thiopental and Hypotension

Electrical cardioversion is an effective procedure for restoring normal sinus rhythm in the hearts of patients with irregular heart rhythms. It is important that the patient is not fully conscious during the procedure, as it can be painful and distressing. The drug used to make patients unaware of the procedure should rapidly achieve the desired level of sedation, should wear off quickly and should not cause cardiovascular or respiratory side effects.. We aimed to compare the safety, effectiveness and adverse events associated with various anaesthetic or sedative agents used in direct current cardioversion for cardiac arrhythmia in both elective and emergency settings.We sought answers to the following specific questions.• Which drugs deliver the best outcomes for patients undergoing electrical cardioversion?• Does using a particular agent confer advantages or disadvantages?• Is additional analgesic necessary to prevent pain?. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) on 27 March 2014. Our search terms were relevant to the review question and were not limited by outcomes. We also carried out searches of clinical trials registers and forward and backward citation tracking.. We considered all randomized controlled trials and quasi-randomized and cluster-randomized studies with adult participants undergoing electrical cardioversion procedures in the elective or emergency setting.. Two review authors independently assessed trial quality and extracted data, consulting with a third review author for disagreements. We used standard Cochrane methodological procedures, including assessment of risk of bias for all studies.. We included 23 studies with 1250 participants that compared one drug with one or more other drugs. Of these comparisons, 19 studies compared propofol with another drug. Seven of these compared propofol with etomidate (four of which combined the drugs with remifentanil or fentanyl), five midazolam, six thiopentone and two sevoflurane. Three studies compared etomidate with thiopentone, and three etomidate with midazolam. Two studies compared thiopentone with midazolam, one thiopentone with diazepam and one midazolam with diazepam. Drug doses and the time over which the drugs were given varied between studies. Although all studies were described as randomized, limited information was provided about the methods used for selection and group allocation. A high level of performance bias was observed across studies, as study authors had not attempted to blind the anaesthetist to group allocation. Similarly, study authors had rarely provided sufficient information on whether outcome assessors had been blinded.Included studies presented outcome data for hypotension, apnoea, participant recall, success of cardioversion, minor adverse events of nausea and vomiting, pain at injection site and myoclonus, additional analgesia and participant satisfaction. We did not pool the data from different studies in view of the multiple drug comparisons, differences in definitions and reporting of outcomes, variability of endpoints and high or unclear risk of bias across studies.. Few studies reported statistically significant results for our relevant outcomes, and most study authors concluded that both, or all, agents compared in individual studies were adequate for cardioversion procedures. It is our opinion that at present, there is no evidence to suggest that current anaesthetic practice for cardioversion should change.

Topics: Anesthetics; Apnea; Diazepam; Electric Countershock; Etomidate; Fentanyl; Humans; Hypnotics and Sedatives; Hypotension; Mental Recall; Methyl Ethers; Midazolam; Piperidines; Propofol; Randomized Controlled Trials as Topic; Remifentanil; Sevoflurane; Thiopental

Topics: Anesthesia; Barbiturates; Blood Circulation; Gastroesophageal Reflux; Humans; Hypotension; Intubation, Intratracheal; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Reflex, Abnormal; Succinylcholine; Thiopental; Time Factors; Vomiting

Propofol is commonly used with remifentanil for induction of general anesthesia (GA); however, it often leads to hypotension. Intraoperative hypotension is associated with postoperative adverse events. By contrast, thiopental has less negative inotropic effects on hemodynamics compared to propofol, which could be suitable to prevent hypotension during GA induction. In the present age-stratified, randomized, assessor-blinded study, using the ClearSight. Patients were divided into young (20-40 year), middle (41-70 year), and elderly (> 70 year) groups (n = 20, each group). General anesthesia was induced with remifentanil 0.3 μg/kg/min, followed by propofol (2.0, 1.5, and 1.2 mg/kg) or thiopental (5.0, 4.0, and 3.0 mg/kg) in the young, middle, and elderly groups, respectively. The primary outcome was the difference in the decrease in mean arterial blood pressure between patients receiving propofol and thiopental in each age group. The secondary outcomes included other hemodynamic parameters and minimal bispectral index values measured up to 10 min after tracheal intubation.. The decrease in mean arterial blood pressure was greater in patients receiving propofol than those receiving thiopental (- 45.4 vs - 26.6 mmHg and - 45.7 vs - 28.9 mmHg, P = 0.003 and 0.007, respectively), whereas no significant difference was observed in the young age group (P = 0.96).. Thiopental is a more suitable agent than propofol for avoiding hypotension during GA induction under remifentanil infusion in the middle and elderly patients.

