thiopental and Seizures

Seizures are common following perinatal asphyxia and may exacerbate secondary neuronal injury. Barbiturate therapy has been used for infants with perinatal asphyxia in order to prevent seizures. However, barbiturate therapy may adversely affect neurodevelopment leading to concern regarding aggressive use in neonates.. To determine the effect of administering prophylactic barbiturate therapy on death or neurodevelopmental disability in term and late preterm infants following perinatal asphyxia.. We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 11), MEDLINE via PubMed (1966 to 30 November 2015), EMBASE (1980 to 30 November 2015), and CINAHL (1982 to 30 November 2015). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials (RCT) and quasi-RCTs.. We included all RCTs or quasi-RCTs of prophylactic barbiturate therapy in term and late preterm infants without clinical or electroencephalographic evidence of seizures compared to controls following perinatal asphyxia.. Three review authors independently selected, assessed the quality of, and extracted data from the included studies. We assessed methodologic quality and validity of studies without consideration of the results. The review authors independently extracted data and performed meta-analyses using risk ratios (RR) and risk differences (RD) for dichotomous data and mean difference for continuous data with 95% confidence intervals (CI). For significant results, we calculated the number needed to treat for an additional beneficial outcome (NNTB) or for an additional harmful outcome (NNTH).. In this updated review, we identified nine RCTs of any barbiturate therapy in term and late preterm infants aged less than three days old with perinatal asphyxia without evidence of seizures. Eight of these studies compared prophylactic barbiturate therapy to conventional treatment (enrolling 439 infants) and one study compared barbiturate therapy to treatment with phenytoin (enrolling 17 infants). Prophylactic barbiturate therapy versus conventional treatment: one small trial reported a decreased risk of death or severe neurodevelopmental disability for barbiturate therapy (phenobarbital) versus conventional treatment (RR 0.33, 95% CI 0.14 to 0.78; RD -0.55, 95% CI -0.84 to -0.25; NNTB 2, 95% CI 1 to 4; 1 study, 31 infants) (very low quality evidence).Eight trials comparing prophylactic barbiturate therapy with conventional treatment following perinatal asphyxia demonstrated no significant impact on the risk of death (typical RR 0.88, 95% CI 0.55 to 1.42; typical RD -0.02, 95% CI -0.08 to 0.05; 8 trials, 429 infants) (low quality evidence) and the one small trial noted above reported a significant decrease in the risk of severe neurodevelopmental disability (RR 0.24, 95% CI 0.06 to 0.92; RD -0.43, 95% CI -0.73 to -0.13; NNTB 2, 95% CI 1 to 8; 1 study, 31 infants) (very low quality evidence).A meta-analysis of the six trials reporting on seizures in the neonatal period demonstrated a statistically significant reduction in seizures in the prophylactic barbiturate group versus conventional treatment (typical RR 0.62, 95% CI 0.48 to 0.81; typical RD -0.18, 95% CI -0.27 to -0.09; NNTB 5, 95% CI 4 to 11; 6 studies, 319 infants) (low quality evidence). There were similar results in subgroup analyses based on type of barbiturate and Sarnat score. Prophylactic barbiturate therapy versus other prophylactic anticonvulsant therapy: one study reported on prophylactic barbiturate versus prophylactic phenytoin. There was no significant difference in seizure activity in the neonatal period between the two study groups (RR 0.89, 95% CI 0.07 to 12.00; 1 trial, 17 infants).. We found only low or very low quality evidence addressing the use of prophylactic barbiturates in infants with perinatal asphyxia. Although the administration of prophylactic barbiturate therapy to infants following perinatal asphyxia did reduce the risk of seizures, there was no reduction seen in mortality and there were few data addressing long-term outcomes. The administration of prophylactic barbiturate therapy for late preterm and term infants in the immediate period following perinatal asphyxia cannot be recommended for routine clinical practice. If used at all, barbiturates should be reserved for the treatment of seizures. The results of the current review support the use of prophylactic barbiturate therapy as a promising area of research. Future studies should be of sufficient size and duration to detect clinically important reductions in mortality and severe neurodevelopmental disability and should be conducted in the context of the current standard of care, including the use of therapeutic hypothermia.

