thiopental and Necrosis

Topics: Animals; Bicarbonates; Calcium Chloride; Cardiac Pacing, Artificial; Cardiography, Impedance; Electric Countershock; Humans; Intubation, Intratracheal; Myocardium; Necrosis; Resuscitation; Thiopental; Ventricular Fibrillation

Intravenous anesthetics have been used during the treatment of various malignant tumors, however, their effects on oral tissues is not well-understood. In the present study, the cytotoxicity of five intravenous anesthetics towards oral tumor and normal cells was compared.. Tumor specificity index was determined by the ratio of the mean 50% cytotoxic concentration for normal cells to that for tumor cells. Apoptosis induction was monitored by internucleosomal DNA fragmentation and caspase-3, -8, and -9 activation. Fine cell structure was observed under transmission electron microscopy.. Benzodiazepines (midazolam and diazepam) exhibited higher cytotoxicity than barbiturates (thiopental and thiamylal), whereas propofol had the intermediate range of cytotoxicity. Midazolam showed the highest cytotoxicity. HL-60 cells were the most sensitive to midazolam, followed by epidermal keratinocytes, oral squamous cell carcinoma (OSCC), glioblastoma and then oral normal cells. Midazolam did not induce the production of apoptosis markers such as internucleosomal DNA fragmentation and activation of caspase-3, -8 and -9, but did induce the appearance of many vacuoles, mitochondrial swelling and cell membrane rupture in OSCC cell lines (HSC-2 and HSC-4) cells. The cytotoxicity of midazolam was not reduced by pre-treatment with autophagy inhibitors (3-methyladenine and bafilomycin A1).. These results suggest that midazolam may induce necrotic cell death, rather than apoptosis or autophagy, in OSCC cell lines.

Topics: Anesthetics, Intravenous; Carcinoma, Squamous Cell; Cell Death; Cell Line, Tumor; Diazepam; DNA Fragmentation; Drug Screening Assays, Antitumor; Humans; Microscopy, Electron, Transmission; Midazolam; Mouth Neoplasms; Necrosis; Propofol; Thiamylal; Thiopental

N-Methyl-D-aspartate (NMDA) antagonists act by an anti-excitotoxic action to provide neuroprotection against acute brain injury, but these agents can also cause toxic effects. In low doses they induce reversible neuronal injury, but in higher doses they cause irreversible degeneration of cerebrocortical neurons. GABAmimetic drugs protect against the reversible neurotoxic changes in rat brain. Here we show that two GABAmimetic anesthetic agents--propofol and sodium thiopental--protect against the irreversible neurodegenerative reaction induced by the powerful NMDA antagonist, MK-801.

Topics: Anesthetics, Intravenous; Animals; Dizocilpine Maleate; Dose-Response Relationship, Drug; Drug Interactions; Excitatory Amino Acid Antagonists; Female; GABA Agonists; gamma-Aminobutyric Acid; Glutamic Acid; Gyrus Cinguli; Necrosis; Nerve Degeneration; Neurons; Neuroprotective Agents; Neurotoxins; Propofol; Rats; Rats, Sprague-Dawley; Receptors, GABA-A; 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

Inadvertent arterial injections, both in cases of drug addiction and in iatrogenic situations, often result in significant loss of tissue and, eventually, loss of function distal to the injection site. Previous experimental studies regarding the effectiveness of agents to reverse vasospasm have been inconclusive. A recent clinical report, however, suggested that intraarterial injection of reserpine was affective in limiting tissue necrosis. This experiment was designed to study the affect of intraarterially injected reserpine and tolazoline hydrochloride in a rabbit ear model of necrosis following intraarterial injection of pentothal. Six groups of 5 rabbits each were studied. Animals in Group 1 received intraarterial saline injections. Animals in Group 2 received intraarterial pentothal. Animals in Group 3 received intraarterially injected pentothal plus intraarterial reserpine 30 minutes later. Animals in Group 4 received intraarterially injected pentothal plus intraarterial tolazoline 30 minutes later. Animals in Group 5 received intraarterially injected pentothal plus intraarterially injected reserpine and intraarterially injected tolazoline both administered immediately. Animals in Group 6 received intraarterially injected pentothal plus intraarterially injected reserpine and intraarterially injected tolazoline, both administered 30 minutes later. Results showed no significant difference in the amount of tissue necrosis between treated and untreated animals. We conclude that the use of intraarterial spasmolytic agents has no effect on the course of tissue necrosis after inadvertent intraarterial injections.

Topics: Animals; Arteries; Disease Models, Animal; Ear, External; Injections, Intra-Arterial; Necrosis; Rabbits; Reserpine; Thiopental; Tolazoline

An account is given of unusual course of a hyperthermic crisis in a 23-year-old male who underwent repeated anesthetics. As yet little has been reported about Isoflurane, which we presume to have been the triggering agent. In this case only the surgically untreated lower extremity developed rigor, with which malignant hyperthermia is associated, whereas the surgically treated extremity, where circulation had been stopped with a tourniquet, remained unaffected. Rigor and contracture of the affected extremity were so severe that they led to a compartment syndrome, necessitating fasciotomy. No observation of this kind has been published before. In addition to a discussion of this dissociated effect in malignant hyperthermia, a detailed account of the course of the crisis is given.

Topics: Adult; Ankle Joint; Anterior Compartment Syndrome; Biopsy; Compartment Syndromes; Humans; Isoflurane; Ligaments, Articular; Male; Malignant Hyperthermia; Muscles; Necrosis; Rhabdomyolysis; Thiopental

Topics: Acepromazine; Animals; Atropine; Chemical and Drug Induced Liver Injury; Dog Diseases; Dogs; Drug Interactions; Female; Liver; Liver Diseases; Methoxyflurane; Necrosis; Pentazocine; Thiopental

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: Antineoplastic Agents; Bicarbonates; Epinephrine; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Necrosis; Skin; Skin Diseases; Thiopental

Topics: Anesthesia, Intravenous; Animals; Arteries; Blood Vessels; Ear, External; Gangrene; Necrosis; Rabbits; Radiography; Spasm; Thiopental; Thrombophlebitis; Thrombosis; Veins; Venous Insufficiency

Topics: Humans; Injections, Intradermal; Injections, Intravenous; Muscular Diseases; Necrosis; Nervous System Diseases; Paralysis; Skin Ulcer; Tendons; Thiopental

Topics: Animals; Chemical and Drug Induced Liver Injury; Chloroform; Disulfiram; Enzyme Induction; Microsomes, Liver; Necrosis; Phenobarbital; Preanesthetic Medication; Rats; Thiopental; Transaminases

Topics: Adult; Aged; Anesthesia, Intravenous; Female; Gangrene; Humans; Iatrogenic Disease; Injections, Intravenous; Male; Middle Aged; Muscular Diseases; Necrosis; Nerve Tissue; Peripheral Nervous System Diseases; Thiopental

Topics: Anesthetics; Animals; Female; Femoral Artery; Injections, Intra-Arterial; Muscles; Muscular Diseases; Necrosis; Rats; Thiopental

Topics: Animals; Arteries; Gangrene; Injections; Injections, Intra-Arterial; Methohexital; Necrosis; Rabbits; Research; Thiopental; Toxicology