status, surgical diagnosis, induction drug use, blood pressure before and after induction and any vasopressor administration, steroid and vasopressor therapy in ICU and patient outcome. Choice of induction drug was at the discretion of the attending anaesthetist.. The drugs (numbers of patients) used to induce anaesthesia were etomidate (52), thiopental (90), propofol (16), midazolam (12) and ketamine (4). Fifty-two patients (30%) died in hospital. ASA status was the only independent predictor of hospital outcome (P < 0.001). Choice of induction drug was related to ASA status. As ASA status worsened, the likelihood of using etomidate or midazolam/ketamine increased (P = 0.001). We found no association between etomidate and dying in hospital, though our study might not have had sufficient power to show a difference between induction drugs. The relative risks [95% confidence interval (CI)] of dying in hospital were etomidate 1.16 (0.72-1.87), thiopental 0.82 (0.52-1.30), propofol 0.40 (0.11-1.49) and midazolam/ketamine 1.84 (1.09-3.12). Vasopressor and steroid therapy in the ICU was not related to induction drug. The risk of developing hypotension at induction or of receiving vasopressor to treat hypotension was least with etomidate.. We found no evidence that etomidate is associated with worse outcome than thiopental or propofol in patients undergoing emergency laparotomy, but we cannot be certain that etomidate is well tolerated in this group of patients. More data are required to address this issue definitively.

Topics: Aged; Anesthetics, Dissociative; Anesthetics, Intravenous; Emergencies; Etomidate; Female; Hospital Mortality; Humans; Intensive Care Units; Ketamine; Laparotomy; Male; Midazolam; Middle Aged; Propofol; Retrospective Studies; Risk Factors; Severity of Illness Index; Thiopental; Treatment Outcome

A questionnaire survey examining rapid sequence induction techniques was sent to all anaesthetists in Wales. The questionnaire presented five common clinical scenarios: emergency appendicectomy; elective knee arthroscopy with a symptomatic hiatus hernia; elective knee arthroscopy with an asymptomatic hiatus hernia; elective Caesarean section; and emergency laparotomy for bowel obstruction. Completed surveys were received from 421 anaesthetists, a 68% response rate. Rapid sequence induction was chosen by 398/400 respondents (100%) for bowel obstruction, 392/399 (98%) for Caesarean section, 388/408 (95%) for appendicectomy, 328/395 (83%) for symptomatic hiatus hernia but only 98/399 (25%) for asymptomatic hiatus hernia (p < 0.001). Trainees were more likely to use a rapid sequence induction technique than consultants and staff grades for the appendicectomy (p = 0.025), symptomatic hiatus hernia (p = 0.004) and asymptomatic hiatus hernia (p = 0.001) scenarios and were also more likely to use a thiopental-suxamethonium combination for rapid sequence induction (p < 0.001).

Topics: Adult; Aged, 80 and over; Anesthesia, General; Anesthesia, Obstetrical; Appendectomy; Cesarean Section; Emergencies; Female; Health Care Surveys; Hernia, Hiatal; Humans; Hypnotics and Sedatives; Intestinal Obstruction; Intubation, Intratracheal; Male; Neuromuscular Blockade; Pneumonia, Aspiration; Pregnancy; Professional Practice; Thiopental; Wales

Topics: Anesthetics, Intravenous; Emergencies; Humans; Intubation, Intratracheal; Professional Practice; Propofol; Thiopental

Serial serum thiopentone concentrations were measured during and following completion of an intravenous infusion of thiopentone in 20 patients with neurosurgical emergencies. The concentration data from a further 55 patients who had had some such measurements were reviewed retrospectively. The patients received an infusion for longer than 24 hours at a rate adjusted to maintain EEG burst suppression. The data were interpreted in terms of thiopentone pharmacokinetics and used to produce statistical models relating to clinical outcomes. In these patients, the one-month mortality rate following commencement of thiopentone treatment was 20%; the mean durations of pupillary and motor unresponsiveness following cessation of an infusion were 22 and 91 hours, respectively. Predictors of a prolonged duration of motor unresponsiveness included a prolonged duration of pupillary unresponsiveness, a low thiopentone clearance and a high maximum serum concentration of thiopentone. From pooled logistic regression, median effective serum thiopentone concentrations (EC50) were found to be 50 mg x l(-1) for recovery of pupillary responsiveness and 12 mg x l(-1) for the recovery of motor responsiveness. Because prolonged high-dose thiopentone leads to prolonged residual serum concentrations, it is difficult to distinguish the residual pharmacological effects of thiopentone from the clinical condition. This study suggests that, based on EC50 values for responses, monitoring of post-infusion serum thiopentone concentrations may help determine whether a patient's clinical state is due to residual thiopentone pharmacological effects.