Topics: Adult; Aged; Anesthesia, General; Anesthetics, Intravenous; Arterial Pressure; Double-Blind Method; Female; Hemodynamics; Humans; Hypotension; Intubation, Intratracheal; Male; Middle Aged; Propofol; Remifentanil; Thiopental; Young Adult

To evaluate the effects of meloxicam on renal function in dogs anaesthetized and rendered hypotensive with acepromazine-thiopental-isoflurane.. Eight healthy beagles, four males and four females, 25.6 +/- 19.3 months old and weighing 12.8 +/- 2.0 kg.. Either meloxicam suspension at a dose of 0.133 mL kg(-1) (0.2 mg kg(-1)) or 0.133 mL kg(-1) saline solution (control), were given by mouth (PO) in a randomized, cross-over fashion. The treatment or control was given 3 hours before anaesthesia. Dogs were sedated with intramuscular acepromazine 0.1 mg kg(-1). Anaesthesia was induced with intravenous thiopental, followed by tracheal intubation and maintenance with isoflurane in oxygen and air, delivered using a semi-closed breathing system. Renal function was quantified using serum biochemistry, urinalysis and glomerular filtration rate measured by scintigraphy. Analysis of variance or Friedman anova were used for statistical analysis.. Values (mean +/- SD) for mean arterial blood pressure did not differ significantly between treatments but was low (54 +/- 7 mmHg) during anaesthesia. Glomerular filtration rate did not differ significantly between treatments or over time, and results of urine and serum analysis were within reference ranges after meloxicam treatment.. Meloxicam caused no adverse effects on renal function when given to healthy dogs anaesthetized and rendered hypotensive with acepromazine, thiopental and isoflurane.

Topics: Acepromazine; Albumins; Analgesics, Non-Narcotic; Anesthesia, General; Animals; Blood Proteins; Cross-Over Studies; Dogs; Female; Glomerular Filtration Rate; Hypotension; Isoflurane; Kidney; Male; Meloxicam; Thiazines; Thiazoles; Thiopental

We evaluated the effectiveness of intentional hypercapnia against hypotension after induction of anaesthesia with thiopental and isoflurane (TI) or propofol (P). For each group, 24 patients were anaesthetized with thiopental 4 mg kg(-1) (TI) or propofol 2 mg kg(-1) (P) for tracheal intubation and then lightly anaesthetized with isoflurane at 0.6% end-expiratory concentration (TI) or by 6 mg kg(-1) h(-1) infusion of propofol (P). In both anaesthesia groups, patients were randomly assigned to either normocapnia (end-tidal CO(2) = 35 mmHg) or hypercapnia (end-tidal CO(2) = 45 mmHg), which were achieved through adjusting the tidal volume. Systolic arterial pressure (SAP) 15 min after intubation was compared with the preanaesthetic baseline value. Under normocapnia, both TI and P induced a comparable, statistically significant suppression of SAP by approximately 20 mmHg from baseline. Hypercapnia prevented the decrease in SAP in TI but not in P. No patient in the TI-hypercapnia group experienced SAP below 100 mmHg, unlike those in the other groups. In conclusion, mild hypercapnia was effective in the prevention of hypotension in patients receiving thiopental followed by 0.6% end-expiratory isoflurane, but not in patients receiving 6 mg kg(-1) h(-1) propofol.

Topics: Adult; Aged; Aged, 80 and over; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Blood Pressure; Carbon Dioxide; Female; Heart Rate; Humans; Hypercapnia; Hypotension; Isoflurane; Male; Middle Aged; Monitoring, Intraoperative; Propofol; Respiratory Mechanics; Thiopental

The efficacy of thoracic epidural sufentanil 50 micrograms was compared with lumbar epidural sufentanil 50 micrograms in 30 patients (n = 15 in each group) undergoing lateral thoracotomy. Sufentanil was administered epidurally after induction of anaesthesia with sufentanil 1 microgram.kg-1 and thiopentone 2-5 mg.kg-1 intravenously. Anaesthesia, nitrous oxide 66%, halothane 0.3% and sufentanil 25 micrograms intravenously were given whenever the systolic arterial blood pressure increased more than 15 mmHg above the preoperative value and heart rate exceeded 90 beat.min-1 in the absence of hypovolaemia, or when other autonomic or somatic signs were seen. Four patients in the thoracic epidural group and five in the lumbar epidural group needed supplementary sufentanil. Six patients in the thoracic epidural group and three in the lumbar epidural group each had a single hypotensive episode. Lumbar and thoracic epidural sufentanil are equally effective in contributing to intra-operative analgesia for lateral thoracotomy.

Topics: Adult; Aged; Anesthesia, Epidural; Anesthesia, Intravenous; Female; Humans; Hypotension; Lumbar Vertebrae; Male; Middle Aged; Sufentanil; Thiopental; Thoracic Vertebrae; Thoracotomy