Topics: Anticonvulsants; Asphyxia Neonatorum; Barbiturates; Humans; Infant; Infant, Newborn; Infant, Premature; Neurodevelopmental Disorders; Phenobarbital; Phenytoin; Randomized Controlled Trials as Topic; Seizures; Thiopental

Acute seizure and status epilepticus constitute one of the major medical emergencies in children. Among children, the incidence ranges from 4-38/100,000 children per year respectively. The incidence in developing countries is somewhat higher because of infections. Although, the definition of status epilepticus is based on duration of seizures, the operational definition is to treat any child who is brought seizing to the emergency room, as status epilepticus. An urgent time bound approach is of paramount importance when managing a child in status epilepticus. Benzodiazepines remain the first line antiepileptic drugs in the emergency room; a long acting drug (Lorazepam) is preferred when available. This is followed by Phenytoin (20 mg/kg) loading. In patients refractory to above drugs, valproate (30 mg/kg) loading is commonly used and if effective, followed by an infusion (5 mg/kg/h) for seizure free period of 6 h. In non-responders, a trial of Levetiracetam (40 mg/kg infused at 5 mg/kg/min) can be used before starting benzodiazepine or thiopental coma (3-4 mg/kg loading dose, followed by 2 mg/kg/min infusion). When pharmacological coma is initiated, the child needs to be shifted to pediatric intensive care unit for proper monitoring and titration of medications.

Topics: Anesthesia, Intravenous; Anticonvulsants; Benzodiazepines; Child; Child, Preschool; Combined Modality Therapy; Cross-Sectional Studies; Developing Countries; Dose-Response Relationship, Drug; Emergency Service, Hospital; Epilepsy; Humans; India; Infant; Infusions, Intravenous; Intensive Care Units, Pediatric; Levetiracetam; Lorazepam; Phenytoin; Piracetam; Seizures; Status Epilepticus; Thiopental; Valproic Acid

It is now clear that "seizure activity", excitatory phenomena, and/or a disorder of muscle tone are potential complications of the use of propofol. Whether this "seizure activity" is primarily, secondarily, or not at all a cerebral cortical event is still to be elucidated. Clearly propofol does have anticonvulsant activity, and also clearly it can produce an involuntary movement disorder, in certain patients, under certain conditions. Propofol is not the first anaesthetic drug to be implicated in the causation of seizures or abnormal movements nor indeed the first to appear to have anti-convulsant and proconvulsant activity (e.g. Althesin). While propofol has undoubtedly proved a very useful drug, the problem of convulsive phenomena creates a degree of background concern about its use. More needs to be known about the mechanism of this complication and any risk factors involved in determining who may have a seizure after propofol. In the clinical setting, the reporting of seizures possibly related to propofol should include--medical history, including personal or family history of epilepsy and movement disorders; a history of previous anaesthetics and whether propofol was used; regular medications; use of drugs or alcohol; history of chemical dependency; emotional state prior to induction; presence of hyperventilation or fever; a description of the alleged seizure, including rate of administration of propofol and amount given, time of onset of seizure in relation to time of drug administration, speed of onset of signs, quality of the abnormal movements, part of body involved, duration, any indication of a postictal state, any cardiovascular changes which may have accompanied the seizure, and any other possible triggers for the reaction such as other drugs used, including premedication; post seizure investigations including temperature, blood sugar, electrolytes, arterial gas analysis, neurological examination, EEG and CT scan. These actions and these investigations concerning propofol should not be delayed. It would appear appropriate to recommend to patients who experience apparent convulsive phenomena after propofol that they not be re-exposed to the drug.

Topics: Adult; Anesthesia, Intravenous; Epilepsy, Tonic-Clonic; Female; Humans; Male; Middle Aged; Phenytoin; Propofol; Seizures; Thiopental

Topics: Anesthesia, Conduction; Anesthetics, Local; Animals; Apnea; Arrhythmias, Cardiac; Barbiturates; Central Nervous System; Critical Care; Diazepam; Drug Hypersensitivity; Epinephrine; Female; Humans; Infusions, Parenteral; Intubation, Intratracheal; Male; Monitoring, Physiologic; Oxygen Inhalation Therapy; Pregnancy; Procaine; Seizures; Succinylcholine; Thiopental