Topics: Adult; Brain Injuries; Cerebrovascular Disorders; Chromatography, High Pressure Liquid; Drug Monitoring; Electroencephalography; Emergencies; Female; Humans; Hypnotics and Sedatives; Infusions, Intravenous; Intracranial Hypertension; Intracranial Pressure; Logistic Models; Male; Middle Aged; Muscle Contraction; Neuroprotective Agents; Prospective Studies; Reflex, Pupillary; Retrospective Studies; Thiopental

Topics: Adult; Anesthesia, Inhalation; Anesthesia, Obstetrical; Cesarean Section; Emergencies; Female; Fetal Distress; Humans; Infant, Newborn; Pneumonia, Aspiration; Postoperative Complications; Pregnancy; Risk Factors; Thiopental

Topics: Anesthesia, General; Anesthesia, Obstetrical; Cesarean Section; Emergencies; Female; Humans; Pregnancy; Research Design; Risk Factors; Thiopental; Vecuronium Bromide

Induction of general anaesthesia for emergency caesarean section has always been hazardous. Acid aspiration syndrome and adverse reactions to suxamethonium are well recognised problems, in spite of which "crash" induction using thiopentone and suxamethonium remains a common induction technique. Recent case reports suggest that the use of medium duration nondepolarising relaxants in place of suxamethonium achieves satisfactory intubating conditions in the emergency caesarean section patient. This study was undertaken to investigate the following aspects of rapid-sequence vecuronium-thiopentone induction for emergency caesarean section. 1. To establish whether 8 mg of vecuronium provides effective intubating conditions. 2. To establish whether placental transfer of vecuronium used in the above dosage has any clinically detectable effect upon the newborn. 3. To establish the limit of lead time by which vecuronium may precede thiopentone to minimise the dangerous period between loss of consciousness and intubation. 4. To detect instances of acid regurgitation or aspiration. 5. To confirm that relaxant reversal is clinically effective at the completion of surgery. In this series of thirty cases, vecuronium 8 mg preceding thiopentone 250 mg and atropine 0.6 mg by 20 seconds provided effective induction and easy intubating conditions without clinical effects on the newborn, maternal acid aspiration, or clinical signs of persistent paralysis after reversal.

Topics: Anesthesia, General; Anesthesia, Obstetrical; Cesarean Section; Emergencies; Female; Humans; Pregnancy; Prospective Studies; Thiopental; Vecuronium Bromide

This review documents the anaesthetic management, haemodynamic function and outcome in 18 of 86 heart-transplanted recipients, who returned for 32 non-cardiac surgical procedures at the Toronto Hospital from 1985 to 1990. General anaesthesia was administered in eight of the 27 elective operations and four of the five emergency operations. Induction medications included thiopentone (2-4 mg.kg-1), fentanyl (1-7 micrograms.kg-1) and succinylcholine (1-1.5 mg.kg-1). Anaesthesia was maintained with a combination of oxygen/nitrous oxide and isoflurane or enflurane. Muscle relaxation was maintained with vecuronium or pancuronium. No delayed awakening or unplanned postoperative ventilation was observed. Neurolept-anaesthesia was administered to 63.0% and 20.0% of the elective and emergency operations, respectively. The anaesthetics included fentanyl (25-100 micrograms) and midazolam (0.5-1.5 mg) or diazemuls (2.5-5.0 mg). Spinal anaesthesia (75 mg lidocaine) was administered to only two of the 27 elective operations. No important haemodynamic changes were observed in any anaesthetic group, but lower systolic BP was found after induction and during maintenance periods in the patients who received general anaesthesia than in those who received neurolept-anaesthesia. However, no anaesthesia-related morbidity or mortality was noted. This suggests that general, neurolept- and spinal anaesthesia do not affect haemodynamic function or postoperative outcome in heart-transplanted recipients undergoing subsequent non-cardiac surgery.

Topics: Adult; Anesthesia, General; Anesthesia, Inhalation; Anesthesia, Intravenous; Blood Pressure; Diazepam; Elective Surgical Procedures; Emergencies; Female; Fentanyl; Heart Rate; Heart Transplantation; Humans; Isoflurane; Male; Midazolam; Middle Aged; Neuroleptanalgesia; Nitrous Oxide; Ontario; Oxygen Consumption; Surgical Procedures, Operative; Thiopental; Treatment Outcome

Most patients who require emergency airway control receive drugs to induce rapidly sufficient anesthesia for direct laryngoscopy and endotracheal intubation, but there are no protocols that outline the use of specific drugs in general use. Drugs should safely and rapidly produce (1) unconsciousness; (2) paralysis; and (3) blunt intracranial pressure (ICP) responses to airway procedures. Consequences to be considered include increased ICP, hemorrhagic shock, and a full stomach. To refine the use of drugs used for airway procedures in pediatric trauma patients, the authors reviewed all cases of emergency endotracheal intubation over a recent 12-month period (1) to see whether medications used met the goals of producing unconsciousness and paralysis and blunting ICP responses were met safely; and (2) to identify potential drug-related complications. From July 1, 1990, to June 30, 1991, 60 of 791 children (7.6%) required endotracheal intubation at the scene of injury, at the referring hospital, or in our emergency department (15; 25%). Ten patients died (16.7%). Three fourths were younger than 9 years of age. All except one suffered blunt injuries. Nearly all (95%) suffered head injuries, isolated in 39 of 57 (68.4%) and combined with injuries in other regions in 18 (31.6%). Fifteen patients were in apnea (25%); seven were both apneic and pulseless. Three fourths (45 of 60) had diminished levels of consciousness; one fourth (15 of 60) were awake. Immediate endotracheal intubation proceeded appropriately without drugs in all seven patients in cardiopulmonary arrest. Only eight of the remaining 53 patients (15.1%) received an optimal medication regimen. Many patients with head injury were inadequately protected against increases in ICP. Thiopental, an effective anesthetic agent that effectively lowers intracranial pressure, was not used in 25 of 35 stable patients with isolated head injury (71.4%). Intravenous lidocaine was not used in 38 of 50 head-injured patients in whom it would have been an appropriate adjunct to control increases in ICP (76%). Eight patients received paralyzing agents alone, without sedatives or narcotics. Medications were thought inadequate to relieve the pain and discomfort of laryngoscopy and endotracheal intubation in 32 of the 53 patients who should have received them (60.4%). No paralyzing agents were used in 36 of the 53 instances where it would have been appropriate (67.9%). In two of 11 instances (18.3%) where succinylcholine was

