thiopental and Scoliosis

We studied the effects of supplementing anaesthesia with halothane (up to 1.5%, inspired) on the somatosensory evoked potential recorded in the extradural space of six patients before corrective surgery for idiopathic adolescent scoliosis. A further six patients in whom anaesthesia was supplemented with thiopentone acted as a control group. Halothane 1.5% resulted in a significant decrease in overall amplitude (P less than 0.05) from the left leg only. Halothane had no significant effect on overall amplitude, first peak amplitude, second peak amplitude and first peak latency. We conclude that halothane is unlikely to alter the interpretation of somatosensory evoked potentials recorded extradurally during scoliosis surgery. A possible unilateral effect of halothane on the concave side in idiopathic adolescent scoliosis needs further investigation.

Topics: Adolescent; Epidural Space; Evoked Potentials, Somatosensory; Female; Halothane; Humans; Male; Preoperative Care; Scoliosis; Thiopental

The investigation was devoted to assessment of the reaction of blood circulation to turning to the position "lying on the belly" in different variants of induction of anesthesia to children aged from 7 to 17 years having deformities of the spinal cord. The following combinations were compared: Ketamin, Fentanyl, and inhalation with nitrous oxide; Propofol and Fentanyl; Thiopental, Clofelin, Fentanyl and inhalation with nitrous oxide; Propofol, Clofelin and Fentanyl. The minimal changes in blood circulation were found to occur when using the combination of Thiopental, Clofelin and Fentanyl.

Topics: Adolescent; Age Factors; Analgesics; Anesthetics, Combined; Anesthetics, Dissociative; Anesthetics, Inhalation; Anesthetics, Intravenous; Child; Clonidine; Fentanyl; Hemodynamics; Humans; Ketamine; Kyphosis; Nitrous Oxide; Prone Position; Propofol; Respiration, Artificial; Scoliosis; Spinal Injuries; Spinal Neoplasms; Thiopental

Advances in the treatment of congenital heart disease have led to a new group of adolescents or adults patients with cardiac anomalies. The anaesthetic management of these patients can be challenging especially when they are scheduled for major noncardiac surgery inducing haemodynamic instability. We report the case of a 14-year-old boy scheduled for posterior spinal fusion for idiopathic scoliosis who underwent a Fontan operation in infancy for pulmonary atresia with right ventricle hypoplasia. The preoperative investigations and the anaesthetic management are described.

Topics: Adolescent; Androstanols; Anesthesia, Intravenous; Anesthetics, Combined; Fentanyl; Fontan Procedure; Heart Defects, Congenital; Heart Ventricles; Humans; Male; Midazolam; Pulmonary Atresia; Rocuronium; Scoliosis; Spinal Fusion; Thiopental

Isoflurane depresses the number and amplitude of I waves of the motor-evoked potential produced by transcranial electrical stimulation of the motor cortex and thus affects components of the corticospinal volley that are believed to arise from Laminae III and V. This study extends these observations to sevoflurane (9 patients) and the two IV anesthetics, thiopental and propofol (10 sets of observations in 10 and 6 patients, respectively). The patients' ages ranged from 10 to 17 yr. Sevoflurane was administered to achieve end-tidal concentrations of 0.5%-3%. Thiopental and propofol were given as boluses of 5 mg/kg and 2 mg/kg, respectively, to patients anesthetized with nitrous oxide, fentanyl, midazolam, and a muscle relaxant. Sevoflurane had a depressant effect on I waves essentially similar to that of isoflurane; thiopental depressed I wave activity by an average of 33% (95% confidence interval: 20%-46%, P < 0.001) and propofol by 39% (95% confidence interval: 20%-40%, P < 0.001). With all three anesthetics, later I waves showed the most amplitude depression. The three anesthetics had qualitatively similar effects on I waves.. Sevoflurane, thiopental, and propofol depress components of the corticospinal volley produced by transcranial electrical stimulation of motor cortex in a manner qualitatively similar to isoflurane. The findings indicate that anesthetics with primarily hypnotic actions suppress interneuronal activity in cerebral cortex.

Topics: Adolescent; Anesthetics, Inhalation; Anesthetics, Intravenous; Child; Depression, Chemical; Electromyography; Evoked Potentials, Motor; Evoked Potentials, Somatosensory; Humans; Interneurons; Methyl Ethers; Monitoring, Physiologic; Motor Cortex; Propofol; Scoliosis; Sevoflurane; Spinal Cord; Thiopental

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

Nemaline rod myopathy is an inherited congenital myopathy first described in 1963. Affected patients characteristically present in infancy with a non-progressive hypotonia and symmetrical muscle weakness. The disease affects all skeletal muscles including the diaphragm with sparing of cardiac and other muscle. Facial dysmorphism is common as are skeletal deformities, including kyphosis, scoliosis and pectus excavatum. We present two sisters with nemaline rod myopathy and their anaesthetic management for scoliosis surgery. Facial dysmorphism was a feature of both cases. Preoperatively, both patients demonstrated poor respiratory function on pulmonary function testing. Both cases were successfully managed using controlled ventilation and inhalational anaesthetic agents, avoiding muscle relaxants. Postoperatively, there were no respiratory complications. Although one case report describes the use of succinylcholine and pancuronium in a patient with nemaline rod myopathy, we feel that neuromuscular blocking agents should be avoided where possible and only used with careful monitoring.

Topics: Adolescent; Anesthesia, General; Atropine; Female; Halothane; Humans; Muscular Diseases; Nitrous Oxide; Scoliosis; Thiopental

A method of intra-operative awakening which allows assessment of spinal cord function during Harrington rod spinal fusion for scoliosis is described. The anaesthetic technique is based on a standard muscle relaxant, N2O anaesthetic sequence supplemented with intravenous morphine 0.1 mg/kg at the commencement of surgery and 0.2 mg/kg intramuscular premedication. This relatively large total dose of morphine may reduce intra-operative awareness, and may also provide substantial pain relief during the initial 24 h postoperative period. It has been used successfully in 20 patients aged between 6 and 16 yr. Five patients remembered being woken, but did not regard it as unpleasant. In one patient, this technique allowed intra-operative detection and correction of impaired motor function of the legs.

Topics: Adolescent; Anesthesia, Intravenous; Awareness; Child; Child, Preschool; Female; Humans; Intraoperative Period; Methods; Morphine; Scoliosis; Thiopental; Wakefulness

Topics: Adolescent; Anesthesia; Anesthesia, General; Female; Gallamine Triethiodide; Halothane; Humans; Neuroleptanalgesia; Postoperative Care; Postoperative Complications; Preoperative Care; Respiratory Function Tests; Scoliosis; Spinal Diseases; Thiopental