thiopental and Hypertension

Topics: Animals; Barbiturates; Brain; Brain Edema; Brain Ischemia; Cerebrovascular Circulation; Dogs; Humans; Hypertension; Hypoxia, Brain; Intracranial Pressure; Ischemic Attack, Transient; Phenobarbital; Thiopental

Topics: Anesthesia; Anesthetics; Antihypertensive Agents; Cardiovascular System; Diazepam; Electrocardiography; Halothane; Hemodynamics; Humans; Hypertension; Succinylcholine; Surgical Procedures, Operative; Thiopental

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

Remifentanil is known to attenuate the cardiovascular responses to tracheal intubation. We determined effective doses (ED(50)/ED(95)) of remifentanil to prevent the pressor response to tracheal intubation in patients with severe preeclampsia.. Seventy-five women with severe preeclampsia were randomly allocated to one of five remifentanil dose groups (0.25, 0.50, 0.75, 1.0, or 1.25 μg/kg) given before induction of anaesthesia using thiopental 5 mg/kg and suxamethonium 1.5 mg/kg. Systolic arterial pressure, heart rate and plasma catecholamine concentrations were measured. Neonatal effects were assessed by Apgar scores and umbilical cord blood gas analysis. A dose was considered effective when systolic arterial pressure did not exceed 160 mmHg for more than 1 min following tracheal intubation.. Baseline systolic blood pressure and heart rate did not differ among the groups. The intubation-induced increases of heart rate and blood pressure were attenuated in a dose-dependent manner by remifentanil. ED(50) and ED(95) were 0.59 (95% CI 0.47-0.70) μg/kg and 1.34 (1.04-2.19)μg/kg, respectively. Norepinephrine concentrations remained unaltered following intubation but increased significantly at delivery, with no differences between the groups. Apgar scores and umbilical arterial and venous pH and blood gas values were comparable among the groups. Two women each in the 1.0 and 1.25 μg/kg groups received ephedrine for hypotension defined as systolic arterial pressure <90 mmHg.. The ED(95) of remifentanil for attenuating the hypertensive response to tracheal intubation during induction of anaesthesia in severely preeclamptic patients undergoing caesarean delivery under general anaesthesia was 1.34 μg/kg.

Topics: Adult; Analgesics, Opioid; Anesthesia, General; Anesthetics, Intravenous; Blood Pressure; Cesarean Section; Dose-Response Relationship, Drug; Female; Humans; Hypertension; Intubation, Intratracheal; Laryngoscopy; Middle Aged; Neuromuscular Depolarizing Agents; Piperidines; Pre-Eclampsia; Pregnancy; Remifentanil; Severity of Illness Index; Succinylcholine; Thiopental; Young Adult

To compare 4 different anesthesia induction protocols, in a simulated model of rapid-sequence induction, in controlled hypertensive patients.. Prospective, randomized, double-blind, clinical investigation.. Large metropolitan university hospital.. 120 ASA II-III adult hypertensive patients.. Patients were allocated to 4 groups at random. After preoxygenation for 3 minutes, induction and tracheal intubation was performed in a 30 degrees head-up position. Thiopental (5-7 mg/kg) was the induction agent. Study groups were as follows: group LS (n = 30), lidocaine (1.5 mg/kg) and succinylcholine (1 mg/kg); group LR (n = 30), lidocaine (1.5 mg/kg) and rocuronium (1 mg/kg); group RS (n = 30), remifentanil (1 microg/kg) and succinylcholine (1 mg/kg); group RR (n = 30), remifentanil (1 microg/kg) and rocuronium (1 mg/kg). Patients were intubated 60 seconds after administration of muscle relaxant.. Hemodynamic data were obtained before induction (baseline), after induction, at intubation, and at 1, 3, 5, and 10 minutes after intubation. More than 20% change in blood pressure and heart rate was considered significant.. Systolic and mean arterial blood pressures at intubation and 1 and 3 minutes after intubation were higher in group LS compared with groups RS and RR (P < 0.01). Mean arterial blood pressure decreased after induction in groups LS, LR, and RR, but increased at intubation and 1 minute after intubation in groups LS and LR (P < 0.01). Mean arterial blood pressure was similar at all measurement intervals in group RS. The median area under the systolic, mean, and diastolic blood pressure time curves was higher in groups LS and LR compared with groups RS and RR (P < 0.05 and P < 0.01).. Remifentanil is a better adjunct for attenuation of the response to laryngoscopy and intubation compared with lidocaine, whereas remifentanil-succinylcholine combination appears to be more beneficial in terms of hemodynamic stability in hypertensive patients.

Topics: Analgesics, Opioid; Androstanols; Anesthesia; Anesthetics, Local; Blood Pressure; Double-Blind Method; Female; Heart Rate; Humans; Hypertension; Hypnotics and Sedatives; Intubation, Intratracheal; Laryngoscopy; Lidocaine; Male; Middle Aged; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Piperidines; Remifentanil; Rocuronium; Succinylcholine; Thiopental

55 patients (age 45-63 years old) scheduled for elective brain artery anaeurysm repair operation were randomly divided into two groups: thiopental, atracurium besilate and fentanyl group (group I; n= 27) and propofol, vecuronium bromide and fentanyl in a continuous intravenous administration group (group II; n=28). In group II little changes of arterial blood pressure during the operation were observed. Also the mean time for patient's awaiking was significantly shorter which allowed effective postoperative evaluation of neurological status. In group II only 1 patient required administration of urapidil and in group I 11 ( 40.7%) of patients required lowering blood pressure treatment. There were 7 cases of intra-operative aneurysm ruptures and 5 cases of brain artery embolism not significantly associated with anaesthesia given. It is of a high importance to maintain intraoperatively normal blood pressure, normal blood oxigenation, normal fluid administration and normal blood carbon dioxide levels.