The present investigation explored the possibility that the commonly observed hypotension that occurs during induction of anesthesia with propofol might be related to its ability to produce venodilation. Thirty-six ASA I and II patients who received no premedication were studied. The first 20 patients were divided into two equal groups. Hemodynamic measurements consisted of heart rate, arterial blood pressure, and forearm venous compliance by occlusive plethysmography. Baseline measurements were made in awake patients while resting in a supine position. Repeat measurements were made during steady-state infusions of propofol (2.5 mg/kg bolus injection, followed by a continuous infusion at 200 micrograms.kg-1.min-1) or thiopental (4 mg/kg bolus injection, followed by continuous infusion at 200 micrograms.kg-1.min-1), 10 min after tracheal intubation while patients were artificially ventilated. Both anesthetics resulted in a significant (P less than 0.05) and similar tachycardia; however, propofol produced significant decreases in systolic (-30 +/- 9 mm Hg) and diastolic (-11 +/- 4 mm Hg) arterial blood pressure. Forearm venous compliance was significantly increased during propofol administration but unchanged in patients receiving thiopental. In four additional patients receiving smaller consecutive infusions of propofol (50 and 100 micrograms.kg-1.min-1), significant subtle increases in forearm compliance were also recorded. These increases were not observed in four patients who received placebo infusions. Thus, one mechanism promoting hypotension during propofol anesthesia in humans seems to be related to its direct effects on venous smooth muscle tone and presumably venous return.

Topics: Adult; Aged; Anesthesia; Blood Pressure; Carbon Dioxide; Cardiac Output; Electroencephalography; Forearm; Humans; Hypotension; Middle Aged; Plethysmography; Propofol; Respiration; Thiopental; Vasodilation; Vasodilator Agents

Atracurium was administered by a variety of techniques to determine whether these influence the onset or duration of muscular relaxation, and the frequency of cutaneous reactions, after a standard induction dose of thiopentone. One-hundred-and-fifty patients were allocated randomly to receive the drug by one of five methods: into a fast-flowing crystalloid infusion in the antecubital fossa; into a winged needle in the antecubital fossa with flushing after the thiopentone; into a winged needle in the antecubital fossa without flushing; into a winged needle in the dorsum of the hand without flushing. The above groups received atracurium freshly removed from the refrigerator whereas the fifth group were given atracurium which had been maintained at room temperature for at least 2 weeks. The frequency of cutaneous reactions was between 60 and 70% overall and there were no significant differences either in this or in the onset or duration of action between the groups. A further 25 patients with a history of drug allergy were also investigated by the first method and showed no significant differences in response, but 25 patients aged over 70 years had a significantly lower frequency of cutaneous reactions with a higher frequency of hypotension than the other groups.

Topics: Adult; Aged; Atracurium; Drug Eruptions; Drug Storage; Humans; Hypotension; Intraoperative Complications; Middle Aged; Thiopental

Topics: Adult; Alcohols; Antioxidants; Benzyl Compounds; Blood Pressure; Clinical Trials as Topic; Humans; Hypotension; Intubation, Intratracheal; Middle Aged; Pharmaceutic Aids; Pulse; Succinylcholine; Sulfites; Thiopental; Tubocurarine

Topics: Adult; Anesthesia; Benperidol; Blood Pressure; Depression, Chemical; Electrocardiography; Female; Fentanyl; Heart Rate; Histamine Release; Humans; Hypotension; Male; Preanesthetic Medication; Propanidid; Stimulation, Chemical; Thiopental; Tremor; Vomiting

Topics: Adult; Aged; Anesthesia, Conduction; Anesthesia, General; Anesthesia, Spinal; Carbon Dioxide; Cardiac Output; Female; Halothane; Humans; Hypotension; Lidocaine; Middle Aged; Obesity; Oxygen; Pulmonary Atelectasis; Thiopental

Topics: Anesthesia, Conduction; Anesthesia, General; Anesthetics; Humans; Hypotension; Isoflurane; Postoperative Complications; Risk Factors; Stroke; Thiopental

Administration of improper drugs into epidural space is occasionally present in anesthetic practice. In most instances it would not contribute to significant neurological complications. There had not been severe hypotension reported in the literature in consequence of inadvertent epidural thiopental administration. Here we describe our experience in a case of inadvertent epidural administration of thiopental coinciding with induction of anesthesia with propofol, as a consequence of which profound hypotension was induced, necessitating aggressive inotropic and vasopressive agents to maintain blood pressure. Rapid vascular uptake of thiopental in the epidural space and synergistic action of propofol jointly contributed to the development of the hypotension. Attempts to forestall neurological sequela after the inadvertence seem unnecessary unless apparent symptoms or signs of neurological injury have come upon.

Topics: Aged; Anesthetics, Intravenous; Drug Synergism; Humans; Hypotension; Injections, Epidural; Male; Medication Errors; Propofol; Thiopental

