thiopental and Fever

Topics: Anemia, Sickle Cell; Anesthetics; Animals; Barbiturates; Cholinesterases; Fever; Genetics, Medical; Humans; Huntington Disease; Hyperkalemia; Metabolism, Inborn Errors; Muscular Dystrophies; Myotonia Congenita; Pharmacogenetics; Porphyrias; Succinylcholine; Swine; 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

Topics: Acidosis; Adult; Anesthetics, Intravenous; Coma; Conscious Sedation; Critical Care; Fatal Outcome; Female; Fever; Humans; Hyperkalemia; Infusions, Intravenous; Male; Propofol; Rare Diseases; Syndrome; Thiopental; Time Factors

This retrospective study includes 139 infants (74 girls and 65 boys) treated for status epilepticus at two University hospitals in Tunisia between 1990 and 1997. Their mean age was 11 months. The majority of seizures were generalized (74%) and lasted between 30 minutes and 1 hour (70%). The cause of status epilepticus was classified as acute symptomatic in 56, febrile in 57, remote symptomatic in nine, progressive neurologic in 10 and idiopathic in seven. Overall mortality was 15.8% and neurological sequelae were identified in 36% of the cases during the mean follow-up time of 3.5 years. The incidence of significant sequelae was a function of aetiology (especially acute symptomatic causes) and age (under 1 year of age). We conclude that the most frequent causes of infantile status epilepticus in Tunisia were fever and acute symptomatic causes. Status epilepticus among infants is an important public health problem, with significant associated mortality and morbidity. Management of status epilepticus can be improved by more rapid access to appropriate medical care.

Topics: Anticonvulsants; Central Nervous System Infections; Chi-Square Distribution; Child, Preschool; Clonazepam; Diazepam; Drug Therapy, Combination; Female; Fever; Follow-Up Studies; Humans; Infant; Male; Phenobarbital; Prognosis; Retrospective Studies; Status Epilepticus; Thiopental; Treatment Outcome; Tunisia

A case of intraoperative convulsions occurring in a child with arthrogryposis multiplex congenita is presented. Arthrogryposis and the anaesthetic management of children with this condition is discussed. Factors which may have contributed to the convulsions are considered.

Topics: Anesthetics, Inhalation; Anesthetics, Intravenous; Arthrogryposis; Fever; Fundoplication; Gastroesophageal Reflux; Humans; Infant; Intraoperative Complications; Intubation, Intratracheal; Male; Neuromuscular Nondepolarizing Agents; Nitrous Oxide; Seizures; Tachycardia, Sinus; Thiopental; Vecuronium Bromide

A case of viral encephalitis is described. A 55-year-old female developed hyperthermia and status epilepticus. Herpes simplex virus was regarded as a factor since viral complex titres were elevated and decreased. In addition to acyclovir and anticonvulsive agents, dantrolene (150 mg/day) was administered orally through a nasogastric tube for heat stroke. Convulsions and hyperthermia gradually decreased and intravenous agents were replaced by oral agents. Dantrolene may be a useful adjuvant in hyperthermia and convulsions associated with encephalitis.

Topics: Anticonvulsants; Dantrolene; Encephalitis, Viral; Female; Fever; Herpes Simplex; Humans; Middle Aged; Status Epilepticus; Thiopental

The development of pneumonia was monitored in head-trauma patients requiring mechanical ventilation. Of the 66 patients studied, 15 (23%) developed pneumonia within 14 days after ICU admission. In each case the diagnosis was based on x-ray evidence and at least two of the following: increased white blood cell count, increased fever, and/or increased sputum production with a predominant organism on the sputum stain. Coagulase-positive Staphylococcus aureus was the most common etiologic agent. There was no difference in the occurrence of pneumonia between patients treated with no steroids or with low, moderate, or high steroid doses. Although there was an association between thiopental use and the development of pneumonia, dexamethasone treatment was not a significant risk factor in the development of pneumonia in this patient population.

Topics: Adrenal Cortex Hormones; Cell Count; Craniocerebral Trauma; Critical Care; Dexamethasone; Fever; Humans; Intensive Care Units; Pneumonia; Respiration, Artificial; Sputum; Thiopental

Somatosensory evoked potentials (SEPs) and body temperature were recorded in patients subjected to induced total hyperthermia for treatment of advanced neoplasms. Elevation of body temperature up to 42 degrees C for 2 h was achieved using a computer-controlled external heating system. SEPs were recorded continuously on-line during the treatment using finger shock stimulation. Evoked potential components later than 160 msec disappeared in the early part of the treatment, but reappeared quickly during cooling. P50 and P50-N70 amplitudes decreased regularly and significantly over the whole duration of the heating period. During the plateau period, no evoked potential peaks could be detected but short latency peaks reappeared as soon as cooling started. The disappearance of SEPs to finger stimulation during sustained hyperthermia at 42 degrees C confirms the findings obtained by EEG recording that a major neuronal dysfunction occurs under these circumstances which subsides quickly as temperature is dropped.

