thiopental and Hemorrhage

A new method for assessing microhaemorrhage in eye surgery was used in 16 patients for cataract extraction. It was shown that bleeding was greatest in the first five minutes and that it correlated with the surgeon's clinical estimate of blood loss. The method was used to assess the effect of two different general anaesthetic induction regimens on intraoperative bleeding.

Topics: Aged; Anesthesia, General; Cataract Extraction; Etomidate; Hemorrhage; Humans; Intraoperative Complications; Middle Aged; Thiopental; Time Factors

In this study, we used a porcine model to investigate whether impaired coagulation and severe arterial or venous bleeding could be normalized by substitution with a prothrombin complex concentrate (PCC), Beriplex P/N, containing coagulation factors II, VII, IX, and X.. Dilutional coagulopathy was induced in anesthetized pigs by fractionated blood withdrawal (approximately 65% of total volume), followed by erythrocyte retransfusion and volume substitution with a total of 1000 mL of hydroxyethyl starch (Infukoll 6%). Animals were randomized to no treatment, treatment with placebo, or treatment with 35 U/kg PCC. Arterial (spleen incision) or venous (bone injury) bleeding was inflicted. Thromboelastometry, hematology, and coagulation tests were performed at baseline, after dilution, and after study treatments had been administered and injury inflicted. The primary end-point was postinjury time to hemostasis.. Hemodilution resulted in a decrease in coagulation factor concentrations to approximately 35% and prolonged prothrombin time. Platelet numbers decreased from approximately 400,000 to approximately 100,000/microL, and aggregation and adhesion were impaired. PCC effectively substituted the deficient prothrombin factors (II, VII, IX, and X) and normalized the prolonged prothrombin time. After spleen injury, PCC significantly reduced time to hemostasis versus dilutional control (median, 35 vs 82.5 min; P < 0.0001), and produced a nonsignificant trend towards reduction in blood loss (mean, 275 vs 589 mL). PCC also significantly reduced time to hemostasis (median, 27 vs 97 min; P < 0.0011) and blood loss (mean, 71 vs 589 mL; P < 0.0017) after bone injury.. Dilutional coagulopathy produced a generalized decrease in coagulation factors and impaired platelet function. Substitution with PCC effectively normalized coagulation and significantly improved hemostasis after venous and arterial bleeding.

Topics: Anesthetics, Intravenous; Animals; Blood Coagulation Disorders; Blood Coagulation Factors; Disease Models, Animal; Hemodilution; Hemorrhage; Platelet Aggregation; Swine; Thiopental

Hemorrhage increases adhesion of leukocytes to the venular endothelium, mediated by increased expression of the Mac-1 integrin complex (CD18/CD11b) present on leukocytes. Anesthetic agents may possess anti-inflammatory properties. Hence, this study determined the effects of i.v. anesthesia on leukocyte adhesion after hemorrhage in relation to expression of CD11b.. Male Wistar rats were (n = 57) anesthetized i.v. with propofol (Diprivan) and fentanyl, ketamine, or thiopental. During anesthesia, 10% of total blood volume was removed and intravital microscopy used to observe the rat mesentery and measure leukocyte (neutrophils) rolling and adhesion in postcapillary venules (15 - 25 microm). Flow cytometry was also used to determine CD11b expression on neutrophils from blood removed at the end of these experiments (n = 25) or blood incubated with anesthetic agents and activated with platelet activating factor ex vivo (0.1 micromol/L) (n = 24).. Hemorrhage increased leukocyte adhesion (stationary count per 150 microm) in rats anesthetized with thiopental (baseline, 3.4 +/- 1.2; hemorrhage, 6.7 +/- 2.0; P < 0.05) but not in those receiving either ketamine (baseline, 3.6 +/- 1.3; hemorrhage, 3.3 +/- 1.3) or propofol/fentanyl (baseline, 6.2 +/- 2.0; hemorrhage, 5.8 +/- 0.8). Neutrophils collected from thiopental-treated rats had elevated CD11b expression with thiopental (mean fluorescence baseline, 67.5 +/- 1.3; hemorrhage, 83.6 +/- 5.3; P < 0.05) but not with propofol/fentanyl (mean fluorescence baseline, 69.1 +/- 1.3; hemorrhage, 65.9 +/- 1.6), and ketamine-treated rats (mean fluorescence baseline, 74.3 +/- 2.1; hemorrhage, 74.8 +/- 1.1). Ketamine also inhibited upregulation of CD11b with platelet activating factor ex vivo.. After hemorrhage, leukocyte adhesion and CD11b expression increased during thiopental anesthesia, but propofol/fentanyl and ketamine protected against hemorrhage-induced leukocyte adhesion. The anti-inflammatory effect of ketamine was mediated by direct inhibition of CD11b expression on leukocytes.

