thiopental and Ischemia

Topics: Anesthetics; Animals; Barbiturates; Brain; Cerebrovascular Circulation; Dogs; Halothane; Haplorhini; Hypoxia, Brain; Ischemia; Mice; Nitrous Oxide; Oxygen Consumption; Pentobarbital; Rabbits; Thiopental

Refractory status epilepticus (RSE) treatment is usually performed with coma induction using an appropriate general anesthetic. Most frequent complications are represented by hypotension and infection. Other side-effects may however be encountered.. We describe two patients suffering from acute bowel ischemia after thiopental (THP) treatment for RSE. A 73-year-old man with a complex-patial RSE following an acute stroke received THP (303 mg/kg over 48 h); 36 h after THP discontinuation, he presented abdominal tenderness and lactate elevation. Necrosis of the terminal ileum and colon was seen during surgical exploration; he deceased shortly thereafter. A 21 year-old woman had a cryptogenic de novo generalized-convulsive RSE resistant to 5 attempts of EEG burst-suppression. During the 6th attempt, after THP (840 mg/kg over 150 h) together with mild hypothermia, she developed an ileus with elevated serum lactate; caecum necrosis was observed during surgery. Hypernatremia, acidosis and hyperlactatemia heralded this complication in both patients.. In these two patients, mechanical vascular ischemia may have resulted from drug-induced paralytic ileus. To our knowledge, this is the first report describing this potential fatal side effect in adults with RSE.

Topics: Aged; Anticonvulsants; Cecum; Colon; Female; Humans; Ischemia; Male; Status Epilepticus; Thiopental; Young Adult

Lidocaine and thiopental improve recovery when administrated during hypoxia and ischemia; however, the effect of pre- or postinsult treatment alone is unknown. We applied either lidocaine or thiopental to hippocampal slice cultures from 20-day-old rats either before or after 10 min of oxygen-glucose deprivation (OGD). Propidium iodide (PI) fluorescence was used as an indicator of neuronal death for 7 days after OGD. OGD-induced neuronal death, in both the Cornus Ammonis 1 (CA1) and the dentate gyrus regions, peaked the first day after ischemia. Preinsult administration of either lidocaine (10, 100 microM) or thiopental (250, 600 microM) significantly reduced the damage measured on the first and second days after OGD; these drugs also significantly decreased the summed daily post-OGD PI fluorescence in both regions. Postinsult administration of lidocaine (10, 100 microM) or thiopental (250, 600 microM) significantly decreased the PI fluorescence on the first day after OGD; postinsult administration of these drugs also attenuated the summed daily post-OGD PI. These data indicate that the administration of lidocaine or thiopental either before or directly after OGD reduced neuronal damage in this in vitro model of cerebral ischemia. Postischemic administration is frequently the first opportunity for treatment.. Lidocaine or thiopental applied either 10 min before or 10 min directly after oxygen-glucose deprivation reduced neuronal cell death in rat hippocampal slice cultures. Postinsult administration is often the first opportunity for treatment after stroke; lidocaine and thiopental reduced damage caused by oxygen-glucose deprivation, an in vitro model of stroke.

Topics: Animals; Cell Death; Cell Hypoxia; Glucose; Hippocampus; Ischemia; Lidocaine; Neuroprotective Agents; Rats; Rats, Sprague-Dawley; Reperfusion Injury; Thiopental

Stobadine, a drug with the pyridoindol structure, was compared with thiopental and pentobarbital for its ability to inhibit stimulated peroxidation in homogenates of spinal cord in vitro. The antioxidative capacity of the drug exceeded that of barbiturates more than 100-fold. Stobadine was also shown to inhibit the increase in formation of TBA-RS in homogenates of rabbit spinal cord, subjected to 20 min ischaemia, to the level comparable with controls. Administration of the drug (6 mg kg-1) to animals 5 min before 20 min ischaemia had no effect on level of lipid peroxidation products in the spinal cord; however, it slowed down stimulated Fe(2+)-dependent peroxidation after in vitro incubation of the homogenates and increased the concentration of phosphatidylserine and ethanolamine plasmalogens, as compared with non-treated animals. Application of stobadine 2 min before the release of an aortic occlusion increased the antiradical capacity in homogenates of spinal cord and revealed an ameliorating effect on the composition of phospholipids.

