thiopental and Hyperkalemia

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

Popular depolarising muscle relaxant, suxamethonium (succinylcholine chloride), produces fasciculation in group of muscles and 'after pain'. Mode of its action is neuromuscular blockage. It also may be associated with muscle fibre injury and altered membrane permeability. These may cause rise of serum K+ and creatinine phosphokinase (CPK) levels. But use of diazepam either during or as pretreatment may reduce the fasciculation, 'after pain' and rise of K+ and CPK levels. Present study was undertaken to show whether any correlation of the degree of fasciculation and postsuxamethonium myalgia is present or not and whether diazepam has any role in reducing muscle injury and in turn reducing the levels of serum K+ and CPK.

Topics: Adult; Anesthetics, Intravenous; Creatine Kinase; Diazepam; Drug Therapy, Combination; Female; Humans; Hyperkalemia; Male; Neuromuscular Depolarizing Agents; Pain; Postoperative Complications; Succinylcholine; Thiopental

Topics: Anesthesia; Drug Combinations; Electroconvulsive Therapy; Humans; Hyperkalemia; Methohexital; Potassium; Succinylcholine; Thiopental

Topics: Adult; Anesthesia, General; Blood Glucose; Ethyl Ethers; Humans; Hyperkalemia; Middle Aged; Potassium; Succinylcholine; Thiopental; Tubocurarine

There have been case reports of hypokalaemia and hyperkalaemia on induction and cessation of thiopentone barbiturate coma for refractory intracranial hypertension, respectively. However, the incidence and characteristics are not well described.. We performed a retrospective review of all patients who received thiopentone barbiturate therapy for refractory intracranial hypertension during an 18-month period from January 2004 to June 2005 in our neurosurgical intensive care unit (ICU).. During this time period, 47 patients received thiopentone barbiturate therapy for refractory intracranial hypertension. Forty-two (89.4%) patients developed hypokalaemia after induction of barbiturate therapy. The median time to onset of hypokalaemia was 11 (6-23) h and time to nadir of serum potassium levels was 25 (15-41) h. Sixteen (34%) patients developed hyperkalaemia on weaning of barbiturate therapy. The peak serum potassium levels developed 31 (28-56) h after cessation. All patients who developed hyperkalaemia had been hypokalaemic previously. The mean potassium replaced during hypokalaemia was higher in patients who developed hyperkalaemia compared to those who did not (230 ± 135 vs. 66 ± 70, p < 0.001).. Hypokalaemia and hyperkalaemia are frequently associated with induction and cessation of thiopentone barbiturate coma. Serum potassium levels must be monitored vigilantly. Patients who develop hypokalaemia and receive large potassium replacement may be at greater risk of hyperkalaemia on cessation.

Topics: Anesthetics, Intravenous; Brain Injuries; Coma; Female; Humans; Hyperkalemia; Hypokalemia; Intensive Care Units; Intracranial Hypertension; Male; Middle Aged; Monitoring, Physiologic; Potassium; Retrospective Studies; Thiopental

Severe disturbance of potassium balance is a rare but life-threatening complication of therapeutic barbiturate coma. A 14-yr-old patient was treated with a thiopental infusion for management of increased intracranial pressure after severe head injury. The patient had persistent hypokalaemia during the thiopental infusion. On cessation of the infusion the patient rapidly developed a tachydysrhythmia associated with a serum K+ of 7.0. Possible mechanisms of this phenomenon are discussed. We conclude that aggressive treatment of hypokalaemia during barbiturate coma should be avoided, and advocate a tapering dose of thiopental and not abrupt cessation of an infusion. Severe disturbance of plasma potassium balance is a rare but life-threatening complication of therapeutic barbiturate coma. Awareness of this complication should be raised and management altered to less aggressive treatment of hypokalaemia occurring during thiopental infusion, with a tapering dose used on discontinuation to limit a rebound phenomenon.

Topics: Accidents, Traffic; Adolescent; Brain Death; Brain Injuries; Coma; Critical Care; Fatal Outcome; Female; Glasgow Coma Scale; Humans; Hyperkalemia; Hypnotics and Sedatives; Hypokalemia; Intracranial Pressure; Thiopental

Topics: Adult; Craniocerebral Trauma; Fatal Outcome; GABA Modulators; Humans; Hyperkalemia; Male; Thiopental

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

To report the occurrence of life-threatening hyperkalaemia following treatment with therapeutic thiopentone coma.. The neurosurgical intensive care units of Royal North Shore Hospital and Liverpool Hospital, Sydney, Australia.. Three patients treated with theraputic thiopentone coma. One patient with raised intracranial pressure secondary to a severe traumatic brain injury and two patients with refractory vasospasm secondary to subarachnoid haemorrhage. Two of the three patients developed hypokalaemia on starting thiopentone, which was resistant to potassium supplementation. All three patients developed severe hyperkalaemia during the recovery phase of coma. This was life-threatening in all three patients and fatal in one.. Severe hypokalaemia refractory to potassium therapy may occur during therapeutic thiopentone coma. Severe rebound hyperkalaemia may occur after cessation of thiopentone infusion. Protocols for the management of patients with therapeutic barbiturate coma should recognise this potentially serious complication.