Hypotension after induction of general anesthesia is a common event. In the current investigation, we sought to identify the predictors of clinically significant hypotension after the induction of general anesthesia. Computerized anesthesia records of 4096 patients undergoing general anesthesia were queried for arterial blood pressure (BP), demographic information, preoperative drug history, and anesthetic induction regimen. The median BP was determined preinduction and for 0-5 and 5-10 min postinduction of anesthesia. Hypotension was defined as either: mean arterial blood pressure (MAP) decrease of >40% and MAP <70 mm Hg or MAP <60 mm Hg. Overall, 9% of patients experienced severe hypotension 0-10 min postinduction of general anesthesia. Hypotension was more prevalent in the second half of the 0-10 min interval after anesthetic induction (P < 0.001). In 2406 patients with retrievable outcome data, prolonged postoperative stay and/or death was more common in patients with versus those without postinduction hypotension (13.3% and 8.6%, respectively, multivariate P < 0.02). Statistically significant multivariate predictors of hypotension 0-10 min after anesthetic induction included: ASA III-V, baseline MAP <70 mm Hg, age > or =50 yr, the use of propofol for induction of anesthesia, and increasing induction dosage of fentanyl. Smaller doses of propofol, etomidate, and thiopental were not associated with less hypotension. To avoid severe hypotension, alternatives to propofol anesthetic induction (e.g., etomidate) should be considered in patients older than 50 yr of age with ASA physical status > or =3. We conclude that it is advisable to avoid propofol induction in patients who present with baseline MAP <70 mm Hg.

Topics: Adult; Aged; Aging; Anesthesia, General; Anesthesia, Intravenous; Anesthetics, Intravenous; Blood Pressure; Databases, Factual; Dose-Response Relationship, Drug; Female; Fentanyl; Hemodynamics; Humans; Hypotension; Male; Medical Records Systems, Computerized; Middle Aged; Models, Statistical; Predictive Value of Tests; Propofol; Retrospective Studies; Risk Assessment; Thiopental

To investigate effects of IV administered carprofen on indices of renal function and results of serum biochemical and hematologic analyses in dogs anesthetized with acepromazine-thiopentone-isoflurane that had low blood pressure during anesthesia.. 6 healthy Beagles.. A randomized crossover study was conducted, using the following treatments: saline (0.9% NaCl solution)-saline, saline-carprofen, and carprofen-saline. Saline (0.08 ml/kg) and carprofen (4 mg/kg) were administered IV. The first treatment was administered 30 minutes before induction of anesthesia and immediately before administration of acepromazine (0.1 mg/kg, IM). Anesthesia was induced with thiopentone (25 mg/ml, IV) and maintained with inspired isoflurane (2% in oxygen). The second treatment was administered 30 minutes after onset of inhalation anesthesia. Blood gases, circulation, and ventilation were monitored. Renal function was assessed by glomerular filtration rate (GFR), using scintigraphy, serum biochemical analyses, and urinalysis. Hematologic analysis was performed. Statistical analysis was conducted, using ANOVA or Friedman ANOVA.. Values did not differ significantly among the 3 treatments. For all treatments, sedation and anesthesia caused changes in results of serum biochemical and hematologic analyses, a decrease in mean arterial blood pressure to 65 mm Hg, an increase of 115 pmol/L in angiotensin II concentration, and an increase of 100 seconds in time required to reach maximum activity counts during scintigraphy.. Carprofen administered IV before or during anesthesia did not cause detectable significant adverse effects on renal function or results of serum biochemical and hematologic analyses in healthy Beagles with low blood pressure during anesthesia.

Topics: Acepromazine; Anesthesia, Inhalation; Angiotensin II; Animals; Anti-Inflammatory Agents, Non-Steroidal; Blood Chemical Analysis; Carbazoles; Cross-Over Studies; Dogs; Dopamine Antagonists; Female; Glomerular Filtration Rate; Hypnotics and Sedatives; Hypotension; Isoflurane; Kidney; Male; Radionuclide Imaging; Random Allocation; Thiopental; Urinalysis; Vasopressins

The objective of this paper was to evaluate the use of romifidine as a premedicant in dogs before general anesthesia induced with propofol or thiopentone and maintained with halothane-N2O. Fifteen healthy dogs were anesthetized twice. Each dog received, as preanesthetic protocol, atropine (10 microg/kg, IM) and romifidine (40 microg/kg, IM); induction was delivered with propofol or thiopentone and anesthesia was maintained with halothane and N2O for 1 h. Some cardiovascular and respiratory variables and recovery times were recorded. Induction doses of propofol or thiopentone and the percentage of halothane necessary for maintaining anesthesia were also registered. Thiopentone as an induction agent is more respiratory depressive but is less hypotensive than propofol. Thiopentone reduces further the percentage of halothane necessary for maintaining the anesthesia. However, the quality of recovery is poorer, as the time to extubation is longer and the dogs occasionally had a violent recovery. The combination of romifidine, atropine, propofol, halothane, and N2O appears to be an effective combination for inducing and maintaining general anesthesia in healthy dogs.

