thiopental and Intestinal-Obstruction

Topics: Anesthesia; Anesthesia, Inhalation; Anesthesia, Intravenous; Animals; Barbiturates; Blood Pressure; Cardiac Output; Cattle; Cattle Diseases; Dog Diseases; Dogs; Horse Diseases; Horses; Humans; Infusions, Parenteral; Intestinal Obstruction; Intestine, Large; Intestine, Small; Potassium; Preanesthetic Medication; Sheep; Sheep Diseases; Sodium; Thiopental; Vascular Resistance

A questionnaire survey examining rapid sequence induction techniques was sent to all anaesthetists in Wales. The questionnaire presented five common clinical scenarios: emergency appendicectomy; elective knee arthroscopy with a symptomatic hiatus hernia; elective knee arthroscopy with an asymptomatic hiatus hernia; elective Caesarean section; and emergency laparotomy for bowel obstruction. Completed surveys were received from 421 anaesthetists, a 68% response rate. Rapid sequence induction was chosen by 398/400 respondents (100%) for bowel obstruction, 392/399 (98%) for Caesarean section, 388/408 (95%) for appendicectomy, 328/395 (83%) for symptomatic hiatus hernia but only 98/399 (25%) for asymptomatic hiatus hernia (p < 0.001). Trainees were more likely to use a rapid sequence induction technique than consultants and staff grades for the appendicectomy (p = 0.025), symptomatic hiatus hernia (p = 0.004) and asymptomatic hiatus hernia (p = 0.001) scenarios and were also more likely to use a thiopental-suxamethonium combination for rapid sequence induction (p < 0.001).

Topics: Adult; Aged, 80 and over; Anesthesia, General; Anesthesia, Obstetrical; Appendectomy; Cesarean Section; Emergencies; Female; Health Care Surveys; Hernia, Hiatal; Humans; Hypnotics and Sedatives; Intestinal Obstruction; Intubation, Intratracheal; Male; Neuromuscular Blockade; Pneumonia, Aspiration; Pregnancy; Professional Practice; Thiopental; Wales

Fulminant hyperammonaemia as a threshold effect of coma-inducing dose of sodium thiopental has been revealed in rats. Blood ammonia content increased progressively after the introduction of 1.0 LD(50) (but not 0.8 LD(50)) of sodium thiopental three times in 3h and five times in 18h. The urinary ammonia excretion was not impaired while the volatilization of ammoniac from the body of ST-treated rats was higher, giving evidence of the augmentation of ammonia production. Blood urea increased by one third despite of insignificant alterations of haematocrit and blood creatinine. Ammonia hyperproduction in the digestive tract could result from gastrointestinal stasis, which has been verified by roentgenography and confirmed by correlation of hyperammonaemia with the stool retardation. In thiopental coma rats the slope of a dose-dependent increase of the blood ammonia and the blood urea after the intraperitoneal injection of ammonium acetate did not exceed that in intact animals. So the ammonia hyperproduction in the digestive tract could be the main contributing cause of fulminant hyperammonaemia in rats with thiopental coma and thus be involved into pathogenesis of the coma.

Topics: Acetates; Ammonia; Animals; Blood Urea Nitrogen; Coma; Defecation; Dose-Response Relationship, Drug; Gastrointestinal Contents; Gastrointestinal Tract; Hyperammonemia; Hypnotics and Sedatives; Injections, Intraperitoneal; Intestinal Obstruction; Rats; Thiopental; Time Factors

The rationale of "crash induction" in patients with full stomach is reviewed. The technique does not precipitate regurgitation in normal patients having competent cardia, provided respiratory obstruction and IPPV are avoided during induction. On the other hand, in patients with incompetent cardia such as intestinal obstruction or hiatus hernia, excessive material may accumulate in the lower oesophagus. The accumulation will be suddenly released with the cricopharyngeal relaxation subsequent to "crash induction". The stomach and oesophagus should be adequately decompressed pre-operatively, and precautionary measures such as backward cricoid pressure must be taken during induction.

Topics: Anesthesia; Esophagogastric Junction; Gastroesophageal Reflux; Hernia, Hiatal; Humans; Intestinal Obstruction; Stomach; Succinylcholine; Thiopental

Topics: Anesthesia; Anesthesia, General; Anesthesiology; Anesthetics; Chloroform; Intestinal Obstruction; Laryngoscopy; Preanesthetic Medication; Thiopental; Toxicology