Topics: Anesthesia, Intravenous; Animals; CD11b Antigen; Cell Adhesion; Endothelial Cells; Endothelium, Vascular; Gene Expression Regulation; Hemorrhage; Inflammation; Leukocytes; Male; Propofol; Rats; Rats, Wistar; Thiopental; Time Factors

Anesthetic agents are known to have differential effects on both the systemic circulation and the microcirculation. The aim of this study was to compare the effects of several intravenous (i.v.) agents on the microcirculatory response to hemorrhage. Male Wistar rats (n = 52) were anesthetized i.v. either with propofol and fentanyl (propofol fentanyl), ketamine, or thiopental. Cardiovascular variables were monitored. The cremaster muscle was observed by using fluorescent intravital microscopy. FITC-BSA was administered (0.25 mL/100 g, i.a.) to determine macromolecular leak, an index of vessel integrity. Animals were further allocated into control (C), 10% hemorrhage (H), or hemorrhage re-infusion (H-R, removal of 10% blood volume and then re-infusion of saline and blood) groups. When systolic arterial pressure (SAP) was maintained after hemorrhage, constriction of A3 and A4 arterioles (5-30 microm) was accompanied by no change in the diameter of A1 (80-130 microm): most frequent with ketamine (A1: -1.7 +/- 1.2; A4: -13.9 +/- 2.7%; H and H-R: n = 9/11). With lower SAP, dilation of the A3 and A4 was accompanied by constriction of the A1: most frequent with propofol/fentanyl (A1: -8.0 +/- 2.5; A4; 35.1 +/- 9.4%; H and H-R: n = 6/11). No increases in macromolecular leak occurred with any anesthetic agent or in H or H-R groups. The response of cremaster muscle microcirculation to hemorrhage differs with different i.v. anesthetic agents. Dilation of small arterioles is the predominant response with propofol/fentanyl and constriction of small arterioles with ketamine.

Topics: Anesthetics, Intravenous; Animals; Blood Gas Analysis; Hemodynamics; Hemorrhage; Ketamine; Male; Microcirculation; Muscle, Skeletal; Nitroprusside; Propofol; Rats; Rats, Wistar; Thiopental

1. This study examined the role of endothelin ET(A) and ET(B) receptors on haemodynamic compensation following haemorrhage (-17.5 ml kg(-1)) in thiobutabarbitone-anaesthetized rats. Rats were divided into four groups (n=6 each): time-control, haemorrhage-control, haemorrhage after treatment with FR 139317 (ET(A)-receptor antagonist), and haemorrhage after treatment with BQ-788 (ET(B)-receptor antagonist). 2. In the time-control rats, there were no significant changes in any haemodynamics for the duration of the experiments. Relative to the time-control rats, rats given haemorrhage had reduced mean arterial pressure (MAP), cardiac output (CO) and mean circulatory filling pressure (MCFP), but increased systemic vascular resistance (R(SV)). Venous resistance (R(V)) was slightly (but insignificantly) reduced by haemorrhage. MAP, however, gradually returned towards baseline (-17+/-4 and -3+/-2 mmHg at 10 and 60 min after haemorrhage, respectively) as a result of a further increase in R(SV). 3. Pre-treatment with FR 139317 (i.v. 1 mg kg(-1), followed by 1 mg kg(-1) h(-1)) accentuated haemorrhage-induced hypotension through abolition of the increase in R(SV). FR 139317 did not modify haemorrhage-induced changes in CO, MCFP and R(V). 4. Pre-treatment of BQ-788 (3 mg kg(-1)) did not affect MAP or MCFP following haemorrhage; however, CO was lower, and R(SV) as well as R(V) were higher relative to the readings in the haemorrhaged-control rats. 5. These results show that following compensated haemorrhage, ET maintains arterial resistance and blood pressure via the activation of ET(A) but not ET(B) receptors.

