thiopental and Lung-Diseases--Obstructive

A total of 139 of 473 severely disabled, mainly ventilator-dependent patients required some form of surgery. Such patients require surgery more frequently than normal individuals, both because of their disability and because even minor unrelated disorders superimposed on permanent disability cause greater handicap. We report the peri-operative management and postoperative complications of 142 operations on 83 patients between 1982 and 1987. A simple inhalational anaesthetic technique was used; opioids and muscle relaxants were seldom given. Negative pressure ventilation was employed in the postoperative period when appropriate, and was combined with vigorous chest physiotherapy. There were three peri-operative deaths, but the overall death rate in the patients who underwent surgery was no greater throughout the study period than in those who did not require surgery. We believe that an aggressive surgical approach is appropriate in severely disabled, ventilator-dependent patients.

Topics: Adult; Aged; Anesthesia, Inhalation; Female; Humans; Intraoperative Care; Lung Diseases, Obstructive; Male; Middle Aged; Physical Therapy Modalities; Postoperative Care; Postoperative Complications; Respiration, Artificial; Surgical Procedures, Operative; Thiopental

Using a dual isohypercapnic technique, the authors compared the effect on ventilatory control of midazolam (0.2 mg/kg) and thiopental (3.5 mg/kg) in normal volunteers and in subjects with chronic obstructive pulmonary disease (COPD). In normal volunteers the slope of the CO2 response curve decreased from 1.77 +/- 0.16 l . min-1 . mmHg-1 (mean +/- SEM) to a minimum of 1.14 +/- 0.17 l . min-1 . mmHg-1 3.5 min after midazolam, returning to 1.32 +/- 0.21 l . min-1 . mmHg-1 15 min after injection. In the same subjects, the slope of the CO2 response curve fell from 1.89 +/- 0.18 l . min-1 . mmHg-1 to a minimum of 1.37 +/- 0.29 l . min-1 . mmHg-1 one minute after injection of thiopental, returning to 1.69 +/- 0.22 l . min-1 . mmHg-1 15 min after injection. These changes were not statistically significant. In subjects with clinical COPD, the slope of the CO2 response curve decreased from 1.89 +/- 0.63 l . min-1 . mmHg-1 to a minimum of 0.39 +/- 0.19 l . min-1 . mmHg-1 two minutes after injection of midazolam (P less than 0.05 compared with control), while 15 min after injection, the slope recovered to only 0.62 +/- 0.40 l . min-1 . mmHg-1 (P less than 0.05 compared with control). In the same subjects, the slope of the CO2 response curve decreased from 1.53 +/- 0.17 to a minimum of 0.69 +/- 0.25 l . min-1 . mmHg-1 0.5 min after injection of thiopental, recovering to 1.47 +/- 0.28 l . min-1 . mmHg-1 15 min after injection. This was significantly greater than the corresponding slope after midazolam (P less than 0.05). The authors conclude that while the time course of ventilatory depression after thiopental is similar in normal volunteers and in patients with COPD, the ventilatory depression 15 minutes after midazolam is more profound in patients with COPD than in normal subjects.

Topics: Anesthetics; Benzodiazepines; Carbon Dioxide; Depression, Chemical; Humans; Lung Diseases, Obstructive; Male; Midazolam; Respiration; Thiopental; Time Factors

Topics: Adult; Age Factors; Aged; Anesthesia, Epidural; Anesthesia, General; Anesthesia, Spinal; Anesthetics; Asthma; Bronchitis; Chronic Disease; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Nitrous Oxide; Oxygen; Postoperative Complications; Pulmonary Emphysema; Surgical Procedures, Operative; Thiopental