Topics: Animals; Antioxidants; Carbolines; Chromatography, Thin Layer; In Vitro Techniques; Iron; Ischemia; Lipid Peroxidation; Pentobarbital; Phosphatidylethanolamines; Phosphatidylserines; Phospholipids; Rabbits; Regional Blood Flow; Spinal Cord; Thiobarbituric Acid Reactive Substances; Thiopental

Inadvertent arterial drug injections continue to be an important source of morbidity. Although the clinical picture of thiopental injection has been well defined over the past 50 years, there is still much controversy concerning pathophysiology and treatment regimen. Recently, a case report showed the efficacy of urokinase in treating this problem. The current study used the reliable ear model to study more closely this phenomenon. Rabbits were divided into four groups. Ears in Group 1 rabbits (n = 10) received an intra-arterial thiopental (15 mg/kg) injection. Group 2 rabbits (n = 10) received thiopental followed by a 1-ml saline injection 15 minutes later. Group 3 rabbits (n = 10) received thiopental followed by 50,000 U of urokinase. Finally, Group 4 rabbits (n = 4) received an intra-arterial injection of saline alone. Necrosis was evaluated 2 weeks later and expressed as a percentage. Student's t tests were used to evaluate data significance.. Group 1 (thiopental alone) and Group 2 (thiopental and saline) rabbits had significantly more necrosis than Group 4 (saline alone) rabbits, 21.2% and 17.5% versus 0% (p less than 0.001 for both). Group 3 (thiopental and urokinase) rabbits had significantly more necrosis (46.5%) than Groups 1 and 2 rabbits (p less than 0.001 for both).. From this study, we found that treatment of intra-arterial thiopental injection injuries with urokinase was of no benefit, but more importantly, it increased tissue necrosis by approximately 100%. Clinical use of this treatment is to be discouraged until underlying mechanisms are better defined.

Topics: Animals; Injections, Intra-Arterial; Ischemia; Necrosis; Rabbits; Skin; Thiopental; Urokinase-Type Plasminogen Activator

Infrarenal circumaortic occlusion devices were operatively placed in 74 New Zealand white rabbits. Two days after operation the animals were randomly assigned to one of seven treatment groups: I, control, n = 23; II, halothane, n = 8; III, thiopental, n = 12; IV, ketamine (30 mg/kg intravenously), n = 6; V, halothane+hypothermia, n = 8; VI, thiopental+hypothermia, n = 12; VII, ketamine+hypothermia, n = 5. In each group, the infrarenal aorta was occluded for 21 minutes. Final neurologic recovery after restitution of blood flow was graded as acute paraplegia, delayed paraplegia (neurologic deficit developing after initial recovery), or normal. Halothane alone was of no benefit. Hypothermia with any anesthetic was completely protective and reduced neurologic deficits to 0% compared with 91% in controls (p less than 0.05). Thiopental and ketamine treatment each reduced acute paraplegia to 17% (as compared with 61% in controls) and increased delayed paraplegia from 30% in controls to 75% and 50%, respectively (p less than 0.05 for thiopental, p = 0.10 for ketamine). The authors interpret the increase in delayed deficits and decrease in acute deficits as being the result of partial spinal cord protection. These findings document that this model of spinal cord ischemia is sufficiently sensitive to identify interventional treatments that protect the ischemic spinal cord.

Topics: Anesthetics; Animals; Aorta, Abdominal; Constriction; Halothane; Hypothermia, Induced; Intraoperative Care; Ischemia; Ketamine; Paraplegia; Postoperative Complications; Rabbits; Reperfusion Injury; Spinal Cord; Thiopental; Time Factors

Spinal cord ischemia and resultant paraplegia are devastating sequelae in up to 40% of patients undergoing repair of thoracoabdominal aneurysms. We investigated the effect of intrathecal tetracaine on the neurological sequelae of spinal cord ischemia and reperfusion with aortic occlusion. Cocaine-derived anesthetics (lidocaine and its analogues) have been shown to decrease neuronal cell metabolism and also have specific neuronal membrane stabilizing effects. New Zealand white rabbits were anesthetized and spinal cord ischemia was then induced by infrarenal aortic occlusion. Animals were divided into six treatment groups. Tetracaine (groups 2 and 4) or normal saline solution (group 5) was administered intrathecally before aortic cross-clamping. Groups 1 and 3 functioned as controls. Group 6 animals received intravenous thiopental. Rabbits were classified as either neurologically normal or injured (paralyzed or paretic). Among controls, 25 minutes of aortic occlusion produced varied neurological sequelae (group 1, 3/6 injured, 50%) whereas 30 minutes resulted in more consistent injury (group 3, 5/6 injured, 83%). All rabbits that received intrathecal saline solution were paralyzed (group 5, 4/4 injured, 100%). Animals treated with intrathecal tetracaine and aortic occlusion of 30 minutes (group 4) showed significantly better preservation of neurological function (6/7 normal, 86%) than controls and saline-treated animals (groups 3 and 5). All animals treated with intrathecal tetracaine and aortic occlusion for 25 minutes (group 2) showed no signs of injury (5/5 normal, 100%), but this was not significant versus controls (group 1). Intravenous thiopental (group 6, 5/5 injured, 100%) had no beneficial effect. Intrathecal tetracaine significantly and dramatically abrogated the neurological injury secondary to spinal cord ischemia and reperfusion after aortic occlusion at 30 minutes in the rabbit model.