Topics: Anesthetics; Animals; Azepines; Blood Volume; Endothelin Receptor Antagonists; Hematocrit; Hemodynamics; Hemorrhage; Indoles; Male; Oligopeptides; Piperidines; Rats; Rats, Sprague-Dawley; Receptor, Endothelin A; Receptor, Endothelin B; Receptors, Endothelin; Thiopental

The differential effects of i.v. anaesthesia on the response of the mesenteric microcirculation after haemorrhage in vivo are previously unexplored.. Male Wistar rats (n=56) were anaesthetized intravenously either with propofol and fentanyl (propofol/fentanyl), ketamine or thiopental. A tracheostomy and carotid cannulation were performed and the mesentery surgically prepared for observation of the microcirculation using fluorescent in vivo microscopy. Animals were allocated to one of three groups: control, haemorrhage or haemorrhage re-infusion.. After haemorrhage, the response of the microcirculation differed during propofol/fentanyl, ketamine and thiopental anaesthesia. During propofol/fentanyl anaesthesia there was constriction of arterioles (-16.7 (3.9)%), venules (-5.9 (1.7)) and capillaries (-16.3 (2.8)) (n=12). During ketamine and thiopental anaesthesia both constriction and dilation was observed. After haemorrhage and re-infusion, macromolecular leak occurred from venules during propofol/fentanyl and thiopental anaesthesia (P<0.05), but not during ketamine anaesthesia.. In summary, i.v. anaesthetic agents differentially alter the response of the mesenteric microcirculation to haemorrhage.

Topics: Anesthetics, Combined; Anesthetics, Intravenous; Animals; Fentanyl; Hemodynamics; Hemorrhage; Ketamine; Male; Microcirculation; Microscopy, Fluorescence; Propofol; Rats; Rats, Wistar; Splanchnic Circulation; Thiopental; Vasoconstriction; Vasodilation

We report a case of ischaemic optic neuropathy which occurred after prolonged spine surgery in the prone position in an obese, diabetic patient.. The patient was a 44-yr-old, 123 kg, 183 cm man for decompressive laminectomy and instrumented fusion of the lumbar spine. Anaesthesia was induced with thiopentone, fentanyl and succinylcholine and maintained with nitrous oxide, oxygen, isoflurane and a fentanyl infusion. He was positioned prone on the Relton-Hall frame and had an uneventful intraoperative course. Estimated blood loss was 3,000 ml. He was taken to the surgical intensive care unit (SICU) and the trachea was extubated 3.5 hr later. He had no pulmonary or haemodynamic problems and went to a regular nursing floor in the morning. He was discharged home on postoperative day #5. He telephoned his surgeon on postoperative day #7 to say that his vision had been blurry since surgery. His visual acuity was decreased, and on examination, he had a bilateral papillary defect, optic swelling and a splinter haemorrhage in the right eye. Magnetic resonance imaging (MRI) scan of the head and orbits detected no other abnormality. Based on this examination, he was felt to have bilateral ischaemic optic neuropathy and treated conservatively. By postoperative day #47, his visual acuity was greatly improved and near normal. Careful review of possible contributing factors suggests that the cause of the ischaemic optic neuropathy was venous engorgement.. This patient developed ischaemic optic neuropathy from a prolonged interval in the prone position of the Relton-Hall frame, which may be related to venous engorgement.

Topics: Adult; Anesthesia, Intravenous; Anesthetics, Inhalation; Anesthetics, Intravenous; Blood Loss, Surgical; Diabetes Mellitus, Type 1; Fentanyl; Hemorrhage; Humans; Immobilization; Isoflurane; Laminectomy; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Neuromuscular Depolarizing Agents; Nitrous Oxide; Obesity; Optic Nerve; Optic Neuropathy, Ischemic; Oxygen; Papilledema; Prone Position; Spinal Fusion; Spinal Stenosis; Succinylcholine; Thiopental; Time Factors; Vascular Diseases; Veins; Visual Acuity

This study was designed to assess the effects of thiopental and ketamine on cardiac function after a blood loss of 2 ml/100 g of body weight. In nine Sprague-Dawley rats, a catheter was placed in the abdominal aorta, a pulsed Doppler probe was positioned around the thoracic aorta, and a wall-thickness probe was sutured onto the left ventricle. On three occasions, all rats were studied awake, during thiopental anesthesia, and during ketamine anesthesia. In awake rats, a 30% blood loss resulted in an immediate, transient hypotension (49%) and a prolonged decrease in cardiac output (39%) and stroke volume (28%). No significant changes were observed in the wall-thickening fraction, which is an index of cardiac contractility, and in the heart rate. The effect of thiopental on cardiovascular responses to moderate hemorrhage was minimal. Although ketamine did not affect the hypotensive response to moderate hemorrhage, it did accentuate systemic vasoconstriction and cardiac depression as indicated by a decrease in cardiac output (57%), stroke volume (49%), and wall thickness (47%).

