thiopental and Lung-Neoplasms

We examined the effect of isoflurane and sevoflurane on respiratory system resistance (Rmin,rs) in patients with chronic obstructive pulmonary disease (COPD). The diagnosis of COPD rests on the presence of airway obstruction, which is only partially reversible after bronchodilator treatment. Ninety-six consecutive patients undergoing thoracic surgery for peripheral lung cancer were enrolled. They were divided into two groups: preoperative forced expiratory volume in 1 s/forced vital capacity ratio <70% or >70%. Rmin,rs was measured after 5 and 10 min of maintenance anesthesia by using the constant flow/rapid occlusion method. Maintenance of anesthesia was randomized to thiopental 0.30 mg . kg(-1) . min(-1) or 1.1 minimum alveolar anesthetic concentration end-tidal isoflurane or sevoflurane. Eleven patients were excluded: two because anesthesia was erroneously induced with propofol and nine because of an incorrect tube position. Maintenance with thiopental failed to decrease Rmin,rs, whereas both volatile anesthetics were able to decrease Rmin,rs in patients with COPD. The percentage of patients who did not respond to volatile anesthetics was larger in those with COPD as well. In conclusion, we have demonstrated that isoflurane and sevoflurane produce bronchodilation in patients with COPD.

Topics: Aged; Airway Resistance; Algorithms; Anesthetics, Inhalation; Bronchodilator Agents; Female; Forced Expiratory Volume; Humans; Isoflurane; Lung Neoplasms; Male; Methyl Ethers; Middle Aged; Monitoring, Intraoperative; Pulmonary Disease, Chronic Obstructive; Respiratory Mechanics; Sevoflurane; Thiopental; Thoracic Surgical Procedures; Vital Capacity

We used the biphasic electroencephalographic (EEG) response to increasing concentrations of thiopental to measure regional brain responses to thiopental. Eight patients with cortical parietal brain tumors, 3.3 (SD 1.3) cm in diameter, and eight control patients with lung cancer and normal brain computed tomography scans received thiopental by infusion (50-75 mg/min) until burst suppression (50% isoelectric activity) on the EEG occurred. Infusion lasted 10.7 (SD 2.4) min, and the average dose of thiopental administered was 810 (SD 170) mg [11.2 (SD 1.9) mg/kg]. During infusion the EEG was continuously recorded from the F3, F4, P3, and P4 electrodes. On-line power spectral analysis was performed, and data were saved for later analysis. Four EEG parameters [log beta (15-30 Hz) power, percent beta power, spectral edge 95% and spectral edge 70%] were plotted against calculated brain concentration of thiopental [using an assumed plasma-effect site rate constant (ke0) of 0.58] for each individual. Three points were measured on each curve (50% upslope, peak, and zero intercept) to quantitate the EEG response. Statistical comparisons were performed between the following sets of data: EEG response at electrode closest to brain tumor versus electrode farthest from tumor (in the same patient); and electrodes closest to brain tumors (parietal P3 and P4) versus same electrode pair in control patients (patients with thoracic tumors) using analysis. No differences were found in any comparison. Thus, the presence of a brain tumor does not affect the response of the brain in this region to thiopental as measured using EEG.

Topics: Aged; Anesthesia; Brain Neoplasms; Carbon Dioxide; Electroencephalography; Humans; Lung Neoplasms; Middle Aged; Parietal Lobe; Thiopental; Tomography, X-Ray Computed

Hypoxemia is one of the major problems during one-lung ventilation (OLV). During two-lung ventilation (TLV) using a double-lumen bronchial tube, bronchial endtidal carbon dioxide partial pressure (ETbr(CO2)) can be determined on both sides, independently. The ETbr(CO2) is mainly dependent on the pulmonary perfusion to each lung. If the degree of oxygenation disorder during OLV were to be predictable before starting OLV, this could provide time to prepare for any subsequent hypoxemia. The aim of this study was to investigate whether the difference of ETbr(CO2) (D-ETbr(CO2)) between the dependent and the nondependent lungs during TLV in the lateral decubitus position (LP) could be a predictive factor for the severity of oxygenation disorder under subsequent OLV.. Eighteen patients undergoing lung surgery were enrolled in this study. Anesthesia was induced with intravenous thiopental and fentanyl, supplemented by the inhalation of sevoflurane. A left-sided double-lumen bronchial tube was placed. The ETbr(CO2) was independently determined on each side during TLV in the supine position (SP) and at 10 min after changing the position from SP to LP. PaO2/inspiratory fraction of oxygen (FIO2) was taken at 15 min after switching from TLV to OLV in LP.. The decrease of PaO2/FIO2 at 15 min during OLV in LP correlated with the reduction of the D-ETbr(CO2) predetermined during TLV in LP (r = 0.698; P < 0.01).. The D-ETbr(CO2) predetermined during TLV in LP could be a predictive factor for the severity of oxygenation disorder after starting OLV in LP.

