thiopental and Respiratory-Insufficiency

We recorded the ventilatory effects of eltanolone 0.75 mg kg-1, propofol 2.5 mg kg-1 and thiopentone 4 mg kg-1 at induction of anaesthesia in 76 unpremedicated patients, aged 18-65 yr. Measurements were made using a pneumotachograph incorporated between a close-fitting face mask and a T-piece delivering 35% oxygen. Eltanolone caused significantly less apnoea than propofol (incidence 57% vs 100%) and less reduction in ventilation than propofol (median maximum decrease 4.8 vs 7.8 litre min-1), but the differences between eltanolone and thiopentone were smaller and generally not significant. Ventilatory frequency was maintained well in the eltanolone group.

Topics: Adolescent; Adult; Anesthetics, Intravenous; Apnea; Female; Humans; Male; Middle Aged; Postoperative Complications; Propofol; Respiration; Respiratory Insufficiency; Steroids; Thiopental

The victim was a morbidly obese and bull-necked woman in her twenties. She had the disorders, due to Down's syndrome, including severe mental retardation, advanced hearing loss, congenital cataract surgery, and amblyopia at postoperative glaucoma. She was deeply sedated for rest with an intravenous drip infusion of 350 mg of thiopental (TP) for 5 minutes during an intraocular pressure examination with secondary glaucoma at a hospital. The examination was finished within 10 minutes after the TP injection, but her respiratory condition deteriorated rapidly when the doctor left the patient. Although immediate artificial respiration was carried out, she was declared dead about 20 hours after the examination. Medical malpractice was suspected for her death. At autopsy, no fatal disease or injury was observed in the victim. The serum TP level was 0.80 µg /ml. TP is an ultra-short-acting intravenous anesthetic, and usually only the smallest amount should be administered by frequent additions after pre-anesthesia administration while maintaining contact with patients. Although contact with patients with a disability can be difficult, it was diagnosed that the death was caused by both respiratory arrest due to a single dose of TP and delay in resuscitation due to the absence of a doctor.

Topics: Adult; Anesthetics, Intravenous; Autopsy; Deep Sedation; Diagnostic Techniques, Ophthalmological; Down Syndrome; Fatal Outcome; Female; Glaucoma; Humans; Hypnotics and Sedatives; Infusions, Intravenous; Intraocular Pressure; Malpractice; Respiratory Insufficiency; Thiopental; Young Adult

Topics: Animals; Disease Models, Animal; Fat Emulsions, Intravenous; Female; Infusions, Intravenous; Pilot Projects; Random Allocation; Rats; Respiratory Insufficiency; Sodium Chloride; Thiopental; Treatment Outcome

The main rationale behind the continuous analgesia/sedation currently practiced in the treatment of neonates with severe respiratory failure in intensive care is an attempt at shielding the sick newborn from exogenous stress and pain caused by diagnostic and therapeutic interventions. Until now, however, the factors which influence endogenous, disease-related distress have been largely ignored.. We retrospectively studied the daily need for analgesics and sedatives (fentanyl, midazolam, pentobarbital, thiopental) of 40 full-term newborns with severe respiratory failure who had been ventilated for at least 48 h over an observational period of 2-5 days. Dosing of the analgesics and sedatives was based on a neonatal sedation score for ventilated infants. These daily amounts were converted to a normative comparative dose (analgesic/sedative need = ASN) and compared with the oxygenation index (OI) as a measure of the degree of pulmonary insufficiency.. Depending on the duration of ventilation, an increasingly close correlation between the ASN and the OI was detected: the index of correlation (r) was detected to be 0.65 on the second day, but increased up to 0.94 after 5 days. The subgroup of patients who had been ventilated for more than 3 days (n = 8) consistently showed a very high correlation, ranging from r = 0.86 to r = 0.94.. Our results indicate a direct relationship between severity of pulmonary failure (expressed as OI) and degree of disease-related distress (reflected by ASN). This supports the hypothesis that in full-term neonates under mandatory intensive care for severe respiratory failure, endogenous distress caused by the primary disease itself, in addition to exogenous distress caused by therapeutic and diagnostic interventions, is key factor for the determination of the required amount of analgesic and sedative drugs.

Topics: Acute Disease; Analgesia; Female; Fentanyl; Humans; Hypnotics and Sedatives; Infant, Newborn; Intensive Care, Neonatal; Male; Midazolam; Pentobarbital; Respiration, Artificial; Respiratory Insufficiency; Retrospective Studies; Stress, Physiological; Thiopental

The acute porphyria is an autosomal dominant disorder of the héme biosynthesis enzyme. The aim of this work is to determin a diagnostic step in order to anticipate porphyric crises. We report the observation of a child which was hospitalized in the pédiatric service three years ago for peripheric arthralgies and myalgies where the diagnosis of an acute porphyria was not posed. He wase admitted in our service for appendicitis, he was operated, the anesthesie was carried out by the thiopenthal and the succinylcholine. At the first post-operative day, a respiratory insufficiency was the cause of death. The rate of coproporphyrines and of uroporphyrines in the urine had confirmed the diagnosis of acute porphyria. The positive diagnostic of acute porphyria is difficult, the association of abdominal, psychological and neurologic signs must suggest the diagnostic, all the more, if the urines have a dark colour. The presence of uroporphyrines and coproporphyrines and certain precursors in the urines or in the high-rated stools confirm the diagnostic. The family survey and dosage of porphyric compounds in the sickness-bearing patient's family members allow to reveal certain asymptomatic forms of the heriditary acute porphyria, it is caused by certain products used in neuropsychiatry, in aneasthesic or in certain circunstances, such as, the infection or the trauma. The treatment of the acute porphyria is an emergency wich requires the transfert of the patient to a unit of intensive care.