Topics: Animals; Blood Gas Analysis; Blood Pressure; Cardiac Output; Heart; Heart Rate; Hematocrit; Hemodynamics; Hemorrhage; Ketamine; Rats; Rats, Sprague-Dawley; Thiopental; Vascular Resistance

Topics: Aged; Airway Obstruction; Anesthesia, Intravenous; Female; Hemorrhage; Humans; Intubation, Intratracheal; Laryngeal Diseases; Laryngoscopy; Lidocaine; Phenylephrine; Thiopental

Topics: Anesthesia; Animals; Dogs; Etomidate; Hemodynamics; Hemorrhage; Hormones; Thiopental

Topics: Anesthesia, Intravenous; Atracurium; Hemorrhage; Humans; Infant, Newborn; Lung Diseases; Male; Thiopental

The anaesthetic requirements of ketamine and thiopentone were studied in eight pig littermates during normovolaemia and after haemorrhage (30% blood loss). Four animals received ketamine and four thiopentone, and the minimal anaesthetic doses of both drugs were determined. Moderate hypovolaemia decreased the anaesthetic requirements significantly and similarly: thiopentone 33 +/- 5%; ketamine 40 +/- 5% (mean +/- SEM).

Topics: Anesthesia, Intravenous; Animals; Blood Volume; Hemorrhage; Ketamine; Swine; Thiopental

Topics: Adolescent; Adult; Female; Fentanyl; Flunitrazepam; Hemorrhage; Humans; Intraoperative Complications; Male; Middle Aged; Pancuronium; Postoperative Complications; Rhinoplasty; Thiopental

Topics: Anesthesia; Animals; Blood Coagulation; Copper; Dogs; Female; Fibrinolysis; Hemorrhage; Liver Circulation; Thiopental; Zinc

Topics: Abscess; Burns, Electric; Electrosurgery; Female; Gynecology; Halothane; Hematoma; Hemorrhage; Hospitalization; Hospitals, Community; Humans; Ileum; Iowa; Laparoscopes; Laparoscopy; Methods; Methohexital; Nitrous Oxide; Peritonitis; Pneumoperitoneum, Artificial; Postoperative Complications; Quality of Health Care; Sterilization, Tubal; Stomach; Thiopental

Topics: Age Factors; Aged; Anesthesia; Anesthesia, Spinal; Blood Pressure; Blood Transfusion; Hematuria; Hemorrhage; Humans; Hypotension, Controlled; Male; Methods; Middle Aged; Organ Size; Postoperative Complications; Prostate; Prostatectomy; Thiopental

Topics: Angiotensin II; Animals; Blood Pressure; Dogs; Hemorrhage; Norepinephrine; Pentolinium Tartrate; Respiration; Thiopental

Topics: Anesthesia, General; Anesthetics; Animals; Benperidol; Blood Chemical Analysis; Blood Gas Analysis; Blood Glucose; Blood Pressure; Blood Volume; Chloroform; Cyclopropanes; Dogs; Electrocardiography; Epinephrine; Ethers; Ethyl Ethers; Halothane; Heart Rate; Hematocrit; Hemorrhage; Histamine; Lactates; Male; Methoxyflurane; Norepinephrine; Pyruvates; Serotonin; Thiopental; Trichloroethylene; Urination

Topics: Anesthesia, Dental; Anesthesia, Inhalation; Blood Gas Analysis; Halothane; Heart Rate; Hemorrhage; Humans; Intubation, Intratracheal; Masks; Oxygen; Thiopental

Topics: Anesthesia; Anesthesiology; Brain; Hemorrhage; Phosphoric Monoester Hydrolases; Thiopental

Topics: Administration, Intravenous; Animals; Barbital; Blood Transfusion; Exsanguination; Hemorrhage; Indicator Dilution Techniques; Rabbits; Sodium; Thiopental

Topics: Administration, Intravenous; Anesthesia; Anesthesiology; Barbital; Blood; Fluids and Secretions; General Surgery; Hemodilution; Hemorrhage; Movement; Postoperative Complications; Sodium; Thiopental; Water