Topics: Aged; Anesthesia, Intravenous; Anesthetics, Intravenous; Blood Gas Analysis; Carbon Dioxide; Female; Fentanyl; Humans; Intubation, Intratracheal; Lung Neoplasms; Male; Middle Aged; Oxygen Consumption; Posture; Respiration, Artificial; Thiopental; Tidal Volume

Postoperative immunosuppression is partly ascribed to anesthesia and has been suggested to compromise patients' resistance to infection and tumor metastasis. We compared the effects of various anesthetics on natural killer (NK) cell activity and on resistance to experimental metastasis, and studied mediating mechanisms and prophylactic measures. Fischer 344 rats served as controls or were anesthetized for 1 h with ketamine, thiopental, halothane, or propofol. Anesthetized rats were either maintained in normothermia or left to spontaneously reach 33 degrees C-35 degrees C. Rats were then injected IV with MADB106 tumor cells, and 24 h later lung tumor retention was assessed, or 3 wk later, lung metastases were counted. Additionally, the number and activity of circulating NK cells were assessed after anesthesia. All anesthetics, except propofol, significantly reduced NK activity and increased MADB106 lung tumor retention or lung metastases. Hypothermia had no significant effects. Ketamine increased metastasis most potently, and this effect was markedly reduced in rats pretreated with a beta-adrenergic antagonist (nadolol) or with chronic small doses of an immunostimulator (polyriboinosinic:polyribocytidylic acid). Overall, the marked variation in the NK-suppressive effects of anesthetics seems to underlie their differential promotion of MADB106 metastasis. Prophylactic measures may include perioperative immunostimulation and the use of beta-blockers.. This study in a rat model of pulmonary metastasis demonstrates that some anesthetics, but not others, increase susceptibility to tumor metastasis, apparently by suppressing natural killer cell activity. Ketamine was most deleterious, and its effects were prevented by peripheral blockade of beta-adrenoceptors combined with low levels of immunostimulation.

Topics: Adjuvants, Immunologic; Adrenergic beta-Antagonists; Anesthetics; Anesthetics, Dissociative; Anesthetics, Inhalation; Anesthetics, Intravenous; Animals; Antiviral Agents; Female; Flow Cytometry; Halothane; Ketamine; Killer Cells, Natural; Lung Neoplasms; Male; Nadolol; Neoplasm Metastasis; Poly I-C; Propofol; Rats; Rats, Inbred F344; Thiopental; Tumor Cells, Cultured

Clinical studies have implicated surgery in promoting infections and compromising immune functions, including natural killer cell activity. Animal studies indicate that surgery-induced suppression of natural killer cell activity also promotes tumor metastasis. Hypothermia, a common surgical complication, has been suggested to underlie some of the deleterious consequences of surgery. This study evaluated the effect of hypothermia on the activity and number of blood natural killer cells and on host susceptibility to metastasis. The involvement of adrenergic mechanisms was also considered.. Fischer-344 rats remained awake in their cages (control group) or were anesthetized with 70 mg/kg thiopental and maintained for 2.5 h at core body temperatures of 30-32 degrees C (hypothermia group) or 38 degrees C (normothermia group). Thereafter, at several time points, blood was drawn so natural killer cell activity could be assessed, or rats were injected with syngeneic MADB106 tumor cells that metastasize only to the lungs. Lungs were removed 9 h later for assessment of lung tumor retention, or 4 weeks later for counting of metastases.. Normothermic anesthesia reduced natural killer cell activity (lytic units at 30% specific killing, mean +/- SEM) to 39+/-6.2% of control levels and hypothermia further reduced it to 15+/-6.6%. These changes were not accompanied by alterations in the numbers of circulating natural killer cells. Hypothermia increased tumor retention to 250% of control levels, and the number of metastases increased from 1.1+/-0.4 to 4.7+/-1.2. Normothermia had no significant effects on this index. Nadolol (0.4 mg/kg), a beta-adrenergic antagonist, significantly attenuated the effect of hypothermia on tumor retention.. Hypothermia under thiopental anesthesia suppresses natural killer cell activity and compromises host resistance to metastatic formation, possibly via adrenergic mechanisms. Such suppression may place patients with metastasizing tumors or dormant viral infections at greater risk for complications after intraoperative hypothermia.