Topics: Acute Disease; Anesthetics, Inhalation; Anesthetics, Intravenous; Appendicitis; Child; Diagnosis, Differential; Fatal Outcome; Halothane; Humans; Pedigree; Porphyria, Acute Intermittent; Postoperative Complications; Prognosis; Respiratory Insufficiency; Thiopental

Topics: Anesthetics, Intravenous; Humans; Myotonic Dystrophy; Respiratory Insufficiency; Thiopental

We report an unintentional thiopental-facilitated interview in a patient presenting with apparent respiratory failure as a manifestation of Munchausen's syndrome. Unnecessary intubation was avoided and correct diagnosis was made using the thiopental interview. Patients with suspected Munchausen's syndrome represent a difficult dilemma for the emergency physician. Use of the barbiturate-facilitated interview in the emergency department may reveal the diagnosis and prevent unnecessary procedures and hospitalization.

Topics: Adult; Humans; Male; Munchausen Syndrome; Respiratory Insufficiency; Thiopental

A clinical trial of the combination of naloxone in a low dose (1-1.5 micrograms X kg-1 body weight) with physostigmine (0.5-1.0 mg i.v.) was made to elucidate whether this combination could reverse postanaesthetic overdosing in neurosurgical patients without increasing postoperative pain. The investigation was made following previous findings that physostigmine has analgesic properties in addition to its systemic antisedative and anticholinergic effects as well as a stimulatory effect on morphine-depressed ventilation. Altogether 198 neurosurgical patients were investigated. The results showed that postanaesthetic over-sedation can be safely treated by a combination of naloxone and physostigmine in the dosages named above, resulting in the rapid reversal of sedation, where opiates, neuroleptics and benzodiazepines have been used. In contrast, this combination has very little effect on sedation following the administration of agents such as halothane and isoflurane. In the great majority of patients (95%), the treatment resulted in excellent analgesia during the first postoperative hour. The incidence of nausea and vomiting was increased somewhat by this treatment, but these side-effects could be minimized by decreasing the rate of drug administration. Physostigmine is contra-indicated in patients having symptoms and signs similar to those of Parkinson's disease, and the dose of physostigmine should also be reduced to 0.5 mg i.v. in all patients over the age of 65.

Topics: Adult; Anesthesia, General; Antidotes; Drug Therapy, Combination; Humans; Middle Aged; Naloxone; Neurosurgery; Physostigmine; Respiratory Insufficiency; Thiopental

Respiratory and cardiovascular complications in a patient in the immediate postoperative period led to the ultimate diagnosis of myotonic dystrophy. The features and anaesthetic-related hazards of the myotonic syndromes are discussed.

Topics: Anesthetics; Female; Humans; Middle Aged; Myotonic Dystrophy; Respiratory Insufficiency; Thiopental

Convulsive status epilepsy is a medical emergency with significant mortality and morbidity. This retrospective survey reports the use of non-anaesthetic doses of thiopentone, given either by intravenous or rectal infusion. The regime was effective in controlling convulsive status without significant complications. It is suggested that this regime can be used safely when standard doses of diazepam (or clonazepam), and/or phenytoin, fail to effect immediate control of convulsive status, and before anaesthetic agents are administered.

Topics: Adolescent; Adult; Child; Child, Preschool; Enema; Extravasation of Diagnostic and Therapeutic Materials; Humans; Infusions, Parenteral; Middle Aged; Respiratory Insufficiency; Status Epilepticus; Thiopental

The influence of modified Type 11 electroconvulsive therapy (ECT) on plasma potasium was studied in 60 patients anaesthetized with a barbiturate and suxamethonium and the finding compared with a "control" group of patients having the same anaesthesia but not ECT. In the ECT series, plasma potassium concentration increased to a maximun 1 min after suxamethonium fasciculations and this increase occurred earlier and was more marked than that observed in the control group. It was also slightly shorter in duration, as was the comparable period of respiratory depression. These findings can be accounted for by the synchronous contraction of muscles containing blood with an increased potassium concentration following suxamethonium.