Topics: Animals; Aorta; Constriction; Injections, Intravenous; Injections, Spinal; Ischemia; Paralysis; Rabbits; Reperfusion Injury; Spinal Cord; Tetracaine; Thiopental

The paper describes five cases of accidental intraarterial injection of pharmacological drugs (diazepam or thiopentone) or dope (heroin) in an upper limb. Following a review of the physiopathological mechanisms which led to ischemic damage, the Authors outline a protocol of continuous pharmacological sympathicolysis in the affected limb, using repeated anesthetic blocks of the homolateral stellate ganglion.

Topics: Arm; Autonomic Nerve Block; Diazepam; Heroin; Humans; Injections, Intra-Arterial; Ischemia; Regional Blood Flow; Stellate Ganglion; Syndrome; Thiopental

Superoxide dismutase (SOD), barbiturates, and hypothermic crystalloid were evaluated for their effectiveness in minimizing ischemic damage to the spinal cord at 40 minutes of aortic occlusion. Forty-two dogs underwent proximal and distal thoracic aortic occlusion for 40 minutes with infusion of test agents into the occluded segment. The dogs were divided into six groups. Group 1 (n = 6) served as control. Group 2 (n = 6) received hypothermic crystalloid. Group 3 (n = 6) animals received thiopental. Group 4 (n = 7) received SOD. Group 5 (n = 9) received hypothermic crystalloid and thiopental. Group 6 (n = 8) received hypothermic crystalloid, thiopental and SOD. The animals were observed for neurologic deficit for 72 hours. In group 1, six of six dogs showed complete paralysis. Five of six dogs from group 2, five of six dogs from group 3, and five of seven dogs from group 4 showed complete paraplegia. The remaining dogs in these groups showed varying degrees of recovery. Four of nine dogs in group 5 had complete paraplegia, three dogs showed varying degrees of recovery, and two dogs had no neurologic deficit. In group 6, one dog had complete paraplegia, three had partial recovery, and four had no neurologic deficit. Group 6 was the only group that showed significantly less late neurologic impairment than the control group. We concluded that although cold perfusion, barbiturates, and SOD are not protective when used alone, they are effective when all are used in combination. The combination of cold perfusion, barbiturates, and SOD significantly decreases neurologic deficit after 40 minutes of aortic occlusion.

Topics: Animals; Aorta, Thoracic; Constriction; Dogs; Hypothermia, Induced; Ischemia; Paraplegia; Perfusion; Spasm; Spinal Cord; Superoxide Dismutase; Thiopental; Thoracotomy; Time Factors

This study was designed to assess the effects of hemodynamic changes and cerebrospinal fluid dynamics on spinal cord function during experimental thoracic aortic occlusion. We investigated the effects of dopamine, sodium nitroprusside, and sodium thiopental in this model. Proximal and distal aortic pressures and cerebrospinal fluid pressure were measured during occlusion in 12 adult mongrel dogs under control conditions and during drug interventions. Spinal cord function was assessed by spinal somatosensory evoked potentials recorded during 3-minute intervals of reversible spinal cord ischemia. By multiple regression analysis, the degree of spinal cord ischemia was positively related to the cerebrospinal fluid pressure (p = 0.0092) and negatively related to the percent change in cerebrospinal fluid pressure (p = 0.028); there were no significant drug effects on cerebrospinal fluid pressure or on the degree of spinal cord ischemia. This study indicates that cerebrospinal fluid pressure is an important factor in determining the degree of spinal cord ischemia during aortic occlusion and suggests that measures to reduce cerebrospinal fluid pressure will mitigate the degree of spinal cord ischemia.

