thiopental and Rupture--Spontaneous

In this study we report our clinical experience with supplementary thiopental loading, based on 30 patients undergoing surgery for intracranial aneurysm after a recent episode of subarachnoid haemorrhage. As standard procedure we used pentobarbitone induction, pancuronium relaxation, endotracheal intubation, maintenance with halothane 0.5%, N2O 66% in oxygen, fentanyl, and moderate hypocapnia. A thiopental load of up to 20 mg X kg-1 was supplied while the aneurysm was approached. Satisfactory and well-controlled hypotension was obtained in five cases after thiopental alone, and after thiopental and sodium nitroprusside (SNP) (means +/- s.d.) 1.3 +/- 0.9 microgram X kg-1 X min-1 in the remaining 25 patients. No ECG sign of myocardial ischaemia was observed. One disadvantage was a prolonged recovery period, which in some cases necessitated controlled ventilation for some hours. We conclude that thiopental loading can be used safely as a supplement to neuroanaesthesia for aneurysm surgery.

Topics: Adult; Anesthesia, General; Blood Pressure; Consciousness; Female; Heart Rate; Humans; Hypotension, Controlled; Intracranial Aneurysm; Male; Middle Aged; Nitroprusside; Pulmonary Gas Exchange; Rupture, Spontaneous; Subarachnoid Hemorrhage; Thiopental; Time Factors

Twenty patients undergoing intracranial aneurysm clipping were anesthetized with doses of thiopental sufficient to produce electroencephalographic burst suppression, nitrous oxide, oxygen, and morphine sulfate. Diuresis was induced with a combination of furosemide and mannitol. The cardiovascular effects of this anesthetic technique were studied. The central venous, pulmonary artery, pulmonary artery wedge, and systemic arterial blood pressures and the cardiac output were determined. The cardiac index and the systemic and pulmonary vascular resistance were calculated. The systemic blood pressure remained unchanged throughout the procedure except during the period of induced hypotension. The cardiac index decreased on the average from 3.3 during the control period to 2.15 litres/minute/m2 after the induction of anesthesia and diuresis (P less than 0.05). During sodium nitroprusside-induced hypotension, there was a further decrease in the cardiac index to 1.81 litres/minute/m2 (P less than 0.05). Changes in the cardiac index were associated with a significant decrease in the central venous and pulmonary artery wedge pressures from 2.5 to 0.1 and 5.9 to 0.2 torr, respectively) and an increased systemic vascular resistance. Cardiovascular performance recovered quickly after termination of the induced hypotension and remained stable in the postoperative period. This anesthetic technique seems to be useful in the surgical repair of intracranial aneurysms.

Topics: Adolescent; Adult; Aged; Anesthesia, Intravenous; Blood Pressure; Cardiac Output; Humans; Intracranial Aneurysm; Middle Aged; Outcome and Process Assessment, Health Care; Rupture, Spontaneous; Thiopental; Vascular Resistance

Topics: Anesthesia, General; Blood Pressure Determination; Female; Halothane; Humans; Hypotension, Controlled; Intracranial Aneurysm; Preanesthetic Medication; Pregnancy; Pregnancy Complications, Cardiovascular; Propranolol; Rupture, Spontaneous; Subarachnoid Hemorrhage; Succinylcholine; Thiopental; Trimethaphan