Topics: Adult; Anesthesia, Intravenous; Barbiturates; Electroconvulsive Therapy; Humans; Methohexital; Muscle Contraction; Potassium; Respiratory Insufficiency; Succinylcholine; Thiopental; Time Factors

Topics: Acidosis, Respiratory; Analgesia; Anesthesia, Conduction; Anesthesia, Epidural; Anesthesia, Obstetrical; Bradycardia; Delivery, Obstetric; Drug Therapy, Combination; Extraction, Obstetrical; Female; Humans; Infant, Newborn; Injections, Intravenous; Labor, Obstetric; Meperidine; Naloxone; Pain; Pregnancy; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Thiopental; Tranquilizing Agents; Vasoconstrictor Agents

Topics: Anesthesia, Intravenous; Anesthetics; Animals; Cat Diseases; Cats; Drug Combinations; Hydroxysteroids; Pregnanediones; Respiratory Insufficiency; Thiopental

Topics: Air; Airway Resistance; Anesthesia; Animals; Arteries; Autonomic Nerve Block; Blood Gas Analysis; Blood Pressure; Dogs; Hypoxia; Lung Compliance; Muscle Contraction; Oxygen; Oxygen Inhalation Therapy; Postoperative Complications; Respiration; Respiratory Dead Space; Respiratory Insufficiency; Respiratory Tract Diseases; Thiopental; Tibia; Tubocurarine

Topics: Anesthesia, General; Brain Diseases; Diazepam; Female; Humans; Male; Positive-Pressure Respiration; Respiratory Insufficiency; Succinylcholine; Thiopental

Topics: Adult; Anesthesia, Intravenous; Arrhythmias, Cardiac; Humans; Male; Nitrous Oxide; Oxygen; Respiratory Insufficiency; Thiopental

Topics: Adolescent; Adult; Anesthesia, Inhalation; Blood Pressure; Heart Rate; Humans; Hypoventilation; Levallorphan; Middle Aged; Nalorphine; Narcotic Antagonists; Nitrous Oxide; Oxymorphone; Pulse; Respiration; Respiratory Insufficiency; Thiopental

Topics: Anesthesia, General; Arousal; Bemegride; Benzamides; Biopsy; Central Nervous System Stimulants; Doxapram; Female; Hemodynamics; Humans; Methylphenidate; Nikethamide; Nitrous Oxide; Pentylenetetrazole; Quinolizines; Respiration; Respiratory Insufficiency; Thiopental

Topics: Anesthesia, General; Atropine; Blood Gas Analysis; Carbon Dioxide; Halothane; Humans; Hypoxia; Oximetry; Papaverine; Postoperative Complications; Preanesthetic Medication; Respiratory Insufficiency; Thiopental

Topics: Anesthesia; Anesthesia, General; Humans; Myotonic Dystrophy; Respiration; Respiratory Function Tests; Respiratory Insufficiency; Thiopental; Toxicology

Topics: Adolescent; Anesthesia; Anuria; Child; Heart Arrest; Heart Massage; Humans; Hydropneumothorax; Kidneys, Artificial; Pleural Effusion; Pulmonary Edema; Respiration, Artificial; Respiratory Insufficiency; Thiopental; Toxicology

Topics: Anesthesia; Antineoplastic Agents; Chemotherapy, Cancer, Regional Perfusion; Ethers; Ethers, Cyclic; Head; Head and Neck Neoplasms; Humans; Neoplasms; Perfusion; Respiratory Insufficiency; Thiopental

Methylethylglutarimide was administered to 488 patients ranging in age from 7 to 89 years, in a study on sleep-reversal after harbiturate anesthesia. Sodium surital or sodium pentothal were the barbiturates used. The drug was administered intravenously in doses varying from 25 to 200 mg. Dosage below 25 mg. was found to be ineffective. Almost all patients showed signs of awakening as evidenced by the return of corneal and conjunctival reflexes, the opening of the eyes, and stirring or moving about. Many responded to questioning. Almost all showed evidence of greater responsiveness within five minutes. No untoward reactions were noted. No convulsions were produced. Five patients ranging in age from 24 to 70 years were treated for barbiturate poisoning with Mikedimide(R) given intravenously in doses varying from 550 mg. to 1950 mg. All recovered consciousness within 30 minutes to an hour. No convulsions were produced. While it is not known whether Mikedimide is a direct barbiturate antagonist, or whether it is an analeptic, it appears to be a useful drug in reversing the respiratory depression and the cerebral depression produced by harbiturate intoxication and barbiturate anesthesia.

Topics: Anesthesia; Antidotes; Barbiturates; Bemegride; Central Nervous System Stimulants; Conjunctiva; Depressive Disorder; Eye; Humans; Respiratory Insufficiency; Sodium, Dietary; Thiamylal; Thiopental

Topics: Analgesia; Anesthesia; Anesthesia and Analgesia; Barbiturates; Oxygen; Pain Management; Respiration; Respiratory Insufficiency; Thiopental

Topics: Anesthesia; Anesthesia, Inhalation; Barbiturates; Disease; Humans; Respiratory Insufficiency; Thiopental; Thumb

Topics: Anesthesia; Anesthesiology; Barbital; Barbiturates; Cell Respiration; Humans; Respiration; Respiratory Insufficiency; Sodium; Thiopental