Topics: Anesthesia, General; Anesthetics; Anesthetics, Inhalation; Anesthetics, Intravenous; Animals; Dogs; Female; Halothane; Hypotension; Imidazoles; Male; Nitrous Oxide; Propofol; Respiration; Thiopental

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anesthetics, General; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Atracurium; Atropine; Diclofenac; Down Syndrome; Drug Therapy, Combination; Face; Fentanyl; Hip; Humans; Hypotension; Intraoperative Complications; Legg-Calve-Perthes Disease; Male; Midazolam; Thiopental

Topics: Aged; Anaphylaxis; Anesthesia, Intravenous; Anesthetics, Intravenous; Bronchial Spasm; Humans; Hypotension; Male; Neuromuscular Nondepolarizing Agents; Pancuronium; Propofol; Tachycardia; Thiopental

Topics: Aged; Anesthetics, Intravenous; Histamine Release; Humans; Hypotension; Male; Thiopental

Pentobarbital is standard treatment for refractory status epilepticus (SE) and is almost uniformly effective, but the morbidity of treatment and the mortality of refractory SE are high. Recurrence of SE after pentobarbital discontinuation may predict a worsened outcome. We sought to determine the optimal use of barbiturate anesthetic treatment of refractory SE.. We reviewed 44 episodes of barbiturate anesthetic treatment for refractory SE in 40 patients, seeking factors predicting freedom from relapse to clinical or electrographic SE after treatment and predicting survival.. Eight of 9 patients with relapse of seizures after barbiturate treatment died, whereas only 9 of 26 with persistently controlled seizures died (p < 0.005). Both likelihood of relapse and survival correlated strongly with etiology, with 19 of 20 patients with chronic epilepsy, infections, or focal lesions having good control as compared with 2 of 9 with multiple medical problems (p < 0.001). Treatment delay did not predict a worsened outcome. Hypotension caused dose reduction but never required treatment discontinuation. Patients with more prolonged treatment and those receiving phenobarbital (PB) at the time of pentobarbital taper were less likely to relapse.. Relapse of SE after barbiturate anesthetic treatment is a poor prognostic sign and should be prevented, if possible. Etiology was the primary predictor of outcome, but more prolonged treatment and the use of PB during pentobarbital withdrawal appeared to provide protection against relapse.

Topics: Adult; Anesthetics, Intravenous; Electroencephalography; Humans; Hypotension; Infusions, Intravenous; Medical Records; Monitoring, Physiologic; Pentobarbital; Phenobarbital; Prognosis; Recurrence; Status Epilepticus; Survival Rate; Thiopental; Treatment Outcome

Autonomic reflex dysfunction in patients with diabetes is associated with an increased incidence of hypotension after induction of anesthesia. Whether this finding can be extrapolated to patients with autonomic dysfunction from other causes (e.g., advanced age, hypertension, altered ventricular function) has not been established.. The authors investigated whether autonomic reflex dysfunction in a more generalized patient group (26 consecutively consenting day-surgery patients older than 39 yr) was similarly associated with the occurrence of hypotension after induction. Preoperative tests of autonomic function included: Valsalva maneuver, change in heart rate with forced breathing, change in heart rate and blood pressure with standing, and spectral analysis of heart rate variability. Anesthesia was induced with 3-5 mg/kg thiopental, 2 micrograms/kg fentanyl, and 60% N2O; 0.1 mg/kg vecuronium was used for paralysis; 0-1.5% isoflurane was added for maintenance of anesthesia after intubation. Noninvasive measurements of mean blood pressure were obtained every minute for 10 min after induction and then every 3 min until skin incision.. Twelve patients developed hypotension (mean blood pressure < 70 mmHg), and 14 patients did not. Measurements of autonomic reflex function were significantly more abnormal in the patients who developed hypotension (P < 0.006 for Valsalva measurements, heart rate variability parameters, and change in heart rate with forced breathing). Using critical test values for autonomic tests, the incidence of hypotension was 67-83% in patients with autonomic nervous system dysfunction versus 9-17% in other patients.. The results document that: (1) some degree of autonomic reflex dysfunction is not uncommon in patients older than 39 yr presenting for elective surgery, and (2) such dysfunction is associated with an increased incidence of hypotension when using the described induction technique.

Topics: Adult; Aged; Ambulatory Surgical Procedures; Anesthesia; Autonomic Nervous System Diseases; Elective Surgical Procedures; Female; Fentanyl; Humans; Hypotension; Isoflurane; Male; Middle Aged; Reflex; Thiopental

This study reports all complications and side effects occurring in 38 patients with severe traumatic brain lesions treated with barbiturate coma because of a dangerous increase in intracranial pressure. The treatment was induced by intravenous infusion of thiopentone (5-11 mg.kg-1) followed by a continuous infusion of 4-8 mg.kg-1.h-1. The subsequent rate of thiopentone infusion was governed by the level of the intracranial pressure with the intention of keeping ICP below 20 mmHg (2.7 kPa). The duration of treatment was 1-15 days. Arterial hypotension occurred in 58%, hypokalemia in 82%, respiratory complications in 76%, infections in 55%, hepatic dysfunction in 87% and renal dysfunction in 47% of the patients. Twenty patients survived. Mortality in 17 patients was caused by an untreatable increase in intracranial pressure. In one patient complications due to barbiturate treatment may have contributed to the fatal outcome. In none of the other cases were the noted complications and side effects associated with any permanent symptoms or dysfunctions.

