thiopental and Heart-Diseases

Successful management of a patient with heart disease requires an understanding not only of the pharmacology of anesthesia but also of the pathophysiology of heart disease. Both of these factors as well as the choice and conduct of anesthesia by the anesthesiologist are thoroughly explored in this article.

Topics: Aged; Anesthesia, Conduction; Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthetics; Benzodiazepines; Cardiovascular System; Child; Coronary Disease; Halothane; Heart Diseases; Heart Valve Diseases; Humans; Morphine; Nitrous Oxide; Succinylcholine; Surgical Procedures, Operative; Thiopental; Tubocurarine

Topics: Anesthetics; Arrhythmias, Cardiac; Catecholamines; Digitalis Glycosides; Electroshock; Heart Diseases; Humans; Hypercapnia; Hypertension; Hypothermia, Induced; Hypoxia; Intubation; Neostigmine; Potassium; Scopolamine; Succinylcholine; Surgical Procedures, Operative; Thiopental

This work evaluates solid lipid nanoparticles of thiopental sodium against obesity-induced cardiac dysfunction and hypertrophy and explores the possible mechanism of action. TS loaded SLNs were formulated by hot-homogenization and solvent diffusion method. TS-SLNs were scrutinized for entrapment efficiency, drug loading capacity, gastric stability, particle size, in vitro drug release. Mice were feed with the normal chow or high-fat diet for 08 weeks to induce obesity and primary cardiomyocytes. The therapeutic effects of thiopental sodium in the high fat diet (HFD) induced cardiac hypertrophy. Systolic blood pressure (SBP) was estimated at a regular time interval. At the end of the experimental study, systolic pressure left ventricular, LV end-diastolic pressure and rate of increase of LV pressure and antioxidant, apoptosis, cytokines and inflammatory scrutinized. HFD induced group mice exhibited a reduction in the body weight and enhancement of cardiac hypertrophy marker and dose-dependent treatment of thiopental sodium up-regulation the body weight and down-regulated the cardiac hypertrophy. Thiopental sodium significantly (

Topics: Animals; Antioxidants; Apoptosis; Blood Pressure; Cardiomegaly; Chemistry, Pharmaceutical; Diet, High-Fat; Dose-Response Relationship, Drug; Drug Delivery Systems; Drug Liberation; GABA Modulators; Heart Diseases; Inflammation; Inflammation Mediators; Lipids; Male; Mice; Mice, Inbred C57BL; Myocytes, Cardiac; Nanoparticles; Obesity; Oxidative Stress; p38 Mitogen-Activated Protein Kinases; Particle Size; Thiopental; Weight Loss

Topics: Anticonvulsants; Brain Diseases; Child, Preschool; Electroencephalography; Extracorporeal Membrane Oxygenation; Heart Diseases; Humans; Male; Seizures; Thiopental; Treatment Outcome

Profound myocardial depression developed in 2 patients after severe anaphylactic reactions following the induction of anaesthesia in 1 case and a bee-sting in the other. Neither patient had pre-existent cardiac disease. In both patients haemodynamic assessment, radionuclide ventriculography, and two-dimensional echocardiography confirmed the clinical impression of profound systolic myocardial dysfunction. Haemodynamic stability was attained by intra-aortic balloon counterpulsation, which was probably life-saving in both cases. Cardiac function improved rapidly although some contractile depression persisted for several days. At follow-up both patients had normal cardiac function with no evidence of underlying heart disease.

Topics: Adult; Alcuronium; Anaphylaxis; Animals; Bees; Female; Heart Diseases; Hemodynamics; Humans; Hypotension; Insect Bites and Stings; Intra-Aortic Balloon Pumping; Thiopental