Topics: Animals; Aorta, Thoracic; Constriction; Dogs; Dopamine; Evoked Potentials, Somatosensory; Hemodynamics; Intracranial Pressure; Ischemia; Nitroprusside; Regression Analysis; Spinal Cord; Thiopental

The authors have studied the protection against ischemic damage to rabbit spinal cord by pretreatment with agents that block neuronal activity and directly or indirectly reduce tissue metabolism. Hypothermia, thiopental, magnesium, lidocaine, and naloxone were used to pretreat the spinal cord prior to ischemia. Hypothermia and thiopental provided comparable protection: they each increased the duration of ischemia required to produce neurological deficits in 50% of the animals from 26 to 41 minutes. They also increased from 10 to 30 minutes the time that the postsynaptic waves of the spinal somatosensory evoked potential (SSEP) could be absent and the animal still have neurological recovery. Hypothermia and thiopental, when used together, increased the duration of ischemia required to produce neurological deficits to 57 minutes in 50% of the animals. Naloxone increased the duration of ischemia required to produce neurological deficits to 36 minutes in 50% of the animals, and increased to 20 minutes the time that the postsynaptic waves of the SSEP could be absent and the animal still have neurological recovery. Magnesium pretreatment improved neurological outcome, possibly by improving collateral circulation as the SSEP did not fail completely during aortic occlusion in all animals. Lidocaine was not beneficial, perhaps because of the prolonged hypotension that resulted.

Topics: Animals; Aorta, Abdominal; Evoked Potentials, Somatosensory; Hypothermia, Induced; Ischemia; Lidocaine; Magnesium Sulfate; Naloxone; Rabbits; Spinal Cord; Thiopental

Recent data indicates that the free-radical anion superoxide (O2-), an unstable cytotoxic form of oxygen, is implicated in the pathogenesis of ischemic bowel following reperfusion after low flow states. This report evaluates the effect of free radical scavengers on survival in an animal model with bowel ischemia. At laparotomy, the superior mesenteric artery (SMA) of 79 weanling rats (90 g) was occluded for one minute and released. Animals were divided into three experimental groups: group I acted as controls (n = 41), group II, received thiopental 5 mg/kg IV (n = 19), group III, received methohexital 2.5 mg/kg IV (n = 19). At one week animals were evaluated for mortality, mean survival time, evidence of bowel necrosis or perforation, and bowel appearance on scanning electron microscopy (EM). Mortality was 63.5% (26/41) in group I, 19 had necrotic bowel and 7 had gross perforation; 31.6% in group II (6/19) (p less than .05 versus control), with one necrotic bowel and 5 perforations; and 57.9% in group III (11/19) where 7 had necrotic bowel and 4 had perforations (p NS v control). Survival time (mean +/- SD in days) post SMA occlusion was 3.2 +/- 1.9 for group I; 4.0 +/- 1.7 for group II; and 2.5 +/- 2.0 for group III. EM showed mucosal destruction worsened by the duration of reperfusion, decreased by thiopental but not by methohexital. Thiopental, a free radical anion scavenger was cytoprotective in this animal model, as it decreased mortality and the incidence of bowel necrosis and perforation. These data support the thesis that following low flow states bowel ischemia may be related to a reperfusion injury due to the release of toxic free radical anions.

Topics: Animals; Anions; Free Radicals; Intestines; Ischemia; Methohexital; Rats; Thiopental

Spinal cord ischemia was produced in male mongrel dogs by permanent occlusion of the infrarenal aorta. All animals were anesthetized with a mixture of nitrous oxide and 1.5% halothane. Group 1 animals were the controls. Group 2 animals were pretreated, 30 minutes prior to aortic occlusion, with sodium thiopental, 20 mg per kilogram of body weight, over 5 minutes, followed by an infusion of 10 mg/kg/hr for 2 1/2 hours. Groups 3 animals received the identical dose of sodium thiopental and, in addition, received mannitol, 1 gm/kg, and methylprednisolone 1 mg/kg. There were no differences in hemodynamic data or arterial blood gases among the groups, except that the thiopental bolus caused a transient reduction in mean arterial pressure. Ninety percent of Group 1 animals were paraplegic, while only 30% of Group 2 and 40% of Group 2 animals were paraplegic. The difference in the incidence of paraplegia in Groups 2 and 3 compared with Group 1 was statistically significant (p less than 0.05). Therefore, thiopental significantly decreased the incidence of paraplegia, while methylprednisolone and mannitol did not enhance its protective effect.

Topics: Animals; Aorta, Abdominal; Disease Models, Animal; Dogs; Ischemia; Ligation; Male; Mannitol; Methylprednisolone; Paraplegia; Postoperative Complications; Spinal Cord; Thiopental

Topics: Acute Kidney Injury; Animals; Humans; Ischemia; Kidney; Kidney Tubules, Proximal; Pentobarbital; Rats; Renal Artery Obstruction; Thiopental

Topics: Acute Kidney Injury; Animals; Ischemia; Kidney; Kidney Tubules, Proximal; Male; Pentobarbital; Polyuria; Rats; Renal Artery Obstruction; Thiopental; Urination

Cases of local complications following the injection of thiopentone and reported to Medical Defence Union and to the Medical Protection Society in the period 1970-77 were analysed. There was no case of gangrene distal to the site of injection, but two cases of isolated damage to nerves, muscles and tendons and two cases of local tissue necrosis at the site of injection. A comparison of the results of the present investigation with those of two previous investigations indicates that the frequency of such complications has diminished over the period 1957-77.

