thiopental and Laryngismus

Topics: Administration, Topical; Adult; Analysis of Variance; Anesthetics, Intravenous; Anesthetics, Local; Humans; Injections, Intravenous; Laryngeal Masks; Laryngismus; Lidocaine; Thiopental

We have performed a randomized, cross over study in 22 children suffering from acute leukaemia, who underwent repeated anaesthesia for bone marrow aspiration and lumbar puncture. For their first anaesthetic, the children (aged 3-10 years old) received, either a thiopentone/isoflurane anaesthetic or intravenous propofol, both supplemented with nitrous oxide. On a second occasion they received the alternative technique. Of those children receiving thiopentone/isoflurane, 32% had significant coughing during anaesthesia, two progressing to laryngospasm requiring 100% oxygen. None of the patients receiving propofol had a respiratory disturbance (P = 0.016). 68% of the children preferred the propofol anaesthetic. Only one child in the thiopentone/isoflurane group preferred this technique. Twenty-seven per cent had no preference. There was no significant difference in length of anaesthetic time (P = 0.07) or the time taken for recovery (P = 0.17) between the two groups. There was a large individual variation in propofol requirements and movement was common during stimulation of patients in this group, though this did not adversely affect the surgical procedure.

Topics: Acute Disease; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Biopsy, Needle; Bone Marrow; Child; Child, Preschool; Cough; Cross-Over Studies; Humans; Isoflurane; Laryngismus; Leukemia; Nitrous Oxide; Patient Satisfaction; Propofol; Spinal Puncture; Thiopental

To assess the ease of insertion of laryngeal mask airway (LMA) comparing propofol with lidocaine or midazolam followed by thiopentone and compare the costs with each technique.. One hundred and fifty ASA 1 or 2 patients equally divided into three groups scheduled for elective surgery were recruited into this prospective, single blind, randomized, parallel groups study. Anaesthetic induction was achieved with 1 microgram.kg-1 fentanyl i.v. followed by either 2.5 mg.kg-1 propofol (group P), or a sequence of 1.5 mg.kg-1 lidocaine and 5 mg.kg-1 thiopentone (group LT), or midazolam 0.1 mg.kg-1 and, three minutes later, 5 mg.kg-1 thiopentone (group MT). The LMA was inserted by the blinded anaesthetist who assessed and graded the conditions for LMA insertion and noted any adverse responses (i.e., inadequate jaw relaxation, gagging, coughing, limb or head movement, hiccough and laryngospasm). Conditions were considered "excellent" if there were no adverse responses, and "satisfactory" if such a response was mild and transient.. Excellent or satisfactory conditions were observed in 48 (96%) patients in the midazolam-thiopentone group, 46 (92%) in the propofol group, and 34 (68%) in the lidocaine-thiopentone group (P = 0.0001). The incidence of gagging (P = 0.042), limb movement (P = 0.031), and laryngospasm (P = 0.0001) was higher in the lidocaine-thiopentone group.. With the above doses, a fentanyl-midazolam-thiopentone combination which is about 35% less expensive than fentanyl-propofol, provides equally good conditions for the insertion of LMA.

Topics: Adult; Anesthetics, Intravenous; Anesthetics, Local; Cough; Drug Costs; Elective Surgical Procedures; Female; Fentanyl; Gagging; Hiccup; Humans; Laryngeal Masks; Laryngismus; Lidocaine; Logistic Models; Male; Midazolam; Middle Aged; Movement; Propofol; Prospective Studies; Sex Factors; Single-Blind Method; Thiopental; Treatment Outcome

Conditions for insertion of a laryngeal mask airway in 90 unpremedicated adult were patients were assessed in a randomised, single-blinded trial. Each patient received fentanyl 1 microgram.kg-1 and thiopentone 5 mg.kg-1, and this was preceded either by lignocaine 0.5 mg.kg-1 intravenously (group 1), lignocaine 1.5 mg.kg-1 intravenously (group 2) or 40 mg of topical lignocaine spray to the posterior pharyngeal wall (group 3). Conditions for laryngeal mask airway insertion were recorded. The group receiving topical lignocaine had a lower incidence of laryngospasm (p < 0.05), required fewer attempts for successful insertion of the laryngeal mask (p < 0.05) and coughed or gagged less frequently than either group receiving lignocaine intravenously (p > 0.05). Overall, the conditions for laryngeal mask airway insertion were better in the topical group (p < 0.05). There were no significant differences in haemodynamic response and apnoea between the three groups. Topical lignocaine spray prior to thiopentone provides conditions for insertion of a laryngeal mask that are superior to those provided by lignocaine and thiopentone intravenously.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anesthesia, Local; Female; Humans; Laryngeal Masks; Laryngismus; Lidocaine; Male; Middle Aged; Single-Blind Method; Thiopental