Topics: Anesthesia, General; Anesthetics, Intravenous; Carbon Dioxide; Female; Fentanyl; Humans; Hydrotherapy; Hypertension; Intracranial Aneurysm; Intraoperative Care; Male; Middle Aged; Neurologic Examination; Neuromuscular Nondepolarizing Agents; Oxygen; Postoperative Care; Propofol; Thiopental; Vecuronium Bromide

Hypertensive patients are prone to haemodynamic changes after laryngoscopy and tracheal intubation. This study was undertaken to compare the efficacy of a combination of diltiazem and lidocaine with that of each drug alone for suppressing the cardiovascular responses to tracheal intubation.. Sixty hypertensive patients (ASA II), defined as systolic blood pressure > 160 mmHg and/or diastolic blood pressure > 95 mmHg (World Health Organization), undergoing elective surgery received, in a randomized, double-blind manner, 0.3 mg.kg-1 diltiazem, 1.5 mg.kg-1 lidocaine, or 0.3 mg.kg-1 diltiazem plus 1.5 mg.kg-1 lidocaine i.v. (n = 20 of each) before the initiation of laryngoscopy. Anaesthesia was induced with 5 mg.kg-1 thiopentone i.v., and tracheal intubation was facilitated with 2 mg.kg-1 succinylcholine i.v. after precurarization with 0.02 mg.kg-1 vecuronium i.v. Changes in heart rate (HR), mean arterial pressure (MAP) and rate-pressure product (RPP) were measured before and at immediate, 1, 2, 3, 5 and 10 min after tracheal intubation.. The inhibitory effects of diltiazem-lidocaine combination on cardiovascular responses to tracheal intubation was greater than those of diltiazem or lidocaine as a sole medicine (RPP; 10,602 +/- 1448 (combination) vs 11,787 +/- 1345 (diltiazem), 15,428 +/- 1756 (lidocaine), mean +/- SD, P < 0.05).. Prophylactic therapy with diltiazem-lidocaine combination is more effective than diltiazem or lidocaine alone for attenuating the cardiovascular changes associated with tracheal intubation in hypertensive patients.

Topics: Aged; Anesthetics, Intravenous; Anti-Arrhythmia Agents; Antihypertensive Agents; Blood Pressure; Diltiazem; Double-Blind Method; Drug Combinations; Female; Heart Rate; Humans; Hypertension; Injections, Intravenous; Intubation, Intratracheal; Laryngoscopy; Lidocaine; Male; Middle Aged; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Succinylcholine; Thiopental; Vecuronium Bromide

The effects of laryngeal mask airway (LMA) insertion and tracheal intubation on circulatory responses were studied in normotensive (n = 24) and hypertensive (n = 22) patients. In a randomized, double-blind manner, LMA insertion or tracheal intubation was performed after induction of anaesthesia with thiopentone and muscle relaxation with succinylcholine. In both normotensive and hypertensive patients, heart rate (HR), mean arterial pressure (MAP) and rate-pressure product increased after tracheal intubation or LMA insertion compared with baseline (P < 0.05). The haemodynamic changes were greater after intubation than after LMA insertion (P < 0.05). Following intubation of the trachea or insertion of the LMA, HR increased more markedly in hypertensive patients than in normotensive patients (P < 0.05). Plasma adrenaline and noradrenaline concentrations after tracheal intubation or LMA insertion increased compared with baseline values (P < 0.05) in normotensive and hypertensive patients. The increase in noradrenaline concentration after tracheal intubation was greater than that after LMA insertion (P < 0.05). No patient revealed ECG evidence of myocardial ischaemia. We conclude that insertion of LMA is associated with less circulatory responses than tracheal intubation in both normotensive and hypertensive patients.

Topics: Adult; Aged; Anesthesia, Intravenous; Blood Pressure; Cardiac Complexes, Premature; Double-Blind Method; Epinephrine; Female; Heart Rate; Humans; Hypertension; Intubation, Intratracheal; Laryngeal Masks; Male; Middle Aged; Myocardial Infarction; Neuromuscular Junction; Norepinephrine; Succinylcholine; Thiopental; Ventricular Dysfunction

Thirty women with pregnancy-induced hypertension (PIH) scheduled for Caesarean section under general anaesthesia were studied to evaluate the efficacy of sublingual nifedipine in attenuating the pressor response to laryngoscopy and tracheal intubation. The patients were randomly given either the contents of a nifedipine capsule 10 mg or placebo sublingually 20 min before induction of anaesthesia. Blood pressure and heart rate were recorded at various time intervals. There was a decrease in mean arterial blood pressure (MAP) after pretreatment with nifedipine (P < 0.01). The increase in MAP during laryngoscopy and intubation was higher in the control group compared with nifedipine pretreatment group (P < 0.01). During laryngoscopy and intubation, MAP decreased by 3 mmHg in the nifedipine pretreatment group, while there was an increase of 14 mmHg in the control group. Heart rate increased in both the groups during the laryngoscopy and tracheal intubation (P < 0.01) but the increase was higher in the nifedipine group than in the control group (P < 0.05). Neonatal Apgar scores in both the groups were comparable. These results suggest that sublingual nifedipine is effective in attenuating the hypertensive response to laryngoscopy and intubation but not the tachycardiac response in parturients with PIH.