Topics: Adrenergic beta-Antagonists; Anesthesia; Anesthetics, Intravenous; Animals; Hypothermia; Killer Cells, Natural; Lung Neoplasms; Male; Rats; Rats, Wistar; Receptors, Adrenergic; Thiopental

Our previous studies indicated that anesthetic drugs cause acceleration of postoperative metastasis of mouse tumors. We tested whether this augmentation could be attributed to a decrease in natural killer (NK) activity. The results indicated that two of the anesthetic drugs used during excision of the Lewis lung carcinoma (3LL) tumor, halothane and ketamine, decreased NK activity, whereas the other two, thiopental sodium and N2O, had no effect on NK activity in in vitro assays. The observed decrease in NK cell activity was reversed following treatment with polyinosinic-polycytidylic acid (poly I:C), which is an NK cell potentiator. Treatment of mice with poly I:C abolished the accelerated growth of metastases following excision of the tumor under ketamine or halothane anesthesia. On the other hand, treatment with poly I:C seemed to have no effect on acceleration of postoperative metastasis in mice anesthetized with N2O or thiopental sodium.

Topics: Anesthesia, General; Anesthetics; Animals; Carcinoma; Female; Halothane; In Vitro Techniques; Ketamine; Killer Cells, Natural; Lung Neoplasms; Mice; Mice, Inbred C3H; Mice, Inbred C57BL; Neoplasm Metastasis; Nitrous Oxide; Poly I-C; Thiopental

Topics: Animals; Humans; Lung Neoplasms; Mice; Neoplasm Metastasis; Neoplasms, Experimental; Species Specificity; Thiopental

This set of experiments was devised to determine the effects of the commonly employed anesthetic induction agent, thiopental, on the incidence of pulmonary metastases in a murine fibrosarcoma system. A correlation was made with cell-mediated immune responses in vivo and in vitro. In two separate experiments, thiopental-treated mice had a significantly increased incidence of pulmonary metastases. This was correlated with an impaired delayed hypersensitivity reaction to the de novo antigen. 2,4-dinitrochlorobenzene (DNCB) and a suppressed mixed leukocyte culture (MLC) reaction. However, if animals were sensitized with DNCB 5 days prior to receiving pentothal, no impairment of DNCB reactivity was noted. This suggests strongly that the observed defect is in the afferent arm of the immune response. Thiopental suppresses cell-mediated immune responses in this system, and the observed biologic consequence is an increase in pulmonary metastases.

Topics: Anesthetics; Animals; Dinitrochlorobenzene; Fibrosarcoma; Hypersensitivity, Delayed; Immunosuppression Therapy; Lung Neoplasms; Lymphocyte Culture Test, Mixed; Mice; Mice, Inbred C57BL; Neoplasm Metastasis; Neoplasms, Experimental; Thiopental

A patient who had a permanent tracheostomy needed to be anaesthetized for thoracotomy. Anticipated difficulty with airway and lung control did not occur following successful intubation via the tracheostomy with a Robertshaw double-lumen tube.

Topics: Aged; Anesthesia, General; Humans; Intubation, Intratracheal; Lung Neoplasms; Male; Nitrous Oxide; Pneumonectomy; Succinylcholine; Thiopental; Tracheotomy

Topics: Ambulatory Care; Anesthesia, General; Bronchoscopy; Electromyography; Hexobarbital; Humans; Lung Neoplasms; Succinylcholine; Thiopental

Topics: Adult; Anesthesia, General; Breast Neoplasms; Bronchial Spasm; Carcinoma; Carcinoma, Squamous Cell; Female; Humans; Lung Neoplasms; Male; Middle Aged; Preanesthetic Medication; Thiopental; Tubocurarine

Topics: Adolescent; Adult; Aged; Anesthesia, Inhalation; Anesthesia, Intravenous; Bronchiectasis; Diazepam; Female; Halothane; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Preanesthetic Medication; Succinylcholine; Thiopental; Tuberculosis, Pulmonary

Topics: Adolescent; Adult; Aged; Anesthesia, General; Anesthesia, Local; Bronchiectasis; Bronchospirometry; Humans; Lidocaine; Lung Abscess; Lung Diseases; Lung Neoplasms; Methods; Middle Aged; Succinylcholine; Thiopental; Tuberculosis, Pulmonary