A double-blind, randomised, controlled study was undertaken to investigate the effects on injection pain and excitatory phenomena of adding thiopentone to methohexitone. One hundred and twenty unpremedicated, day-case patients received one of four induction regimens: unmodified 1% methohexitone, or a mixture of 2.5% thiopentone and 1% methohexitone in ratios of 1:1, 1:3 or 1:9 by volume. The addition of one part of thiopentone to three parts of methohexitone produced a mixture which significantly reduced the occurrence of pain and discomfort compared with methohexitone alone from 67% to 13% (p < 0.01) and reduced the occurrence of excitatory effects from 50% to 13% (p < 0.01).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia, Intravenous; Female; Hiccup; Humans; Intraoperative Complications; Laryngismus; Male; Methohexital; Middle Aged; Muscle Contraction; Pain; Thiopental

The response to insertion of the laryngeal mask airway (LMA) following either propofol 2.5 mg.kg-1 or thiopentone 5 mg.kg-1 was assessed in two groups of patients. The purpose of the study was to ascertain which of these two induction agents provided the better conditions for insertion of the LMA. Anaesthesia was induced by propofol in 35 patients and by thiopentone in 37. Following induction, ventilation was assisted for two minutes using 50% oxygen and nitrous oxide and 2% isoflurane, before insertion of the LMA. The presence of gagging, coughing, laryngospasm and movement was noted and graded. Thiopentone was associated with an adverse response in 76% of patients, compared with propofol in 26% (P < 0.01). Gagging, laryngospasm and head movement were more common using thiopentone (P < 0.01, P < 0.05 and P < 0.05 respectively) and in 11% (P < 0.05) of the thiopentone group insertion of the LMA was impossible due to inadequate relaxation. We conclude that, using these doses, propofol is superior to thiopentone as an induction agent for insertion of the laryngeal mask airway.

Topics: Adult; Anesthesia, Inhalation; Anesthesia, Intravenous; Cough; Extremities; Female; Gagging; Head; Humans; Isoflurane; Laryngeal Masks; Laryngismus; Larynx; Male; Movement; Muscle Relaxation; Nitrous Oxide; Propofol; Reflex; Thiopental

Clinical observations during anaesthesia and intubation of emergency patients are presented showing a differentiated impact of etomidate (Hypnomidate) on upper airway reflexes: a blockade of pharyngeal reflexes with sustained but possibly delayed laryngeal reflexes and a certain protection against laryngospasm and vomiting. In addition etomidate enables, preferably in combination, difficult intubation with sustained spontaneous breathing due to its low respiratory depressant effect. These features were confirmed in a small foreshortened clinical study using thiopentone (Trapanal) or etomidate without muscle relaxants, whereby the difference in high risk patients became obvious. The impact of anaesthetics on airway reflexes is generally concealed by muscular relaxants, and observations on this matter are difficult to make subject to quantifiable parameters and controlled studies; accordingly such observations are scarcely found in newer anaesthetic literature. In the development of new techniques for intubation and anaesthesia without muscle relaxation, these methodical problems deserve attention.

Topics: Etomidate; Gagging; Humans; Laryngismus; Larynx; Reflex; Thiopental; Vomiting

Topics: Anesthesia, Inhalation; Anesthesia, Intravenous; Animals; Cat Diseases; Cats; Consciousness; Diaphragm; Electromyography; Ethyl Ethers; Halothane; Laryngismus; Larynx; Oxygen; Reflex; Stimulation, Chemical; Thiopental

Topics: Anesthetics, Local; Animals; Apnea; Atropine; Cats; Laryngismus; Larynx; Lidocaine; Respiration; Succinylcholine; Thiopental

Topics: Barbiturates; Humans; Laryngeal Diseases; Laryngismus; Larynx; Spasm; Thiopental