Topics: 4-Butyrolactone; Aging; Animals; Auditory Diseases, Central; Autoradiography; Blood Glucose; Blood-Brain Barrier; Brain; Carbon Radioisotopes; Cats; Central Nervous System; Cerebrovascular Circulation; Deoxy Sugars; Deoxyglucose; Dogs; Electrophysiology; Energy Metabolism; Humans; Macaca mulatta; Morphine; Rats; Rats, Inbred Strains; Receptors, Dopamine; Sciatic Nerve; Seizures; Thiopental; Visual Cortex

This study aimed to compare the effects of propofol, thiopental, and etomidate, which are routinely used in anesthesia for electroconvulsive therapy (ECT), on the cardiovascular system, seizure variables, recovery, cognitive functions, and response to treatment.. Male patients hospitalized at the Seventh Psychiatry Clinics of the Bakırköy Teaching Hospital for Psychiatry, Neurology, and Neurosurgery who were treated with ECT were investigated prospectively. The effects on cardiovascular system parameters (heart rate, blood pressure, and blood oxygenation), seizure variables (duration and intensity of seizure), and recovery variables were recorded at every session, on prespecified time points, and the findings of the first session were used in this evaluation. In addition, clinical responses to treatment were evaluated with tests of cognitive functions before and after a course of ECT. Adverse effects were recorded.. The sociodemographic characteristics of the 3 treatment groups were similar. There were no significant differences among the groups in terms of effects on cardiovascular system variables, seizure variables, and cognitive functions. The clinical response to ECT was good in all groups, without any significant differences.. Propofol, etomidate, and thiopental are associated with similar safety and efficacy profiles.

Topics: Adult; Anesthesia Recovery Period; Anesthesia, Intravenous; Anesthetics, Intravenous; Cognition; Double-Blind Method; Drug Interactions; Electroconvulsive Therapy; Electroencephalography; Etomidate; Female; Hemodynamics; Humans; Male; Mental Disorders; Middle Aged; Propofol; Seizures; Socioeconomic Factors; Thiopental; Young Adult

General anesthesia is required for Electroconvulsive Therapy (ECT) and it is usually provided by a hypnotic agent. The seizure duration is important for the treatment, and it is usually accompanied by severe hemodynamic changes. The aim of this study was to compare the effects of sodium thiopental versus Propofol on seizure duration and hemodynamic variables during ECT.. A number of 100 patient-sessions of ECT were included in this randomized clinical trial. The initial hemodynamic state of each patient was recorded. Anesthesia was induced by Sodium thiopental in the 1st group and with Propofol in 2nd group. All the patients received the muscle relaxant succinylcholine. The hemodynamic variables after seizure and seizure duration were recorded. The data were analyzed through SPSS 20 and independent t-test. P<0.05 was considered significant.. The mean duration of seizure in the sodium thiopental group was significantly longer than the Propofol group (40.3±16.6 sec versus 32±11.3 sec) (P=0.001). There was no statistically significant difference between the mean energy level applied in the two groups (20.5±3.81 joules in the sodium thiopental versus 20.2±3.49 joules in the Propofol group). The mean systolic and diastolic blood pressure at all times after seizure and mean heart rate at 3 and 5 minutes after seizure were significantly lower in Propofol than sodium thiopental groups.. Propofol provides a more stable hemodynamic state for the ECT procedures, and its use is highly preferred over sodium thiopental in patients with cardiovascular disease.

Topics: Adolescent; Adult; Double-Blind Method; Electroconvulsive Therapy; Female; Hemodynamics; Humans; Hypnotics and Sedatives; Iran; Male; Mental Disorders; Middle Aged; Propofol; Prospective Studies; Seizures; Thiopental

Recently, ketamine has attracted attention for induction of anesthesia during electroconvulsive therapy (ECT). This study compared the effects of thiopental and ketamine in patients undergoing this procedure.. This randomized, double-blind clinical trial included inpatients, with major depressive disorder, undergoing ECT. Subjects were randomly allocated to receive either ketamine or thiopental. Mini-Mental State Examination and Hamilton Depression Rating Scale were used to assess memory and depression, respectively, before the first and second ECT sessions as well as a few days and 1 month after the sixth session. The electrical charge, seizure duration, blood pressure, and heart rate were also recorded.. Of the 31 patients, 17 met the criteria for the ketamine group but 2 dropped out of the study. Therefore, 15 patients received ketamine and 14 received thiopental. Each patient underwent 6 ECT sessions. At the end of the study, depression improved significantly in both groups. However, a significant difference in depression improvement was noted only before the second ECT with ketamine compared with thiopental. Despite a significant decline in Mini-Mental State Examination scores in both groups after the first ECT, cognitive function improved afterward but was only significant in ketamine group. Seizure duration was found to be significantly longer with ketamine. Stimulus intensity used for each ECT increased gradually and linearly with a greater increase observed in thiopental group.. Ketamine administration during ECT is well tolerated and patients may experience earlier improvement in depressive symptoms, longer seizure duration, and better cognitive performance when compared with thiopental.