Topics: Administration, Sublingual; Adult; Anesthesia, Intravenous; Apgar Score; Blood Gas Analysis; Blood Pressure; Cesarean Section; Female; Heart Rate; Humans; Hypertension; Intubation, Intratracheal; Laryngoscopy; Nifedipine; Placebos; Pregnancy; Pregnancy Complications, Cardiovascular; Thiopental; Time Factors

The effect of fentanyl, 8 micrograms/kg, used as an adjunct to thiopental for induction of anesthesia, on the circulatory response to tracheal intubation was investigated in 36 patients undergoing major vascular surgery. Patients were randomly assigned to receive either thiopental, 6 mg/kg, alone (N = 18), or thiopental, 3 mg/kg, along with fentanyl, 8 micrograms/kg (N = 18), for induction of anesthesia. The electrocardiogram, arterial pressure, pulmonary capillary wedge pressure, cardiac output, and central venous pressure were measured during induction of anesthesia, laryngoscopy, and intubation. Mean arterial blood pressure increased more following intubation in patients given thiopental than in patients given fentanyl-thiopental, reaching a peak value of 144 +/- 4 torr in patients receiving thiopental only, compared with 108 +/- 6 torr in those receiving fentanyl and thiopental (p less than 0.0001). Increases in systolic blood pressure, diastolic blood pressure, and pulmonary capillary wedge pressure with intubation were also significantly greater following administration of thiopental than following fentanyl-thiopental. Doses of fentanyl that are low enough to cause little postoperative respiratory depression significantly blunt postintubation hypertension when used as an adjunct to thiopental.

Topics: Anesthesia; Fentanyl; Heart Rate; Hemodynamics; Humans; Hypertension; Intubation, Intratracheal; Laryngoscopy; Random Allocation; Thiopental

Arterial blood pressure and pulse rate changes following tracheal intubation were studied in 20 patients undergoing intracranial surgery who received a thiopentone/suxamethonium anaesthetic induction sequence. Ten of the patients were pretreated with 0.4 mg/kg of hydrallazine and 10 with saline to determine whether hydrallazine prevents intubation hypertension. The results show that the incidence of intubation hypertension can be reduced using this dose of hydrallazine. Hydrallazine pretreatment is therefore recommended in patients at risk from hypertension following tracheal intubation.

Topics: Adult; Anesthesia, General; Brain; Clinical Trials as Topic; Female; Humans; Hydralazine; Hypertension; Intubation, Intratracheal; Male; Middle Aged; Premedication; Random Allocation; Succinylcholine; Thiopental

The blood pressure responses of 34 unselected hypertensive patients with and without preoperative antihypertensive therapy during thiopentone-N2O-O2-relaxant-analgesic anesthesia and the immediate postoperative period were studied. The blood pressure fluctuations, expressed as differences between the highest and lowest levels of both systolic and diastolic pressure during anaesthesia were significantly (p less than 0.01) greater in untreated hypertensive patients than in treated ones. A significant decline (p less than 0.01) of the mean blood pressure values from the initial level was seen in both treated and untreated patients during the first 24 postoperative hours. Urinary output was greater (p less than 0.05) in treated than in untreated hypertensive patients during a postoperative follow-up of 4 hours. The results show that hypertensive patients treated with antihypertensive drugs until the day of operation endure the anesthesia and the operation better than untreated patients.

Topics: Adult; Anesthesia, General; Antihypertensive Agents; Blood Pressure; Female; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Surgical Procedures, Operative; Thiopental

A technique of nebulizing lidocaine in the upper airways was developed and its effectiveness in preventing cardiovascular responses to laryngoscopy and intubation was documented. In ten pre-treated patients the average percentage-rise in systolic blood pressure was 10.3 per cent and there were no arrhythmias. The pulse rate increased by 16.8 per cent. In ten control patients, the systolic blood pressure increased by 56 per cent and the incidence of arrhythmias was 40 per cent. The pulse rate increased by 38.8 per cent. The significance and application of these results is discussed and compared to other available methods. The opinion is expressed that the effect of the aerosol, especially as it relates to the suppression of arrhythmias, is partly due to systemic absorption of lidocaine.

Topics: Aerosols; Aged; Arrhythmias, Cardiac; Blood Pressure; Carbon Dioxide; Clinical Trials as Topic; Electrocardiography; Halothane; Humans; Hypertension; Intubation, Intratracheal; Laryngoscopy; Lidocaine; Male; Middle Aged; Nitrous Oxide; Oxygen; Potassium; Pulse; Thiopental

The aim of this study is to establish the initial safety of triple neuroprotection (TNP) in an acute stroke setting in patients presenting outside the window for systemic tissue plasminogen activator (tPA).. Over 12,000 patients were referred to our vascular services with carotid artery disease, of whom 832 had carotid intervention with a stroke rate of 0.72%. Of these, 25 patients presented (3%), between March 2015 and 2019, with acute dense stroke. These patients had either failed tPA or passed the recommended timing for acute stroke intervention. Fifteen (60%) had hemi-neglect with evidence of acute infarct on magnetic resonance imaging of the brain and a Rankin score of 4 or 5. Ninety-six percent had an 80-99% stenosis on the symptomatic side. Mean ABCD3-I score was 11.35. All patients underwent emergency carotid endarterectomy (CEA) with therapeutically induced hypothermia (32-34°C), targeted hypertension (systolic blood pressure 180-200 mm Hg), and brain suppression with barbiturate.. There were no cases of myocardial infarction, death, cranial nerve injury, wound hematoma, or procedural bleeding. Mean hospital stay was 8.4 (±9.5) days. All cases had resolution of neurological symptoms, except 3 who had failed previous thrombolysis. Eighty percent had a postoperative Rankin score of 0 on discharge and 88% of patients were discharged home with 3 requiring rehabilitation.. Positive neurological outcomes and no serious adverse events were observed using TNP during emergency CEA in patients with acute brain injury. We recommend TNP for patients who are at an increased risk of stroke perioperatively, or who have already suffered from an acute stroke beyond the recommended window of 24 hr. Certainly, the positive outcomes are not likely reproducible outside of high-volume units and patients requiring this surgery should be transferred to experienced surgeons in appropriate tertiary referral centers.