Topics: Body Temperature; Evoked Potentials; Fever; Humans; Male; Somatosensory Cortex; Thiopental

Topics: Adolescent; Adult; Aged; Anesthetics; Body Temperature; Body Temperature Regulation; Chemical and Drug Induced Liver Injury; Fentanyl; Fever; Heating; Humans; Middle Aged; Neoplasm Metastasis; Neoplasms; Pain; Thiopental

A non-lethal procedure for identifying pigs apt to develop malignant hyperthermia is described. Susceptible animals were exposed to a variety of anaesthetic and other agents and it was shown that thiopentone sodium and CT 1341 (Glaxo) afforded a measure of protection against the development of the syndrome. Pretreatment with procaine did not prevent the onset of the condition and the administration of procaine when muscle rigidity was present failed to prevent a fatal outcome. The syndrome was induced in susceptible animals by halothane, chloroform, and a combination of halothane with suxamethonium. The effects of cyclopropane in susceptible pigs could not be predicted, and other tests showed that suxamethonium alone would not induce muscle contracture. Pretreatment with lignocaine failed to prevent induction of the syndrome by halothane.We believe that the porcine syndrome may result from more than one defect and that in one particular type the most effective treatment is immediate cooling coupled with the administration of sodium bicarbonate.

Topics: Acidosis; Anesthesia, General; Anesthetics; Animals; Chloroform; Cyclopropanes; Fever; Halothane; Ketones; Lidocaine; Pregnanes; Procaine; Succinylcholine; Swine; Swine Diseases; Thiopental; Tubocurarine

Topics: Adolescent; Anesthetics; Fever; Halothane; Humans; Male; Nitrous Oxide; Oxygen Inhalation Therapy; Postoperative Care; Postoperative Complications; Succinylcholine; Thiopental

Topics: Action Potentials; Adolescent; Adult; Anesthesia, General; Apnea; Biopsy; Central Nervous System; Child; Creatine Kinase; Electromyography; Female; Fever; Follow-Up Studies; Heart Rate; Humans; Male; Middle Aged; Muscles; Nerve Degeneration; Reflex, Abnormal; Succinylcholine; Thiopental

Topics: Acidosis; Anesthesia, General; Child; Fever; Humans; Meperidine; Scopolamine; Thiopental

Topics: Acidosis; Adolescent; Alkaline Phosphatase; Anesthesia, Inhalation; Anesthetics; Appendectomy; Aspartate Aminotransferases; Basal Metabolism; Clinical Enzyme Tests; Creatine Kinase; Fever; Halothane; Hernia, Inguinal; Humans; Hypercapnia; L-Lactate Dehydrogenase; Liver; Male; Muscular Diseases; Nitrous Oxide; Pneumothorax; Succinylcholine; Thiopental

Topics: Adult; Anesthesia, Intravenous; Female; Fever; Humans; Succinylcholine; Thiopental; Tooth Extraction; Tooth, Impacted

Topics: Acidosis; Adenosine Triphosphate; Anesthesia, General; Animals; Cyanosis; Fever; Halothane; Hyperventilation; Muscles; Oxygen; Prognosis; Sodium; Swine; Tachycardia; Thiopental

Topics: Adolescent; Anesthesia, General; Cholecystectomy; Fever; Humans; Intubation, Intratracheal; Male; Thiopental

Topics: Acidosis; Adolescent; Adult; Anesthesia, General; Animals; Cats; Child; Child, Preschool; Dogs; Female; Fever; Halothane; Humans; Male; Nitrous Oxide; Rats; Sodium Chloride; Succinylcholine; Surgical Procedures, Operative; Thiopental

Topics: Adult; Anesthesia, General; Apnea; Bicarbonates; Decamethonium Compounds; Fever; Heart Massage; Humans; Isoproterenol; Male; Metaraminol; Methamphetamine; Pulmonary Atelectasis; Pulmonary Edema; Spasm; Succinylcholine; Thiopental

Topics: Analgesia; Anesthesia; Anesthesia, General; Blood Pressure; Dihydroergotoxine; Electrocardiography; Ergot Alkaloids; Fever; Geriatrics; Heparin; Humans; Myocardial Infarction; Sodium; Theophylline; Thiopental

Topics: Acetylcholine; Aminobutyrates; Amphetamine; Amphetamines; Atropine; Chlordiazepoxide; Chlorpromazine; Cocaine; Convulsive Therapy; Electroconvulsive Therapy; Fever; Hexobarbital; Histamine; Hypothermia; Hypothermia, Induced; Lidocaine; Lobeline; Morphine; Papaverine; Phenobarbital; Promethazine; Thiopental