Topics: Adult; Analysis of Variance; Anesthesia; Anesthetics, Dissociative; Cognition; Depressive Disorder, Major; Double-Blind Method; Electroconvulsive Therapy; Female; Hemodynamics; Humans; Hypnotics and Sedatives; Ketamine; Male; Middle Aged; Neuropsychological Tests; Psychiatric Status Rating Scales; Recovery of Function; Seizures; Thiopental; Young Adult

To compare propofol and sodium thiopental as anesthetic agents for electroconvulsive therapy (ECT) in major depression with respect to clinical effect.. Participants were composed of 96 patients with depression who were administered either propofol or sodium thiopental as an anesthetic agent for bilateral ECT. The Hamilton Depression Rating Scale was administered at baseline and after 6 treatments. Algorithm-based charge dosing was used.. There was a statistically significant difference between the groups regarding postintervention Hamilton Depression Rating Scale score. The preintervention mean (SD) scores in the propofol group and the sodium thiopental group were 37.3 (2.2) and 36.7 (1.2), respectively. The postintervention mean (SD) scores in the propofol group and the sodium thiopental group were 10.7 (1.8) and 13.4 (3.3), respectively. No correlation was found between clinical response and age, weight, and body mass index. There was no association between the groups' seizure time and duration of recovery.. In conclusion, propofol may improve major depressive disorder more than sodium thiopental in patients who are receiving ECT.

Topics: Adult; Age Factors; Algorithms; Body Mass Index; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Double-Blind Method; Electroconvulsive Therapy; Female; Humans; Hypnotics and Sedatives; Male; Propofol; Psychiatric Status Rating Scales; Seizures; Sex Characteristics; Socioeconomic Factors; Thiopental

Studies now provide strong evidence that the N-methyl-D-aspartate receptor antagonist ketamine possesses rapidly acting antidepressant properties. This study aimed to determine if a low dose of ketamine could be used to expedite and augment the antidepressant effects of electroconvulsive therapy (ECT) treatments in patients experiencing a severe depressive episode.. Subjects with major depressive disorder or bipolar disorder referred for ECT treatment of a major depressive episode were randomized to receive thiopental alone or thiopental plus ketamine (0.5 mg/kg) for anesthesia before each ECT session. The Hamilton Depression Rating Scale (HDRS) was administered at baseline and at 24 to 72 hours after the first and sixth ECT sessions.. Electroconvulsive therapy exerted a significant antidepressant effect in both groups (F2,24 = 14.35, P < 0.001). However, there was no significant group effect or group-by-time interaction on HDRS scores. In addition, post hoc analyses of the time effect on HDRS showed no significant HDRS reduction after the first ECT session for either group.. The results of this pilot study suggest that ketamine, at a dose of 0.5 mg/kg, given just before ECT, did not enhance the antidepressant effect of ECT. Interestingly, the results further suggest that the coadministration of ketamine with a barbiturate anesthetic and ECT may attenuate the immediate antidepressant effects of the N-methyl-D-aspartate antagonist.

Topics: Adolescent; Adult; Aged; Anesthesia; Anesthetics, Dissociative; Antidepressive Agents; Bipolar Disorder; Combined Modality Therapy; Depression; Depressive Disorder, Major; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Hypnotics and Sedatives; Ketamine; Male; Middle Aged; Psychiatric Status Rating Scales; Seizures; Thiopental; Treatment Outcome; Young Adult