Topics: Adolescent; Adult; Bacterial Infections; Brain Injuries; Child; Female; Humans; Hypotension; Infusions, Intravenous; Intracranial Pressure; Kidney; Liver; Male; Middle Aged; Retrospective Studies; Sweden; Thiopental; Water-Electrolyte Imbalance

Tryptase is predominantly found in mast cells, where it resides in secretory granules, and is released with other mediators during mast cell degranulation. By using a newly developed commercial assay for measurements of tryptase levels we have investigated two cases of suspected drug-induced anaphylaxis. Each patient had a similar clinical presentation, consisting of hypotension and cyanosis after administration of thiopentone and suxamethonium. One of the patients showed a highly elevated serum level of tryptase reaching 26 micrograms/l 30 min after the initial reaction. In addition, slightly elevated levels of specific IgE antibodies to thiopentone were detected. The other patient with similar symptoms showed no increase in the level of tryptase, nor any specific IgE to thiopentone or suxamethonium. These data indicate the patient I suffered from true anaphylaxis, whereas the reaction of patient II occurred by a different mechanism.

Topics: Anaphylaxis; Anesthesia; Cytoplasmic Granules; Humans; Hypotension; Immunoglobulin E; Mast Cells; Peptide Hydrolases; Succinylcholine; Thiopental

Intracranial hypertension complicating fulminant hepatic failure has a mortality in excess of 90% in the presence of renal failure if not rapidly responsive to mannitol and ultrafiltration. Based on data which suggest that barbiturates can be of value in controlling the intracranial hypertension of head injury, intravenous thiopental was assessed in 13 patients with fulminant hepatic failure. All had developed acute renal failure complicated by intracranial hypertension unresponsive to other modes of therapy and were likely by all published criteria to have little chance of survival. The dosage of thiopental was adjusted incrementally until intracranial pressure, measured by extradural transducers, fell to within normal limits or adverse hemodynamic changes occurred. The intracranial pressure was reduced, in each case, by 185 to 500 mg (median: 250 mg) thiopental given over 15 min, and in eight cases continuing infusion achieved stable normal intracranial pressure and cerebral perfusion pressure. Five of the patients made a complete recovery and there were only three deaths from intracranial hypertension. Side effects were few and included minor hypotension controlled by dose reduction. The response of otherwise intractable intracranial hypertension and the 38% survival rate was remarkable for a group of patients with such a poor prognosis.

Topics: Adult; Female; Hepatic Encephalopathy; Humans; Hypotension; Infusions, Intravenous; Intracranial Pressure; Male; Middle Aged; Pseudotumor Cerebri; Thiopental

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

A review of 45 cerebral vasospasm cases for cerebral infarct under computer tomography (CT) scanner and based on activities of daily living (ADL) resulted in the finding that, of 19 cases with vasospasm of "diffuse, severe" grade, 14 cases were rated "poor (disabled)" to "dead": CT-diagnosed cerebral infarct was found in 4 out of 6 cases. From this, it was believed that indication for B-therapy was clinically significant vasospasm (diffuse, severe), which falls under the clinical grade of III or IV by Hunt and Kosnik without considering such incidental condition as severe vasospasm. After B-therapy, 45% showed ADL of at least "fair". CT-diagnosed cerebral infarct was found in 4 out of 10 cases. None died from complications as a result of B-therapy. The examination of ineffectual cases pointed to the importance of the first choice application of B-therapy, the continuation of the therapy as long as vasospasm continues, and the sustenance of cerebral perfusion pressure by the use of vasopressor (Dopamine) to offset the hypotensive effect of barbiturate. With these points of care exercised, the B-therapy is believed to achieve good results.

Topics: Adult; Aged; Anesthesia, Endotracheal; Cerebral Infarction; Dopamine; Drug Therapy, Combination; Female; Humans; Hypotension; Intracranial Aneurysm; Ischemic Attack, Transient; Male; Middle Aged; Thiopental

Topics: Anesthesia; Animals; Buffaloes; Chloral Hydrate; Hypotension; Hypoventilation; Male; Tachycardia; Thiopental

Topics: Adrenergic beta-Agonists; Anesthesia, Obstetrical; Cesarean Section; Drug Interactions; Female; Humans; Hypotension; Labor, Obstetric; Pregnancy; Thiopental

Topics: Alfaxalone Alfadolone Mixture; Anesthetics; Animals; Bradycardia; Diazepam; Dogs; Femoral Artery; Hypotension; Injections, Intra-Arterial; Muscular Diseases; Shock; Thiopental; Vascular Diseases

Arterial blood pressures were taken by the Doppler ultrasound method in 134 unselected mature neonates (birthweights 2,600-3,900 grams) who were managed in the same manner after birth. Blood pressures were measured at 3-5, 10 and 30 minutes of life and, if indicated, intermittently during the next 24-48 h. Left and right arm pressures were identical or differed by only 1-2 mm Hg. Lower than normal blood pressures were found in 4 groups of infants: those born by cesarean section, those recovering from intrauterine asphyxia, those exposed to maternal anti-hypertensive therapy, and those whose mothers received thiopental within four minutes of delivery. Return of the low pressures to within the normal range was fastest following thiopental induction in the absence of fetal asphyxia and slowest after antihypertensive therapy.