Topics: Adult; Female; Humans; Injections; Ischemia; Muscles; Necrosis; Skin Diseases; Tendon Injuries; Thiopental

Topics: Animals; Brain; Cyclic AMP; Haplorhini; Ischemia; Thiopental

Topics: Animals; Brain; Cats; Cerebrovascular Circulation; Glucose; Ischemia; Lactates; Oxygen Consumption; Thiopental

Topics: Animals; Brain; Disease Models, Animal; Haplorhini; Ischemia; Macaca mulatta; Thiopental

Topics: Animals; Blood Vessels; Chiroptera; Disease Models, Animal; Dosage Forms; Gangrene; Injections, Intra-Arterial; Ischemia; Secobarbital; Thiopental

Irreversible brain damage after a short period of cerebral ischemia is a clinical drama. Not neuronal dead in se, but a hemodynamic event, described as no reflow phenomenon (NRF) seems to be the primary pathogenetic factor towards fatal outcome. A combination of four flow promoting therapeutic measures (heparinisation, hemodilution, systemic arterial hypertension and brainflushing with dextran 40) greatly improves recovery of the brain function after 12 min. of cardiac arrest in dogs. Short acting barbiturates provide remarkable amelioration of postischemic encephalopathy in the monkey.

Topics: Animals; Brain; Brain Damage, Chronic; Cats; Dogs; Haplorhini; Hemodynamics; Intracranial Pressure; Ischemia; Thiopental; Time Factors

In unilateral nephrectomized beagle dogs the remaining kidney was subjected to 2 hrs of ischemia in situ. The ischemic organ was cooled to 22--23 degrees C by initial hypothermic perfusion over a 5-F catheter introduced into the renal artery via the carotid artery. It was then left in the open abdominal wound without any further attempts of cooling. Three perfusates were used: an isoosmolar Dextran solution (Eisenberger), a hyperosmolar, "intracellular" electrolyte solution (Sacks), and a hyperosmolar, "extracellular" electrolyte solution. There was a mean postoperative increase in serum creatinine levels of 0.6 mg-%. By the 3rd p.o. day at latest the serum creatinine was again within normal limits. The inulin and PAH clearances on the 7th and 14th p.o. day showed no significant differences to preoperative determinations. No definite advantage or disadvantage was noted among the three perfusates. All control dogs whose kidneys were made ischemic for 2 hrs without perfusion died due to acute tubular necrosis. Apparently the homogenous cooling and flushing by the initial perfusion is of more importance for good preservation in this situation than the composition of the perfusate.

Topics: Aminohippuric Acids; Animals; Catheterization; Cold Temperature; Creatinine; Dextrans; Dogs; Female; Hypothermia, Induced; Inulin; Ischemia; Kidney; Kidney Function Tests; Mannitol; Nephrectomy; Organ Preservation; Osmolar Concentration; Perfusion; Postoperative Complications; Radiography; Renal Artery; Thiopental; Time Factors; Tissue Preservation; Uremia

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: Acepromazine; Alcohol Oxidoreductases; Anesthesia, Inhalation; Animals; Aspartate Aminotransferases; Chloral Hydrate; Creatine Kinase; Female; Forelimb; Gait; Halothane; Horse Diseases; Horses; Ischemia; Lactates; Male; Methohexital; Muscles; Oxygen; Potassium; Preanesthetic Medication; Pyruvates; Sorbitol; Thiopental; Time Factors

Topics: Aged; Androstanes; Anesthesia, General; Blood Pressure; Female; Humans; Ischemia; Leg; Male; Middle Aged; Muscles; Neuromuscular Nondepolarizing Agents; Nitrous Oxide; Oxygen; Piperidines; Positive-Pressure Respiration; Pulse; Regional Blood Flow; Succinylcholine; Thiopental; Tubocurarine

Topics: Adolescent; Adult; Aneurysm; Angiomatosis; Aorta; Atropine; Blood Circulation; Brain; Catheterization; Child; Coronary Vessels; Electrocardiography; Female; Humans; Hypotension, Controlled; Hypothermia, Induced; Intracranial Aneurysm; Ischemia; Male; Methods; Middle Aged; Perfusion; Preanesthetic Medication; Promazine; Propranolol; Succinylcholine; Thiopental; Thromboembolism; Ventricular Fibrillation