To compare propofol and thiopental as anesthetic agents for electroconvulsive therapy (ECT) with respect to seizure duration, stimulus charge, clinical effect, and cognitive side effects.. Randomized, blinded study of 62 depressed patients treated with bilateral ECT. Algorithm-based charge dosing was used.. The mean seizure duration of the patients in the thiopental group was 36.3 seconds versus 25.7 seconds in the propofol group (P = 0.001). The charge per treatment was 79.5 mC in the thiopental group versus 109.8 mC in the propofol group (P = 0.026). Sixteen patients in the propofol group (52%) reached the highest electrical dose versus 8 patients (26%) in the thiopental group (P = 0.014). No difference in response to treatment or number of treatments was observed. The mean score on Mini-Mental State Examination (MMSE) was 28.9 in the thiopental group versus 26.8 in the propofol group (P = 0.014). However, age distribution of patients completing the study differed between the groups.. Propofol significantly decreases seizure duration without significant difference in the clinical outcome. Using the employed treatment algorithm, patients anesthetised with propofol received higher electrical charge. Mini-Mental State Examination scores suggest that this results in more severe cognitive side effects. Results, however, might be confounded by the differences in age distribution in the groups.

Topics: Adult; Aged; Algorithms; Anesthesia, Intravenous; Anesthetics, Intravenous; Cognition Disorders; Double-Blind Method; Electroconvulsive Therapy; Female; Humans; Male; Middle Aged; Monitoring, Physiologic; Neuropsychological Tests; Propofol; Seizures; Thiopental; Young Adult

Among the drugs used for the induction of anesthesia for electroconvulsive therapy (ECT), thiopental induces a greater degree of cardiovascular alteration than other agents. Remifentanil has been found to reduce blood pressure and heart rate when administered as an adjuvant during general anesthesia, with unknown effects on the duration of motor or electroencephalographic seizure activity during ECT. The purpose of this prospective, randomized, double-blind, placebo-controlled, crossover study was to evaluate the effects of supplementing thiopental anesthesia with remifentanil on convulsion duration and cardiovascular response during ECT.. Twenty-four American Society of Anesthesiologists I and II patients receiving 6 sessions of ECT were randomly allocated to 2 groups. All patients were premedicated with atropine (0.4 mg, intravenously), then anesthesia was induced by thiopental (1.0 mg/kg), succinylcholine (0.5 mg/kg), and remifentanil (1.0 microg/kg) in the case group or normal saline (3 mL) in the control group in a crossover format. Stimulus amplitude for applying ECT was kept constant during the sessions of treatment in the course of study for each patient. Hemodynamic parameters, convulsion duration, and recovery parameters were recorded. Statistical analysis was done using paired t tests.. There was no statistically significant difference between the groups regarding convulsion duration, recovery times to eye opening, obeying specific commands, and walking without help. Remifentanil significantly attenuated the increase in heart rate and arterial blood pressure (P < 0.05).. Remifentanil (1 microg/kg) administered before thiopental (1 mg/kg) has no adverse effect on the duration of ECT-induced convulsion and recovery time, but it can attenuate the increase in heart rate and arterial blood pressure.

Topics: Adolescent; Adult; Anesthesia; Blood Pressure; Double-Blind Method; Electroconvulsive Therapy; Female; Heart Rate; Hemodynamics; Humans; Hypnotics and Sedatives; Male; Middle Aged; Piperidines; Prospective Studies; Remifentanil; Seizures; Thiopental; Young Adult

Thiopental and suxamethonium have been recommended as anesthetic agents for electroconvulsive therapy (ECT). We hypothesize that propofol and vecuronium can also be used and superior to thiopental and suxamethonium in seizure duration and hemodynamics.. We made couples of anesthetic and muscle relaxant with these anesthetic agents and obtained four different combinations. We evaluated 10 patients with cross-over design, undergoing first four sequential ECTs using these four combinations in random turn. Total 40 ECTs were divided to four groups and compared with each other in seizure duration, blood pressure, and pulse rate. Group TS: thiopental (2 mg x kg(-1)) and suxamethonium (1.2 mg x kg(-1)), group PS: propofol (0.75 mg x kg(-1) and suxamethonium (1.2 mg x kg(-1)), group TV thiopental (2 mg x kg(-1)) and vecuronium (0.07 mg x kg(-1)), group PV: propofol (0.75 mg x kg-1) and vecuronium (0.07 mg x kg(-1)). Seizure duration was measured by EEG engineer to whom anesthetic agents were unknown. We measured blood pressure and heart rate before anesthetic induction, pre-ictal, post-ictal, and every minute for ten minutes thereafter. Wilcoxon signed-rank test was used as statistic measures.. In between-group comparison of dynamics, there was no significant difference in these four groups. In seizure duration there was no significant difference between thiopental and propofol. Vecuronium (group TV: 27.0 +/- 24.6s, group PV: 17.5 +/-15.1s) shortened the seizure duration in comparison with suxamethonium (group TS: 43.0 +/-25.9s, group PS: 39.2 +/- 28.9s).. Rocuronium, which will be used for ECT in future, is needed to be studied in suxamethonium-controlled design.