Topics: Adult; Australia; Brain Injuries; Coma; Critical Illness; Female; Glasgow Coma Scale; Humans; Hyperkalemia; Hypnotics and Sedatives; Male; Middle Aged; Subarachnoid Hemorrhage; Thiopental; Treatment Outcome

Elderly patients with hyperkalaemia often have low concentrations of plasma renin and aldosterone, perhaps secondary to reduced glomerular filtration and sympathetic insufficiency. The endocrine response to surgical stress and volume expansion during anaesthesia was studied in seven elderly patients with hyperkalaemia (mean age 87.7 +/- SD 5.3 years), 18 elderly patients without hyperkalaemia (86.5 +/- 5.5 years), and 18 younger patients (52.6 +/- 7.2 years) as controls. Base-line values, in hyperkalaemic elderly patients, for plasma renin activity and plasma aldosterone concentration were 0.8 +/- 0.3 ng mL-1 h-1 and 2.8 +/- 0.8 pg mL-1 respectively (significantly lower than in the younger patients), and 287 +/- 42 pg mL-1 for plasma atrial natriuretic peptide levels, which were significantly higher. The plasma renin activity and aldosterone concentrations in elderly patients with hyperkalaemia were at all times lower, but not significantly, than those of the elderly patients without hyperkalaemia. The atrial natriuretic peptide concentrations (351 +/- 48 pg mL-1) in the hyperkalaemic elderly were significantly higher 90 min after induction of anaesthesia than in the normokalaemic elderly (108 +/- 38 pg mL-1). Hormone concentrations in the hyperkalaemic patients did not change during anaesthesia, but plasma atrial natriuretic peptide concentrations increased significantly in the normokalaemic elderly, and plasma renin activity and aldosterone of the younger patients increased significantly during anaesthesia. These results indicate that plasma renin activity, and the concentrations of aldosterone and of atrial natriuretic peptide in elderly patients with hyperkalaemia are unresponsive to surgical stress and volume expansion.

Topics: Adult; Aged; Aged, 80 and over; Aging; Aldosterone; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Atrial Natriuretic Factor; Femoral Neck Fractures; Follow-Up Studies; Glomerular Filtration Rate; Humans; Hyperkalemia; Isoflurane; Middle Aged; Nitrous Oxide; Plasma Substitutes; Potassium; Renal Insufficiency; Renin; Sodium; Stress, Physiological; Thiopental

Topics: Adult; Atropine; Diazepam; Humans; Hyperkalemia; Potassium; Preanesthetic Medication; Succinylcholine; Thiopental

Topics: Adult; Anesthesia, Intravenous; Electrocardiography; Fentanyl; Gallamine Triethiodide; Heart Arrest; Humans; Hyperkalemia; Lumbosacral Region; Male; Nitrous Oxide; Paraplegia; Potassium; Spinal Cord Compression; Spinal Cord Injuries; Succinylcholine; Thiopental; Tubocurarine; Urinary Bladder, Neurogenic

Topics: Acidosis; Acute Kidney Injury; Anemia; Anesthesia; Anesthesia, Epidural; Anesthesia, Spinal; Antihypertensive Agents; Arrhythmias, Cardiac; Heart Failure; Hepatitis; Humans; Hyperkalemia; Hypertension; Hypocalcemia; Hyponatremia; Kidney Failure, Chronic; Nausea; Preanesthetic Medication; Seizures; Thiopental; Uremia; Vomiting

Topics: Anesthesia, Intravenous; Cerebral Ventricles; Electrocardiography; Electrolytes; Humans; Hyperkalemia; Jugular Veins; Male; Memory Disorders; Middle Aged; Pneumoencephalography; Succinylcholine; Thiopental

Topics: Anesthesia, Inhalation; Halothane; Heart Arrest; Humans; Hyperkalemia; Male; Military Medicine; Paraplegia; Succinylcholine; Thiopental; Wounds and Injuries