Topics: Aged; Aged, 80 and over; Carotid Stenosis; Databases, Factual; Emergencies; Endarterectomy, Carotid; Female; Humans; Hypertension; Hypothermia, Induced; Infusions, Intravenous; Length of Stay; Male; Middle Aged; Neuroprotective Agents; Pilot Projects; Retrospective Studies; Risk Factors; Stroke; Thiopental; Time Factors; Time-to-Treatment; Treatment Outcome

Topics: Adult; Anesthesia Recovery Period; Anesthesia, Inhalation; Aortic Valve Insufficiency; Cerebrovascular Circulation; Electroencephalography; Extracorporeal Circulation; Heart Arrest, Induced; Heart Valve Prosthesis Implantation; Humans; Hypertension; Hypothermia, Induced; Hypoxia, Brain; Intraoperative Complications; Male; Methyl Ethers; Monitoring, Intraoperative; Propofol; Sevoflurane; Thiopental

Posterior reversible encephalopathy syndrome refers to a neuroradiologic disorder in which seizure activity (multiple seizures are more common than single events) is commonly the initial presenting symptom. We describe a case of posterior reversible encephalopathy syndrome in a previously healthy parturient who presented to the labor and delivery suite with generalized tonic-clonic seizures. Prompt recognition and treatment of this potentially catastrophic disease may avert injury to the patient and neonate.

Topics: Adolescent; Anesthetics, Intravenous; Anticonvulsants; Brain; Cesarean Section; Epilepsy, Tonic-Clonic; Factor V; Female; Humans; Hypertension; Intubation, Intratracheal; Magnesium Sulfate; Magnetic Resonance Imaging; Neuromuscular Depolarizing Agents; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Succinylcholine; Syndrome; Tachycardia; Thiopental; Tomography, X-Ray Computed

HELLP syndrome is a severe complication of pre-eclampsia characterised by hemolysis, elevated liver enzymes and a low platelet count. It is associated with an increased risk of adverse outcome for both the mother and the fetus. Patients with HELLP syndrome are also at greater risk of pulmonary edema, adult respiratory distress syndrome, abruptio placentae, intracerebral hemorrhage, eclamptic convulsions, disseminated intravascular coagulation, ruptured liver hematomas and acute renal failure. Perinatal mortality is equally high. Before delivery, aggressive obstetric management is directed toward stabilization of the affected organ systems, if possible, and interruption of the pregnancy in the early phase of the accelerated disease progression. Definitive therapy is delivery. Parturients HELLP syndrome often require general anesthesia for Cesarean section delivery. The anesthetic technique is critical for these patients with a high risk of uncontrollable hypertension, bleeding and multiple organ failure. Remifentanil is increasingly used as a very short analgesic agent providing cardiovascular stability in high-risk patients. We report the management of a patient presenting in labor with HELLP syndrome, and describe the successful use of remifentanil as part of the anesthetic technique for her subsequent Cesarean section.

Topics: Adult; Anesthesia, General; Anesthesia, Obstetrical; Anesthetics, Combined; Anesthetics, Intravenous; Antihypertensive Agents; Cesarean Section; Female; HELLP Syndrome; Hemodynamics; Humans; Hypertension; Methyldopa; Monitoring, Intraoperative; Neuromuscular Depolarizing Agents; Piperidines; Pregnancy; Remifentanil; Succinylcholine; Thiopental

This study utilized the dorsal microcirculatory chamber (DMC) model to determine differential effects of i.v. propofol, ketamine, and thiopental anaesthesia on the skeletal muscle microcirculation (10-180 micro m) of normotensive (Male Wistar Kyoto, WKY) and hypertensive (spontaneously hypertensive Harlan, SHR) rats, importantly, comparing responses to a conscious baseline.. Three weeks following implantation of the DMC in WKY (n=8) and SHR (n=6) (130 g) 0.25 ml 100 g(-1) FITC-BSA (i.v.) was administered and the microcirculation viewed using fluorescent in vivo microscopy for a 30 min baseline (t=0-30 min). This was followed by either propofol, thiopental, ketamine, or saline (i.v. bolus induction over 5 min (t=30-35 min)), then maintenance step-up infusion for 60 min (t=45-105 min), so that animals received all four agents 1 week apart (56 experiments).. Dilation of A3 arterioles (15-30 micro m) and V3 venules (20-40 microm) with propofol was greater in SHR (t=95 min, A3 36.7 (12)%, V3 15.5 (2.3)%) than WKY (t=95 min, A3 19.4 (7.4)%, V3 8.0 (2.3)%) (P<0.05). Constriction of A3 with ketamine was greater in SHR (t=95 min, A3 -29.1 (6.4)%) than WKY (A3 -17.5 (8.8)%) (P<0.05). This was accompanied by hypotension with propofol in SHR (-32% decrease in systolic arterial pressure), but not WKY (-6%) and hypertension with ketamine in WKY (-15%) and SHR (-24%) (P<0.05). During thiopental anaesthesia there was dilation of A1 (80-180 microm), A3, and V3 in WKY (P<0.05). Conversely, in SHR dilation of venules (29.2 (8.7)%) was accompanied by constriction of A1 and A3 (t=95 min, A1 -25.1 (5.9)%, A3-45.2 (3.1)%) (P<0.05).. Within the skeletal muscle microcirculation of hypertensive rats there is enhanced dilation with propofol and constriction with ketamine, associated with exaggerated changes in arterial pressure. Thus, dysfunctional control mechanisms at the level of the microcirculation alter responses to anaesthesia during hypertension.

Topics: Anesthetics, Dissociative; Anesthetics, Intravenous; Animals; Arterioles; Dose-Response Relationship, Drug; Hypertension; Ketamine; Male; Microcirculation; Muscle, Skeletal; Propofol; Rats; Rats, Inbred WKY; Thiopental; Venules

Anaesthetic management of a parturient with predicted difficult airway presenting for caesarean section (CS) is not a straightforward decision: general anaesthesia should be avoided because intubation can be impossible and a "cannot intubate, cannot ventilate" scenario might ensue, on the other hand regional techniques can be unsuccessful or, though rarely, have complications that require emergency intubation. The case is presented of a primigravida admitted to hospital at 37 weeks' gestation with hypertension, intrauterine growth retardation and oligohydramnios. After a few days' observation, it was decided to proceed with an elective CS. The preoperative airway examination revealed a poor mouth opening with an interdental distance of 20 mm and a Mallampati class IV. The patient was classified as a case of difficult intubation and the following anaesthetic options were considered: epidural anaesthesia, spinal anaesthesia and awake fibreoptic intubation followed by general anaesthesia. The pros and the cons of these techniques were explained to the patient and it was suggested that awake fibreoptic intubation was the safest option. The patient gave her consent, so an uneventful nasal awake fibreoptic intubation was carried out under local anaesthesia. This case report offers the opportunity to underline the risk to perform a central blockade in a parturient with predicted difficult intubation, arguing that the safest course of action is an awake fibrescopic intubation, besides some controversial points to safely perform awake fibreoptic intubation in obstetric patients are discussed.

