thiopental and Epilepsies--Partial

To justify the use of ondansetron as a preventive treatment for postoperative nausea and vomiting (PONV) of adults and children in neurosurgery.. Meta-analysis.. Six published, randomized, double-blinded, placebo-controlled trials were selected to study the efficacy of ondansetron on PONV in adults undergoing craniotomy. Similarly, three studies were selected in children. The treated adults received 4 or 8 mg of ondansetron during the peroperative period. As for children, they were given a repeated dose of 0.15 mg/kg of ondansetron. The emetic episodes noted for 24 hours in children and until 48 hours in adults were analyzed. The results were presented as relative risks (RR) following a fixed model and a 95% confidence interval (CI). The test for heterogeneity was measured with the I(2) Altman DG test.. At 24 hours, among the 308 adults tested, nausea and vomiting were significantly reduced by 22% and 57%, respectively; no significant reduction in vomiting was noted for the 149 children patients. At 48 hours, no significant modification was observed in adults.. Peroperative intravenous dose of ondansetron 4 mg in neurosurgery in adults is required to prevent PONV during the first postoperative 24 hours. However, further studies are needed to determine best time and dose infusion to prolong clinical efficacy.

Topics: Adult; Age Factors; Anesthetics, Intravenous; Antiemetics; Brain Neoplasms; Child; Craniotomy; Dose-Response Relationship, Drug; Double-Blind Method; Epilepsies, Partial; Head; Humans; Ondansetron; Postoperative Nausea and Vomiting; Prospective Studies; Randomized Controlled Trials as Topic; Risk; Thiopental; Time Factors

Topics: Amobarbital; Bemegride; Cerebral Cortex; Electric Stimulation; Electrodes; Electrodes, Implanted; Electroencephalography; Epilepsies, Partial; Epilepsy; Epilepsy, Temporal Lobe; Humans; Methohexital; Neurosurgery; Pentylenetetrazole; Photic Stimulation; Respiration; Sleep; Thiopental

We report on three acute encephalitis patients with refractory, repetitive partial seizures (AERRPS). All three suffered acute febrile episodes associated with status epilepticus, which necessitated high-dose barbiturate therapy under artificial ventilation for several weeks. Electroencephalography (EEG) revealed a predominance of diffuse epileptiform discharges initially, subsequently developing into periodic bursts of these discharges. Reduction of the barbiturate dosage resulted in clinical and subclinical partial seizures appearing repetitively in clusters. Prolonged fever persisted for 2-3 months, even several weeks after normalization of cell counts in the cerebrospinal fluid. The EEG showed an improvement after resolution of this fever, and seizures became less frequent, although still intractable. Oral administration of high-dose barbiturate and benzodiazepines were partially effective during the acute phase, and a barbiturate dependency, lasting for years, was noted in one patient. Steroid administration was effective in stopping the febrile episodes in one patient, with concurrent improvement in seizure control. Magnetic resonance imaging showed enhancement of bitemporal cortical areas in one patient, and high signal intensity on T2 weighted image in the bilateral claustrum in another patient. Diffuse cortical atrophy appeared within two months after the onset of encephalitis in all patients. The evolution of the seizures and EEG findings suggested a high degree of cortical excitability in AERRPS. In this report, we propose a tentative therapeutic regimen for seizure control in this condition. We also hypothesize that a prolonged inflammatory process exists in the cerebral cortex with AERRPS, and may be pivotal in the epileptogenesis.

Topics: Acute Disease; Anti-Inflammatory Agents; Anticonvulsants; Brain; Cell Count; Cerebrospinal Fluid; Child; Delirium; Drug Resistance; Electroencephalography; Encephalitis; Epilepsies, Partial; Female; Fever; Humans; Magnetic Resonance Imaging; Male; Midazolam; Pneumonia; Status Epilepticus; Thiopental; Tomography, X-Ray Computed; Treatment Outcome; Unconsciousness

The present study was performed in order to compare: 1) the differences between oral and intravenous barbiturate on interictal epileptiform activity (sharp-waves and spikes) in the EEG, and 2) interictal epileptiform activity in the sphenoidal electrode compared to the temporal and zygomatic electrodes (an electrode placed at the cutaneous entry of the sphenoidal electrode) during intravenous barbiturate administration in patients with epilepsy. Two procedures were performed: 1) an oral pentobarbital sleep induction with 10-20 electrode placement including a zygomatic electrode, and 2) an intravenous thiopental sleep induction with the same electrode placement including a sphenoidal electrode. Thirty eight patients with complex partial seizures were included. During the oral pentobarbital procedure 34 of 38 (90%) patients showed interictal epileptiform activity compared with 22 of 38 (55%) patients during the intravenous thiopental procedure (p < 0.005). A interictal epileptiform focus was observed in 33 (87%) patients in the oral procedure and in 19 (50%) patients in the intravenous procedure (p < 0.01). Interictal epileptiform activity recorded in the sphenoidal electrode was also recorded in the zygomatic electrode. Except from two patients a good correlation was observed between the zygomatic electrodes and the F7/F8 electrodes. We conclude that administration of intravenous thiopental offers no advantage compared to the administration of oral pentobarbital as an activating procedure, and for standard interictal EEG recordings with sleep activation procedures, suitable places scalp electrodes including a zygomatic electrode with the use of oral pentobarbital may be sufficient.

Topics: Administration, Oral; Adolescent; Adult; Brain; Electrodes; Electroencephalography; Epilepsies, Partial; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pentobarbital; Thiopental

Frequent epileptic seizures in children are often related to delayed psychomotor development, and status epilepticus is always a neurological emergency. In both situations barbiturate anaesthesia has been used for status epilepticus since the 1960s, and for intractable seizures in children since the 1980s. However, the clinical results on the effectiveness of barbiturate anaesthesia in children with chronic epileptic disorders remain contradictory. Between 1986 and 1991 in Tampere University Hospital in Finland long barbiturate anaesthesia was introduced--using thiopentone sodium--to eight children with very severe epilepsy. Children were 10 months to 7 years 11 months of age and the mean time from the onset of seizures to the introduction of BA was 2 years 8 months. Effects upon seizure frequency, antiepileptic medication and/or psychomotor development were clearly positive in three patients, slightly positive in one patient and in four patients there was no effect. Good effect seemed to be associated with an anaesthesia which is deep and long enough to produce loss of consciousness and spontaneous reactions, and an electroencephalographic pattern of burst-suppression. Positive results were also more often achieved when the treatment lag was less than 12 months. Physical and neurophysiological properties of barbiturates make their effectiveness as anticonvulsants understandable, but there is only little evidence to explain the mechanism of this action.

Topics: Anesthesia, General; Anticonvulsants; Child; Child, Preschool; Drug Therapy, Combination; Epilepsies, Myoclonic; Epilepsies, Partial; Epilepsy; Female; Humans; Infant; Male; Phenobarbital; Polysomnography; Spasms, Infantile; Status Epilepticus; Thiopental

Topics: Anesthesia, General; Anesthetics; Brain; Electroencephalography; Epilepsies, Partial; Halothane; Humans; Nitrous Oxide; Thiopental