Topics: Antihypertensive Agents; Asphyxia Neonatorum; Birth Weight; Blood Pressure; Blood Pressure Determination; Cesarean Section; Female; Fetal Distress; Humans; Hypotension; Infant, Newborn; Pregnancy; Thiopental; Time Factors; Ultrasonography

The feasibility of providing postoperative analgesia using thoracic extradural blockade following thoracotomy has been assessed. Extradural block was produced by intermittent injections of 0.5% bupivacaine with adrenaline 1:200,000 or a continuous infusion of 0.25% or 0.125% bupivacaine. The only toxic symptom was drowsiness which was most frequent after a continuous infusion of 0.25% bupivacaine and with arterial plasma bupivacaine concentrations above 1.5 mug/ml. Arterial hypotension was a troublesome complication with all techniques although stability of arterial pressure was more easily achieved with a continuous infusion technique. However, this produced a high incidence of urinary retention. Practical aspects and effectiveness of providing extradural analgesia in patients following thoracotomy are discussed.

Topics: Aged; Anesthesia, Epidural; Bupivacaine; Epinephrine; Female; Fentanyl; Halothane; Humans; Hypotension; Male; Middle Aged; Pain, Postoperative; Thiopental; Urination Disorders

Topics: Adolescent; Adult; Aged; Anesthesia, General; Atropine; Blood Pressure; Cerebrovascular Circulation; Cerebrovascular Disorders; Diazepam; Female; Fentanyl; Halothane; Humans; Hypotension; Male; Middle Aged; Nitrous Oxide; Preanesthetic Medication; Subclavian Steal Syndrome; Succinylcholine; Thiopental; Time Factors

Topics: Acute Disease; Adult; Age Factors; Aged; Anesthesia; Anesthesia, Intravenous; Anesthesia, Local; Blood Pressure; Blood Transfusion; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypotension; Intensive Care Units; Male; Middle Aged; Postoperative Complications; Prognosis; Respiration, Artificial; Retrospective Studies; Thiopental

Topics: Adenosine Triphosphate; Anesthesia, Inhalation; Animals; Arteries; Brain; Dogs; Electroencephalography; Hypotension; Hypoxia; Lactates; Nitrous Oxide; Oxygen; Partial Pressure; Preanesthetic Medication; Shock, Hemorrhagic; Thiopental; Time Factors

Topics: Adolescent; Adult; Aged; Anesthesia, General; Anesthetics; Arrhythmias, Cardiac; Blood Pressure; Carbon Dioxide; Cardiac Surgical Procedures; Child; Female; Gallamine Triethiodide; Heart Rate; Humans; Hypotension; Intubation, Intratracheal; Male; Methohexital; Middle Aged; Neuromuscular Nondepolarizing Agents; Oxygen; Pancuronium; Thiopental; Toxiferine; Tubocurarine

Topics: Acridines; Animals; Antineoplastic Agents; Cats; Chloral Hydrate; Female; Fertility; Guinea Pigs; Heart; Hypotension; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Lethal Dose 50; Male; Methylamines; Mice; Muscle, Smooth; Nitro Compounds; Oxides; Propylamines; Rabbits; Rats; Respiration; Thiopental; Urinary Bladder

Topics: Anesthesia, Conduction; Anesthesia, Epidural; Anesthetics; Fecal Incontinence; Humans; Hypotension; Hypotension, Orthostatic; Male; Mepivacaine; Methoxyflurane; Middle Aged; Nitrous Oxide; Ophthalmoplegia; Succinylcholine; Thiopental; Urinary Bladder, Neurogenic; Urinary Incontinence

Topics: Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthetics; Animals; Camphor; Cerebral Cortex; Cerebrovascular Circulation; Cyclohexanes; Dogs; Ethers; Halothane; Hypotension; Hypotension, Controlled; Methoxyflurane; Regional Blood Flow; Thiopental; Trimethaphan

Topics: Acid-Base Equilibrium; Acidosis; Acidosis, Respiratory; Anesthesia, Inhalation; Anesthesia, Obstetrical; Anesthesia, Spinal; Carbon Dioxide; Cesarean Section; Female; Humans; Hypotension; Infant, Newborn; Infant, Newborn, Diseases; Lidocaine; Nitrous Oxide; Oxygen; Physical Examination; Pregnancy; Succinylcholine; Thiopental

Topics: Adult; Aminophylline; Anesthesia, General; Bronchial Spasm; Cyanosis; Cystoscopy; Drug Hypersensitivity; Female; Humans; Hydrocortisone; Hypotension; Male; Middle Aged; Tachycardia; Thiopental

Topics: Anesthesia, General; Blood Pressure Determination; Cardiac Surgical Procedures; Electrocardiography; Electroencephalography; Extracorporeal Circulation; Heart Arrest; Humans; Hypotension; Methods; Nitrous Oxide; Opium; Oxygen; Preanesthetic Medication; Respiration, Artificial; Scopolamine; Thiopental