Topics: Adjuvants, Anesthesia; Adolescent; Anesthesia; Child; Child, Preschool; Clinical Protocols; Diazepam; Emergencies; Humans; Intubation, Intratracheal; Laryngoscopy; Lidocaine; Narcotics; Neuromuscular Nondepolarizing Agents; Succinylcholine; Thiopental; Wounds and Injuries

Serum potassium and sodium changes following suxamethonium (1.5 mg/kg) administration were studied in 25 patients with septic peritonitis and 25 with no signs of peritonitis. A highly significant rise (P less than 0.001) in serum potassium (0.1-2.5 mEq/l) above the pre-induction levels was observed following suxamethonium administration in patients with septic peritonitis with maximum rise at 5 min following suxamethonium. This rise in potassium was significantly higher (P less than 0.001) in peritonitis patients at 3,5, and 10 min interval. A positive correlation was found between rise of potassium and duration of illness (P less than 0.01). No statistically significant changes were observed in serum sodium levels in both groups.

Topics: Adolescent; Adult; Anesthesia, Intravenous; Emergencies; Female; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Peritonitis; Potassium; Succinylcholine; Thiopental

Topics: Anesthesia, Obstetrical; Drug Stability; Drug Storage; Emergencies; Female; Humans; Pregnancy; Solutions; Thiopental

Narcosis applied in emergency care is a possibility of offering pain relief to the emergency patient. Over and above this, however, it has become increasingly important to prevent pathophysiological changes resulting from the state of shock of the patient. Nevertheless, this measure should be restricted to skilled personnel only, provided of course that the emergency service in question is adequately equipped both technically and with suitable drugs. A decisive role is played by the drugs selected for this purpose. The article describes the pros and cons of various drugs administered via the intravenous route to induce narcosis. So far, there is no ideal drug for this purpose. It will always be necessary to arrive at a compromise and to adapt the drug to the individual situation and to the extent of basic damage suffered by the emergency patient.

Topics: Analgesia; Anesthesia, General; Carbon Dioxide; Diazepam; Emergencies; Etomidate; First Aid; Hemodynamics; Humans; Intracranial Pressure; Ketamine; Methohexital; Oxygen; Risk; Thiopental; Wounds and Injuries

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

Topics: Adenoidectomy; Adolescent; Anesthesia; Anesthetics; Emergencies; Female; Humans; Infectious Mononucleosis; Intubation, Intratracheal; Nitrous Oxide; Oxygen; Succinylcholine; Thiopental; Tonsillectomy

Topics: Acidosis; Aged; Anesthesia, General; Cholangitis; Cholecystectomy; Cholecystitis; Coma; Emergencies; Female; Humans; Hyperglycemia; Infusions, Parenteral; Insulin; Nitrous Oxide; Osmolar Concentration; Thiopental

Topics: Anesthesia, Intravenous; Anesthesia, Obstetrical; Apgar Score; Cesarean Section; Color; Emergencies; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intubation, Intratracheal; Labor, Obstetric; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Pregnancy; Propanidid; Thiopental

Topics: Anesthesia, Intravenous; Emergencies; Humans; Intubation, Intratracheal; Methods; Oxygen Inhalation Therapy; Succinylcholine; Surgical Procedures, Operative; Thiopental; Vomiting

Topics: Anesthesia, General; Atropine; Blood Pressure; Bronchitis; Cyclopropanes; Duodenal Ulcer; Emergencies; Heart Failure; Hepatomegaly; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Preanesthetic Medication; Pulmonary Emphysema; Pulmonary Heart Disease; Respiratory Tract Infections; Thiopental; Tracheotomy

Topics: Blood Circulation; Emergencies; Heart; Hyperbaric Oxygenation; Hypoxia, Brain; Oximetry; Oxygen; Physiology; Respiration; Seizures; Shock; Thiopental; Toxicology

Topics: Anesthesia; Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthesiology; Atropine; Child; Cyclopropanes; Emergencies; Gallamine Triethiodide; Humans; Infant; Infant, Newborn; Pediatrics; Preanesthetic Medication; Thiopental