Topics: Administration, Intranasal; Adult; Anesthesia, Inhalation; Anesthesia, Local; Anesthesia, Obstetrical; Atracurium; Cesarean Section; Elective Surgical Procedures; Female; Fetal Growth Retardation; Fiber Optic Technology; Humans; Hypertension; Infant, Newborn; Intubation, Intratracheal; Lidocaine; Methyl Ethers; Monitoring, Intraoperative; Nitrous Oxide; Oligohydramnios; Patient Acceptance of Health Care; Pregnancy; Pregnancy Complications; Sevoflurane; Thiopental; Wakefulness

Topics: Adolescent; Adult; Aged; Anesthetics, Intravenous; Hemodynamics; Humans; Hypertension; Intubation, Intratracheal; Middle Aged; Propofol; Prospective Studies; Random Allocation; Tachycardia; Thiopental

The aim of the present study was to investigate the role of potential clinical risk factors in the causation of peri-operative stroke associated with carotid endarterectomy. With the change in carotid endarterectomy practice from the use of a shunt to high-dose thiopental for cerebral protection (a previously undocumented method), it was essential to identify accurately the causes of all perioperative strokes.. A prospective audit was undertaken of 1000 carotid endarterectomies in which the causes and pathology of all peri-operative strokes were documented. The roles of advanced age, female gender, hypertension, previous stroke, contralateral carotid stenosis >70%, and contralateral carotid occlusion as potential causes of peri-operative stroke were defined. Results were statistically analysed using odds ratio and Fisher's exact test.. None of the potential risk factors was statistically significant for peri-operative stroke. Female gender was associated with a significant risk of peri-operative stroke due to operative site thrombosis. Complications at the endarterectomy site were the commonest cause of stroke.. Prospective audit is a useful tool for identifying causes of peri-operative stroke and indicating the need for modifications to surgical clinical management which might improve outcomes for carotid endarterectomy.

Topics: Age Factors; Aged; Anesthetics, Intravenous; Carotid Stenosis; Endarterectomy, Carotid; Female; Humans; Hypertension; Male; Medical Audit; Postoperative Period; Prospective Studies; Risk Factors; Sex Factors; Stroke; Thiopental

This study was designed to test whether previous work, which showed that the angiotensin converting enzyme (ACE) inhibitor enalaprilat potentiated the alpha 1-adrenoceptor antagonist activity of doxazosin in isolated rat tail arteries, could be extended to demonstrate a synergistic hypotensive effect of these two drugs.. Groups of untreated or chronically deoxycorticosterone acetate (DOCA)-salt-treated female Sprague-Dawley rats were used. Rats were anaesthetized with Inactin (barbiturate); drugs were administered via a jugular venous catheter; blood pressure was monitored via a carotid arterial catheter.. In previously untreated rats, pretreatment with enalaprilat shifted the dose-response curve for the hypotensive effect of doxazosin to the left, indicating synergism. In rats dosed with DOCA-salt (which suppresses renin and angiotensin II production): (1) there was no synergism between the hypotensive actions of enalaprilat and doxazosin; (2) doxazosin was more potent than in untreated rats; and (3) enalaprilat lowered blood pressure, suggesting a hypotensive mechanism separate from ACE inhibition.. In the absence of angiotensin II (resulting from enalaprilat administration or from chronic DOCA-salt), doxazosin had a greater hypotensive action than in the presence of angiotensin II. This is consistent with the concept that angiotensin II modulates alpha 1-adrenoceptor activity.

Topics: Anesthesia; Animals; Antihypertensive Agents; Desoxycorticosterone; Disease Models, Animal; Dose-Response Relationship, Drug; Doxazosin; Drug Evaluation, Preclinical; Drug Interactions; Enalaprilat; Female; Hypertension; Prazosin; Rats; Rats, Inbred Strains; Thiopental

The effects of antihypertensive drugs, such as nifedipine, chlorpromazine, reserpine and thiopental on mean arterial blood pressure (ABP), mean intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were studied in 43 patients with systemic hypertension and intracranial hypertension due to hemorrhagic cerebrovascular diseases and other causes. These drugs are commonly used in neurosurgical practice for the treatment of systemic hypertension. Nifedipine, chlorpromazine and reserpine reduced the mean ABP, raised the mean ICP and decreased the CPP. The effects of these drugs on mean ICP and CPP were more pronounced in patients with severely increased ICP (more than 40 mmHg) than in patients with moderately increased ICP (20-40 mmHg). Thiopental reduced both mean ABP and ICP, whereas the CPP was unchanged from the preadministration level. During thiopental administration, however, respiratory depression was observed, and hence, intubation and ventilation were required. We suggest that, in the treatment of systemic hypertension in patients with increased ICP, barbiturates are more desirable than agents with calcium channel or alpha-adrenergic blocking actions, despite the problem of respiratory control.