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: Adult; Anesthesia, Intravenous; Antigen-Antibody Reactions; Blood Pressure; Depression, Chemical; Drug Hypersensitivity; Eosinophils; Gastric Juice; Glucocorticoids; Histamine; Histamine H1 Antagonists; Histamine Release; Humans; Hypotension; Leukocyte Count; Leukocytes; Male; Mast Cells; Metaproterenol; Propanidid; Skin Tests; Stimulation, Chemical; Students; Thiopental; Vasoconstrictor Agents

Topics: Anesthesia; Anesthesia, Spinal; Blood Pressure Determination; Cadaver; Cyclopropanes; Ethers; Ethyl Ethers; Fluorine; Halothane; Humans; Hypotension; Kidney Transplantation; Methoxyflurane; Neostigmine; Neuromuscular Depolarizing Agents; Nitrous Oxide; Postoperative Care; Preanesthetic Medication; Thiopental; Tissue Donors; Transplantation Immunology; Transplantation, Homologous; Water-Electrolyte Balance

Topics: Analgesics; Animals; Antitussive Agents; Body Weight; Cardiovascular System; Constriction; Digestive System; Drug Synergism; Drug Tolerance; Humans; Hypotension; Male; Meperidine; Methods; Mice; Morphine; Nalorphine; Piperidines; Pupil; Rats; Respiration; Substance-Related Disorders; Thiopental

Topics: Anesthesia; Anesthetics; Carbon Dioxide; Cerebrovascular Circulation; Curare; Humans; Hypotension; Lactates; Nitrous Oxide; Oxygen Consumption; Pyruvates; Respiration; Thiopental

Topics: Anesthesia, General; Bradycardia; Cholecystectomy; Cyanosis; Female; Humans; Hypotension; Middle Aged; Pneumothorax; Radiography; Succinylcholine; Thiopental

Topics: Animals; Blood Pressure; Body Temperature Regulation; Chloralose; Dogs; Forelimb; Ganglionic Blockers; Hindlimb; Hypotension; Hypoxia; Muscle Contraction; Neural Conduction; Pentobarbital; Pentolinium Tartrate; Perfusion; Phenoxybenzamine; Saphenous Vein; Sympathectomy; Sympathetic Nervous System; Temperature; Thiopental; Veins

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

Topics: Adolescent; Adult; Aged; Anesthetics; Apnea; Blood Pressure; Child; Female; Halothane; Humans; Hyperventilation; Hypotension; Male; Middle Aged; Postoperative Complications; Pulse; Tachycardia; Thiopental

Topics: Blood Pressure; Cocaine; Dogs; Guanethidine; Hypotension; Norepinephrine; Pharmacology; Research; Reserpine; Thiopental

Topics: Anesthesia; Anesthesia, Inhalation; Anesthesia, Obstetrical; Angiotensins; Cesarean Section; Chemical and Drug Induced Liver Injury; Chloroform; Epinephrine; Ether; Female; Gynecology; Halothane; Hepatitis; Hypotension; Obstetrics; Pregnancy; Thiopental; Toxicology

Topics: Anesthesia; Anesthesia, Endotracheal; Anesthesiology; Cardiac Surgical Procedures; Cardiac Tamponade; Halothane; Humans; Hypotension; Lidocaine; Mitral Valve; Nitrous Oxide; Oxygen; Pericardial Effusion; Succinylcholine; Thiopental; Thoracic Surgery

Topics: Atropine; Catecholamines; Dogs; Hypotension; Ouabain; Pharmacology; Research; Reserpine; Thiopental

Topics: Anesthesia; Anesthesia, Inhalation; Anesthesia, Spinal; Cardiac Output; Halothane; Heart Function Tests; Hexamethonium Compounds; Humans; Hypotension; Hypotension, Controlled; Lidocaine; Pharmacology; Thiopental

Topics: Adolescent; Anesthesia; Anesthesia, Intravenous; Aortic Coarctation; Blood Transfusion; Child; Electroencephalography; Ganglionic Blockers; Humans; Hypotension; Hypotension, Controlled; Infant; Phenobarbital; Preanesthetic Medication; Thiopental; Vascular Surgical Procedures

Topics: Anesthetics; Humans; Hypotension; Hypotension, Controlled; Intraocular Pressure; Intubation; Intubation, Intratracheal; Ophthalmologic Surgical Procedures; Ophthalmology; Pentolinium Tartrate; Postoperative Complications; Surgical Procedures, Operative; Thiopental; Tonometry, Ocular; Trimethaphan

Topics: Anesthesia; Anesthesia, Intravenous; Anesthetics, Intravenous; Atropine; Barbiturates; Hexobarbital; Humans; Hypotension; Meperidine; Methohexital; Respiration; Thiopental; Toxicology; Vomiting

Topics: Analgesia; Anesthesia; Anesthesia and Analgesia; Anesthesiology; Cerebral Cortex; Hypotension; Hypotension, Controlled; Motor Cortex; Pain Management; Thiopental

Topics: Barbital; Biomedical Research; Blood Pressure; Blood Pressure Determination; Hypotension; Methamphetamine; Thiopental