Local anaesthetic systemic toxicity is a rare but often dramatic complication of regional anaesthesia. Convulsions often follow warning signs, easily recognized when looked for; but they may occur from the first. They are rapidly followed by hypoxia and hypercapnia which greatly enhance the risk of severe cardiac depression, mainly with bupivacaine or etidocaine. Thiopentone is able to stop convulsions quickly, but may further depress the cardiovascular system. Diazepam has been shown to be effective in the treatment of local anaesthetic-induced convulsions. It gives less myocardial depression, but is much slower in effect. Midazolam, a new short-acting benzodiazepine, should be the best choice. Should tracheal intubation become necessary, suxamethonium can be used. Indeed, the principal use of these drugs is to make ventilation easier, so as to restore rapidly correct oxygenation. Severe cardiac depression, often leading to cardiac arrest, may occur from the first or after the appearance of convulsions. It generally follows a regional block carried out with bupivacaine. A few antiarrhythmic drugs have been used to treat ventricular arrhythmias, either in experimental studies (lidocaine, bretylium) or after clinical accidents (lidocaine). Their efficacy and innocuity have to be proved before they can be proposed to treat these accidents. Bradycardia only needs treatment with atropine when it causes severe haemodynamic disturbances. When cardiac arrest occurs, cardiopulmonary resuscitation must be carried out; its mainstays are: oxygen, sodium bicarbonate, adrenaline, calcium and perhaps glucagon. This must be continued for a long time, as late successes have been published.

Topics: Anesthetics, Local; Anti-Anxiety Agents; Arrhythmias, Cardiac; Benzodiazepines; Calcium Gluconate; Epinephrine; Glucagon; Heart Arrest; Heart Diseases; Humans; Seizures; Succinylcholine; Thiopental

Thiopentone (thp) infusion was administered to 33 patients with cerebral dysfunction or convulsions out of 2986 patients operated on via extracorporeal circulation because of valvular disease, coronary insufficiency, septum defects and intrathoracic aortic aneurysms. If phenytoin, diazepam and clonazepam proved ineffective, thp 10-15 mg/kg was injected slowly, followed by infusion of 2-4 mg/kg/h for 0.5-5 days. 9 patients died. 18 survivors had a good recovery, 6 were moderately disabled. In the survivors embolisation of particulate matter prevailed as a cause of cerebral dysfunction while in nonsurvivors prolonged pre- and postoperative hypotension was the main cause, with one patient suffering a hemispheric infarction. The amelioration of convulsions and psychosyndromes in the survivors is compatible with the known anticonvulsive effect of thp and its alleged influence on cerebral focal ischaemia. However, in protracted cerebral hypoperfusion as a cause of cerebral dysfunction no protection can be expected from thp. The known effects of barbiturates do not justify the use of these substances for the purpose of cerebral protection.

Topics: Adolescent; Adult; Aged; Aortic Aneurysm; Brain Ischemia; Dose-Response Relationship, Drug; Extracorporeal Circulation; Female; Follow-Up Studies; Heart Diseases; Humans; Infusions, Intravenous; Male; Middle Aged; Postoperative Complications; Seizures; Thiopental

The average dose of thiopental necessary for induction was 3.4 mg/kg body weight in seven patients on long-term therapy with digoxin and a diuretic and 4.7 mg/kg body weight in seven matched control patients (P less than 0.05). The initial volumes of distribution (V1) did not differ significantly. The amounts of thiopental redistributed (removed from V1) during the induction were calculated as V1 X k12 X ct and V1 X k13 X ct, where k12 and k13 are the rate constants describing the drug transfer from V1 to V2 and V3 and ct the computer-calculated average thiopental concentration in V1 during the initial 40 s of the induction period. There was no evidence of a lower amount being removed during the induction in the cardiac patients. The intravascular drug concentration at the time of sleep was expressed as the average of the arterial and the venous sleep concentrations. In the cardiac patients the average of that value was 20.1 micrograms/ml and in the control patients 30.2 micrograms/ml (P less than 0.05). It is concluded that the lower dose requirement in the cardiac patients was caused at least in part by a higher cerebral sensitivity to the drug.