Topics: Adult; Aged; Antihypertensive Agents; Blood Pressure; Brain Edema; Cerebral Hemorrhage; Cerebrospinal Fluid Pressure; Chlorpromazine; Female; Humans; Hypertension; Intracranial Pressure; Male; Middle Aged; Nifedipine; Pseudotumor Cerebri; Reserpine; Thiopental

Topics: Anesthetics; Arterial Occlusive Diseases; Carotid Artery Diseases; Fentanyl; Humans; Hypertension; Intracranial Aneurysm; Male; Middle Aged; Phenylephrine; Sufentanil; Thiopental

Open-loop tubulo-glomerular feedback (TGF) responses were measured in halothane anaesthetized spontaneously hypertensive rats (SHR), in normotensive Wistar Kyoto (WKY) and Sprague-Dawley rats (SPRD), and in inactin anaesthetized SPRD. Proximal intratubular free flow pressures (FFP) (13.8-14.7 mm Hg) and stop-flow pressures (40.0-42.4 mm Hg) were similar in the four groups, but systemic arterial pressure was significantly lower in WKY, and significantly higher in SHR than in SPRD. The turning point (Tp) of the feedback curve was 9.87 nl/min in SHR, significantly lower than the 13.04 nl/min found in WKY. Maximum TGF pressure response was 28.6% greater in SHR than in the normotensive rats (13.3 vs. 9.5 mm Hg; p less than 0.025). The sensitivity, as estimated from the slope of the feedback curve at the Tp [f'(Tp)] was 87% greater in SHR than in WKY. There was no significant difference between these parameters in WKY and SPRD. The TGF pressure response was biphasic in the 3 groups of halothane anaesthetized rats with a steady state level reached in about 2 min after the change in late proximal microperfusion rate. In inactin anaesthetized rats the sensitivity was 41% lower than in the halothane anaesthetized control group of SPRD, the feedback response was lower, and the feedback curve was displaced to the right with the Tp at 15.9 nl/min, significantly higher than in the control group (p less than 0.001). Although the steady state level also was reached within 2 min, the clearly biphasic pattern of the pressure response was less consistent.

Topics: Animals; Blood Flow Velocity; Blood Pressure; Feedback; Halothane; Hypertension; Kidney Glomerulus; Kidney Tubules, Proximal; Male; Rats; Rats, Inbred SHR; Rats, Inbred Strains; Rats, Inbred WKY; Thiopental

The clinical course and the intracranial pressure (ICP) changes in 66 severe head injury patients presenting bulk enlargement of one cerebral hemisphere within a few hours of trauma have been analyzed. These patients represent 11% of a series of 589 severe head injury cases studied with computerized tomography (CT). Cerebral hemisphere swelling, which was associated with an ipsilateral subdural haematoma of variable extent in 58 patients (88%), or a large epidural haematoma in 5 patients (7%), and occurred as an isolated lesion in 3 patients (4%), carried the highest incidence of uncontrollable intracranial hypertension, the highest mortality rate and the shortest survival period after trauma in the authors' severe head injury series. The high incidence of arterial hypotension and/or hypoxaemia at admission (48% of cases), and the severity of clinical presentation (82%) of patients scored 5 patients or less in the Glasgow Coma Scale, 77% had uni- or bilateral mydriasis and 82% initial ICP above normal limits) correlated with the very poor final outcome (85% mortality). Only one of the 12 patients with normal initial ICP continued to have low pressure throughout the course. High dose thiopental failed to control severe intracranial hypertension in 29 patients (44%) who had a fulminant, malignant course. A transient decrease in ICP elevation was achieved in 17 patients (26%) and a definitive control in 12 patients (18%), among them the 10 survivors in this series. In the authors experience once ICP is controlled, and unless haemodynamic instability compells action to the contrary, barbiturate should not be discontinued until a control CT scan shows complete disappearance of the mass effect.

Topics: Adolescent; Adult; Aged; Brain Edema; Brain Injuries; Child; Child, Preschool; Humans; Hypertension; Hypoxia; Infant; Intracranial Pressure; Male; Middle Aged; Thiopental; Tomography, X-Ray Computed

Topics: Animals; Drug Interactions; Hypertension; Ischemic Attack, Transient; Isoflurane; Papio; Phenylephrine; Thiopental

Proximal tubular compliance (C) was measured in free flow microperfusion experiments from the initial slope of the increase in proximal luminal pressure divided by the step input of volume flow delivered from a microperfusion pipette inserted in a downstream proximal convolution. Five groups of rats were studied: Munich Wistar (WU, n = 11) and Sprague-Dawley rats (SPRD, n = 6) anaesthetized with inactin; and SPRD (n = 11), Wistar Kyoto (WKY, n = 9), and spontaneously hypertensive rats (SHR, n = 11) anaesthetized with halothane. In the inactin groups, C was: 0.309 +/- 0.161 and 0.266 +/- 0.136 nl mm Hg-1, respectively. In the halothane groups, C was: 0.125 +/- 0.023, 0.125 +/- 0.029, and 0.119 +/- 0.0127 nl mm Hg-1, respectively. The means in the inactin groups were significantly higher than those from the halothane groups (P less than 0.001). It is concluded that the choice of anaesthetics has a profound influence on the proximal tubular compliance in the rat, and that the compliance of SHR is equal to that of normotensive rats.

Topics: Anesthesia, Inhalation; Animals; Compliance; Halothane; Hypertension; Kidney Tubules, Proximal; Male; Nitrous Oxide; Perfusion; Pressure; Rats; Rats, Inbred SHR; Rats, Inbred Strains; Rats, Inbred WKY; Thiopental

Topics: Anesthesia, Obstetrical; Cesarean Section; Diazoxide; Female; Humans; Hypertension; Pregnancy; Pregnancy Complications, Cardiovascular; Thiopental

Renin and angiotensin II have been measured before and 10 minutes after anaesthesia, in 23 patients undergoing minor gynaecological surgery. Twelve were anaesthetised with ketamine 2 mg/kg i.v. and the remainder with thiopentone 5-10 mg/kg i.v. Arterial blood pressure was monitored automatically throughout. The arterial blood pressure rose significantly in the group given ketamine and plasma AII concentration fell. In the group given thiopentone there was no significant overall change in blood pressure but an increase in AII. Plasma renin concentration and activity showed significant increases following the administration of ketamine but were unchanged following thiopentone. Overall, there was a significant inverse relationship between the change in blood pressure and the change in AII. This is compatible with a negative feedback being exerted on the renin-angiotensin system by the raised blood pressure, which has itself been evoked by some quite different factor or factors. We conclude that the renin-angiotensin system is not concerned in the pressor response to ketamine.

