thiopental and Nervous-System-Diseases

Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during temporary occlusion of the cerebral vasculature during intracranial aneurysm surgery (temporary clipping) is not established.. A post hoc analysis of patients from the Intraoperative Hypothermia for Aneurysm Surgery Trial who underwent temporary clipping was performed. Univariate and multivariate logistic regression methods were used to test for associations between hypothermia, supplemental protective drug, and short- (24-h) and long-term (3-month) neurologic outcomes. An odds ratio more than 1 denotes better outcome.. Patients undergoing temporary clipping (n = 441) were assigned to intraoperative hypothermia (33.3 degrees +/- 0.8 degrees C, n = 208) or normothermia (36.7 degrees +/- 0.5 degrees C, n = 233), with 178 patients also receiving supplemental protective drug (thiopental or etomidate) during temporary clipping. Three months after surgery, 278 patients (63%) had good outcome (Glasgow Outcome Score = 1). Neither hypothermia (P = 0.847; odds ratio = 1.043, 95% CI = 0.678-1.606) nor supplemental protective drug (P = 0.835; odds ratio = 1.048, 95% CI = 0.674-1.631) were associated with 3-month Glasgow Outcome Score. The effect of supplemental protective drug did not significantly vary with temperature. The effects of hypothermia and protective drug did not significantly vary with temporary clip duration. Similar findings were made for 24-h neurologic status and 3-month Neuropsychological Composite Score.. In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.

Topics: Aged; Anesthesia, General; Aneurysm, Ruptured; Body Temperature; Double-Blind Method; Female; Glasgow Outcome Scale; Humans; Hypnotics and Sedatives; Hypothermia, Induced; Intracranial Aneurysm; Logistic Models; Male; Middle Aged; Nervous System Diseases; Neuropsychological Tests; Neurosurgical Procedures; Postoperative Complications; Prospective Studies; Protective Agents; Thiopental; Treatment Outcome

Giant axonal neuropathy is a generalised disorder of cytoplasmic intermediate filaments which particularly involves the peripheral and central nervous systems. In this paper we describe a child with giant axonal neuropathy and discuss the anaesthetic management in the light of the pathology and physiology of the condition.

Topics: Anesthesia, General; Child; Diazepam; Humans; Intermediate Filaments; Kyphosis; Male; Muscles; Nervous System Diseases; Orchiectomy; Scoliosis; Spermatic Cord Torsion; Thiopental

Traditional visual inspection of electroencephalographic (EEG) tracings and computer-assisted topographic mapping were compared in their abilities to detect and locate supratentorial lesions following intravenous sodium thiopental administration. Of the 13 subjects, 8 had atrophic and 5 had mass lesions, all defined by computed tomographic scan and 11 confirmed at operation. EEGs made before and after thiopental administration were evaluated separately from topographic maps of statistical difference between EEGs at multiple frequency ranges made before and after thiopental injection. Topographic mapping of statistical difference accurately detected all thirteen lesions, whereas EEG detected eight. In addition to demonstrating reduced beta production overlying structural abnormalities, topographic mapping revealed regionally augmented beta, especially over irritative lesions. Moreover, localization was possible with the topographic method after the first thiopental injection, whereas a second injection was required for EEG localization by visual inspection. Changes in slow (delta) activity were also useful in delineation of atrophic lesions, in which delta was usually augmented but occasionally regionally reduced. Multielectrode studies with topographic mapping appear essential in delineating cerebral abnormalities, because both slow and fast activities may be increased or reduced over such areas. The relative response of EEG background activity to thiopental at different frequencies may assist lesion characterization as well as localization.

Topics: Adolescent; Adult; Brain; Brain Diseases; Brain Mapping; Child; Child, Preschool; Electroencephalography; Female; Humans; Male; Nervous System Diseases; Thiopental; Tomography, Emission-Computed; Tomography, X-Ray Computed

Topics: Abdomen; Adrenal Glands; Adult; Aged; Anesthesia, General; Betamethasone; Brain Neoplasms; Craniotomy; Female; Halothane; Humans; Hydrocortisone; Laminectomy; Male; Meningioma; Middle Aged; Nervous System Diseases; Nitrous Oxide; Parasympathetic Nervous System; Preanesthetic Medication; Spinal Cord Neoplasms; Thiopental

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

Topics: Electroencephalography; Epilepsy; Humans; Nervous System Diseases; Pharmacology; Thiopental

Topics: Humans; Nervous System Diseases; Patient Discharge; Physiological Phenomena; Seizures; Sleep; Thiopental