Topics: Aged; Brain; Dose-Response Relationship, Drug; Female; Heart Diseases; Hemodynamics; Humans; Male; Thiopental

Brain damage following open-heart surgery is receiving increasing attention. Efforts are being made to improve the setting for cardiac surgery so as to avoid such complications. When they occur, their recognition is retrospective, when the cerebral lesion is inevitable. Because heavy sedation is necessary, clinical supervision with respect to brain function is both difficult and unreliable in the early postoperative period. We therefore submitted 34 selected patients to neurosurgical intensive care supervision. The measures included postoperative monitoring of intracranial epidural pressure (EDP), of arterial blood pressure (BP) and of central venous pressure (CVP). In 25 patients there was rise in EDP during the first postoperative hours. Six of these patients received mannitol treatment and in three of them barbiturate was additionally given, in order to reduce EDP and improve the cerebral perfusion pressure (CPP = BP-EDP). Nevertheless EDP progressed to brain tamponade six days postoperatively in one case. In patients with raised EDP, weaning from the ventilator should be postponed until EDP has almost normalized. The EDP recording is a valuable guide in the postoperative management of the individual patient.

Topics: Blood Pressure; Brain Damage, Chronic; Carbon Dioxide; Extracorporeal Circulation; Heart Diseases; Humans; Intracranial Pressure; Mannitol; Postoperative Complications; Thiopental

Topics: Adolescent; Adult; Age Factors; Aged; Anesthesia, General; Anesthesia, Intravenous; Child; Creatinine; Digoxin; Diuretics; Female; Heart Diseases; Hemoglobins; Humans; Male; Middle Aged; Premedication; Sex Factors; Thiopental

Twenty-four patients with severe, 24 with moderate, and 24 without heart disease were selected for measurements of systolic time intervals (STI) and blood pressure before and during anesthesia. In all patients anesthesia was induced with thiopental, 4 mg/kg. After tracheal intubation, 12 patients from each heart-disease class received halothane-N2O-O2 (halothane) and 12 patients from each class morphine-d-tubocurarine-N2O-O2 (MS-dTc). Thiopental increased the pre-ejection period (PEP), decreased left ventricular ejection time (LVET), and accelerated heart rate (HR). These changes were similar in patients with and without heart disease. Halothane and and MS-dTc lowered systolic blood pressure and increased PEP/LVET. With halothane but not with MS-dTc these changes were more pronounced in patients who had heart disease. Changes of the PEP/LVET ratio during halothane anesthesia were a better discriminating variable among patients without, with moderate, and with severe heart disease than were changes in systolic blood pressure.

Topics: Adult; Aged; Anesthesia, Inhalation; Anesthesia, Intravenous; Blood Pressure; Female; Halothane; Heart Diseases; Hemodynamics; Humans; Male; Middle Aged; Morphine; Myocardial Contraction; Nitrous Oxide; Oxygen; Thiopental; Time Factors; Tubocurarine

Topics: Adult; Aged; Alfaxalone Alfadolone Mixture; Heart Diseases; Hemodynamics; Humans; Middle Aged; Thiopental

Topics: Anesthesia, Inhalation; Anesthetics; Blood Pressure; Cyclopropanes; Electrocoagulation; Female; Halothane; Heart Diseases; Heart Rate; Humans; Lidocaine; Middle Aged; Nitrous Oxide; Succinylcholine; Thiopental

Topics: Adolescent; Anesthesia, Dental; Anesthesia, General; Atropine; Auscultation; Blood Pressure Determination; Child; Child, Preschool; Dentistry, Operative; Electrocardiography; Female; Halothane; Heart Defects, Congenital; Heart Diseases; Hospitalization; Humans; Intellectual Disability; Male; Meperidine; Nitrous Oxide; Oxygen; Pediatric Dentistry; Postoperative Complications; Succinylcholine; Thiopental

Topics: Abdomen; Adjuvants, Anesthesia; Analgesics; Anesthesia, General; Blood Pressure; Chlorpromazine; Curare; Female; Heart; Heart Diseases; Humans; Hypotension; Isonipecotic Acids; Meperidine; Methoxyflurane; Nitrous Oxide; Phenoperidine; Positive-Pressure Respiration; Postoperative Care; Preanesthetic Medication; Pulmonary Edema; Respiratory Tract Diseases; Thiopental; Thoracic Surgery; Thorax