Topics: Adult; Aldosterone; Angiotensin II; Blood Pressure; Female; Humans; Hypertension; Ketamine; Renin; Renin-Angiotensin System; Thiopental

Using two infusion anaesthesiamethods for laryngomicroscopy in 187 non-selected patients we studied the recovery phase with the aid of a special questionnaire filled in by the recovery room nurse. Premedication was with Thalamonal and atropine. Muscle relaxation was achieved by a succinylcholine drip. Induction doses: fentanyl 0.05-0.1 mg and thiopental 3-5 mg/kg bodyweight (Th-group) or diazepam 10-20 mg and ketamine 1 mg/kg bodyweight (K-group). Infusion doses: Thiopental 11.7 mg/min. (Th-group) or diazepam 0.2 mg/min. and ketamine 2 mg/min (K-group). Anaesthesia lasted for 20-30 min. We observed and noted during recovery: Breathing, cough-frequency and -quality, alertness, reaction to speech and stimulation, orientation, motor behaviour and well-being. Anaesthesia was sufficient in both groups. The patients of the K-group woke up earlier and their laryngeal reflexes seemed to stabilize quicker than in the Th-group. Because of the elevation of blood pressure caused by the stimulation of the laryngoscopy both methods are not recommended for patients at risk from high blood pressure.

Topics: Adult; Aged; Anesthesia, Intravenous; Blood Pressure; Diazepam; Female; Fentanyl; Humans; Hypertension; Ketamine; Laryngoscopy; Male; Middle Aged; Postoperative Period; Respiration; Risk; Thiopental

The hemodynamic effects of a single dose of fentanyl (4 micrograms/kg) and of thiopental (5 mg/kg) were studied on cranial trauma patients who have hypertension and who are ventilated at constant volume and frequency. At first the results were collected without an hypertensive treatment, in the second time the same results were collected after the injection of an anti-hypertensive drug (guanoxabenz 70 micrograms/kg). The results showed that in two series the modification in the measured parameters was not statistically significant; the used drugs produced little change in the hemodynamic profile: a) Even with insignificant, we noted that the injection of fentanyl after an anti-hypertensive drug caused a smaller change in the blood pressure and cardiac index then was seen in untreated subjects. b) With thiopental treated subjects, the arterial pressure is not decreased because of the increased systemic resistances, at the same time changes in cardiac index are essentially identical whether or not the subject was treated with guanoxabenz. The results therefore tend to show that the anti-hypertensive treatment can be continued without any interruption by a surgical operation.

Topics: Aged; Antihypertensive Agents; Craniocerebral Trauma; Drug Interactions; Fentanyl; Guanabenz; Guanidines; Hemodynamics; Humans; Hypertension; Middle Aged; Thiopental

Topics: Analgesics, Opioid; Anesthesia, Inhalation; Anesthesia, Intravenous; Humans; Hypertension; Intraoperative Period; Nitrous Oxide; Postoperative Complications; Retrospective Studies; Thiopental

The authors had observed that on intraoperative discontinuation of sodium nitroprusside being administered to induce hypotension, mean arterial pressure increased to above the pre-hypotension level. Twelve patients who recieved hypotensive anesthesia for surgical correction of cerebral aneurysms were studied to evaluate the role of the renin-angiotensin system in this phenomenon. In the awake state, mean arterial pressure was 100 +/- 2 torr and plasma renin activity 3.0 +/- 0.1 ng/ml/hr. Thirty minutes after the establishment of stable halothane-nitrous oxide anesthesia, mean arterial pressure decreased to 85 +/- 1 torr and plasma renin activity increased to 4.4 +/- 0.1 ng/ml/hr. No appreciable change in either occurred over the next two hours of operation. During sodium nitroprusside-induced hypotension, mean arterial pressure decreased to 49 +/- 2 torr and plasma renin activity increased to 15.2 +/- 0.2 ng/ml/hr. Thirty minutes after discontinuation of sodium nitroprusside administration, mean arterial pressure increased to 112 +/- 2 torr, which was not only higher than the prehypotension level, but also significantly higher than that recorded in the awake state. Plasma renin activity at that time was 10.9 +/- 0.1 ng/ml/hr. As the half-life of plasma renin is 15 min, the data suggest that the persistently increased plasma renin activity is probably responsible for the increase of arterial pressure following sodium nitroprusside-induced hypotension.

Topics: Adolescent; Adult; Anesthesia, General; Blood Pressure; Ferricyanides; Halothane; Humans; Hypertension; Hypotension, Controlled; Injections, Intravenous; Intracranial Aneurysm; Middle Aged; Nitroprusside; Nitrous Oxide; Renin; Thiopental

Topics: Anesthesia, Inhalation; Animals; Blood Pressure; Blood-Brain Barrier; Carbon Dioxide; Cerebral Arteries; Evans Blue; Halothane; Hypertension; Nitrous Oxide; Norepinephrine; Pancuronium; Rabbits; Thiopental; Vasoconstriction; Vasodilation

Topics: Acute Disease; Anesthetics; Animals; Blood-Brain Barrier; Halothane; Hypertension; Rabbits; Thiopental

A case is reported of a patient with a cerebral aneurysm in whom it was difficult to induce hypotension. The hyperadrenergic state mimicked, in some respects, that seen in patients with neural crest lesions. Possible mechanisms are discussed and the anaesthetic management described.

Topics: Adult; Anesthesia, General; Female; Humans; Hypertension; Hypotension, Controlled; Intracranial Aneurysm; Metanephrine; Nitroprusside; Thiopental; Tubocurarine; Vanilmandelic Acid

Topics: Anesthetics; Angiotensin II; Animals; Autoradiography; Blood Flow Velocity; Blood Pressure; Blood-Brain Barrier; Brain; Carbon Radioisotopes; Cerebrovascular Circulation; Cerebrovascular Disorders; Disease Models, Animal; Hypertension; Methoxyflurane; Rabbits; Thiopental; Vasomotor System

Topics: Adult; Aged; Anesthesia, Intravenous; Anesthesia, Local; Arteriosclerosis; Blood Pressure; Carotid Arteries; Carotid Sinus; Electrodes; Endarterectomy; Female; Humans; Hypertension; Male; Manometry; Middle Aged; Nitrous Oxide; Oscillometry; Oxygen; Pancuronium; Sodium; Thiopental; Trichloroethylene

Twenty patients with aneurysms of the internal carotid artery underwent temporary clamping, in turn, of the internal and then the common carotid artery. Cerebral blood flow, internal carotid artery pressure, and the EEG were recorded to assess the probability of cerebral ischaemia after permanent ligation. With this method of monitoring the cerebral circulation, 17 of the 20 patients had a permanent carotid ligation without neurological deficit; in the other three ligation was contraindicated. Although a correlation was observed between the reduction of cerebral blood flow and the fall in internal carotid artery pressure caused by temporary clamping (P<0·01), the scatter of data was too wide to predict cerebral blood flow from the change in carotid artery pressure. Similarly, EEG slowing was usually associated with low cerebral blood flow but exceptions occurred. Ligation was safe when, during temporary clamping, cerebral blood flow exceeded 40 ml/100 g/min, but was deemed unsafe when flow was less than 20 ml/100 g/min. In the range 20-40 ml/100 g/min, consideration of the internal carotid artery pressure permitted more patients to be safely ligated than if the decision had rested on changes in cerebral blood flow alone.

Topics: Adolescent; Adult; Aged; Anesthesia, General; Blood Pressure; Brain; Carotid Artery Diseases; Carotid Artery, Internal; Cerebrovascular Circulation; Electroencephalography; Humans; Hypertension; Intracranial Aneurysm; Ischemia; Middle Aged; Nitrous Oxide; Postoperative Complications; Respiration, Artificial; Subarachnoid Hemorrhage; Thiopental

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: Adolescent; Adult; Anesthesia, General; Anesthetics; Arrhythmias, Cardiac; Chlorprothixene; Female; Hemodynamics; Humans; Hypertension; Male; Methoxyflurane; Middle Aged; Phenoxybenzamine; Pheochromocytoma; Postoperative Care; Preanesthetic Medication; Premedication; Propranolol; Succinylcholine; Thiopental

Topics: Adult; Aged; Anesthesia, General; Arteries; Benperidol; Blood Pressure; Cardiac Output; Diazepam; Electrocardiography; Female; Heart Rate; Humans; Hypertension; Intubation, Intratracheal; Laryngoscopy; Male; Methohexital; Middle Aged; Neuroleptanalgesia; Phenoperidine; Propanidid; Tachycardia; Thiopental; Vascular Resistance

Topics: Adjuvants, Anesthesia; Adolescent; Adrenal Gland Neoplasms; Anesthesia, General; Appendicitis; Humans; Hypertension; Male; Nitrous Oxide; Pheochromocytoma; Preanesthetic Medication; Thiopental

Topics: Adult; Aged; Anesthesia, General; Blood Pressure; Brachial Artery; Cardiac Output; Cardiovascular System; Electrocardiography; Female; Halothane; Heart Rate; Humans; Hypertension; Male; Middle Aged; Nitrous Oxide; Pressoreceptors; Surgical Procedures, Operative; Thiopental; Vascular Resistance

Topics: Amphetamine; Ataxia; Bone Marrow; Cerebral Hemorrhage; Depression, Chemical; Dicumarol; Dihydroxyphenylalanine; Disulfiram; Drug Antagonism; Ephedrine; Humans; Hypertension; Hypotension; Isoniazid; Mercaptopurine; Methamphetamine; Microsomes, Liver; Monoamine Oxidase Inhibitors; Norepinephrine; Phenethylamines; Phenytoin; Reserpine; Stimulation, Chemical; Thiazines; Thiopental; Tyramine

Topics: Anesthesia, General; Child; Chlorpromazine; Fractures, Bone; Humans; Hypertension; Male; Meperidine; Nitrous Oxide; Oxygen; Promethazine; Radius Fractures; Tachycardia; Thiopental; Ulna; Urination Disorders

Topics: Adolescent; Adult; Amobarbital; Anesthesia; Blood Pressure Determination; Electrocardiography; Female; Humans; Hypertension; Intubation, Intratracheal; Laryngoscopy; Middle Aged; Morphine; Nitrous Oxide; Oxygen; Premedication; Succinylcholine; Thiopental

Topics: Adult; Aminobenzoates; Atropine; Bis-Trimethylammonium Compounds; Blood Pressure; Electrocardiography; Heart Conduction System; Humans; Hypertension; Male; Medication Errors; Meperidine; Preanesthetic Medication; Procaine; Pupil; Reflex, Pupillary; Seizures; Succinylcholine; Tachycardia; Thiopental

Topics: Angiography; Arm; Arteritis; Body Temperature; Diabetic Angiopathies; Hypertension; Leg; Raynaud Disease; Thiopental; Thromboangiitis Obliterans; Vascular Diseases; Vasomotor System

Topics: Adult; Brain; Central Nervous System Stimulants; Doxapram; Electroencephalography; Epilepsy; Female; Humans; Hydrochloric Acid; Hypertension; Hypoxia; Injections, Intravenous; Male; Middle Aged; Morpholines; Pyrrolidinones; Thiopental

Topics: Anesthesia; Anesthesiology; Barbital; Blood Pressure; Hypertension; Nervous System; Neurosurgical Procedures; Sodium; Thiopental