Topics: Adult; Androstanols; Anesthetics; Cross-Over Studies; Drug Therapy, Combination; Electroconvulsive Therapy; Electroencephalography; Female; Hemodynamics; Humans; Male; Middle Aged; Propofol; Rocuronium; Seizures; Succinylcholine; Thiopental; Vecuronium Bromide; Young Adult

Metachromatic leukodystrophy (MLD) is a lysosomal storage disease with infantile and juvenile onset with a poor prognosis and magnetic resonance imaging (MRI) plays a fundamental role in its diagnosis. Procedural sedation is needed to carry out MRI on children. Very few case reports have been published on anesthesia or sedation for MLD patients.. We prospectively studied 18 MLD patients undergoing sedation for brain MRI. Twenty consecutive similar-aged ASA I children undergoing MRI during the same time span for suspected seizures and exhibiting no MRI brain alteration healthy (HLT) patients were also studied for comparison. In patients up to 3 years of age (T_MLD and T_HLT groups), sedation was induced with thiopental 5 mg x kg(-1) i.v. and further 2.5 mg x kg(-1) i.v. rescue boluses were given if the sedation level was inadequate. In patients over 3 years of age (P_MLD and P_HLT groups), sedation was induced with propofol 1-1.5 mg x kg(-1) i.v. and maintained with 0.1-0.15 mg x kg(-1) x min(-1) continuous i.v. infusion, which was increased if the sedation level was inadequate. We recorded complications, if any, caused by sedation (hypoxia, vomiting, bradycardia, other major arrhythmias, convulsions, MRI artifact movements with increasing sedation, prolonged recovery).. No sedation complications occurred. The mean dose of thiopental required to warrant patient immobility was 0.227 +/- 0.053 mg x kg(-1) x min(-1) of procedure in T_MLD patients and 0.119 +/- 0.061 mg x kg(-1) x min(-1) of procedure in T_HLT patients (difference not significant). The mean dose of propofol required for immobility was 0.119 +/- 0.054 mg x kg(-1) x min(-1) of procedure in T_MLD patients and 0.115 +/- 0.043 mg x kg(-1) x min(-1) of procedure in T_HLT patients (difference not significant).. Our protocol for sedation in the MRI setting proved safe and effective in children with MLD, who do not require different doses of sedatives compared with healthy children.

Topics: Anesthesia; Artifacts; Brain; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Humans; Hypnotics and Sedatives; Leukodystrophy, Metachromatic; Magnetic Resonance Imaging; Male; Propofol; Prospective Studies; Reference Values; Seizures; Thiopental; Treatment Outcome

In general, seizure length does not correlate with clinical outcome with electroconvulsive therapy (ECT), but whether markedly short seizures are still therapeutic is unknown. Furthermore, seizure length effects on clinical outcome in ECT may be different among the various anesthetic agents available. Several studies have investigated the use of inhalational anesthesia in ECT with sevoflurane. In general, seizure length when reported has been in the range of typical values encountered in practice. We recently completed a randomized double blind trial with sevoflurane induction compared with thiopental. Seizure duration with sevoflurane anesthesia was 8 seconds shorter than with thiopental for electroencephalogram and 6.4 seconds shorter for motor, the latter just barely missing statistical significance. Absolute values for seizure duration with both sevoflurane and thiopental are well within typical ranges for those seen with the more commonly used methohexital as anesthetic.

Topics: Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Double-Blind Method; Electroconvulsive Therapy; Female; Humans; Male; Methyl Ethers; Middle Aged; Seizures; Sevoflurane; Thiopental; Time Factors

To determine the association between bispectral index (BIS) and seizure duration obtained by electroconvulsive therapy (ECT) administered sooner or later after anesthetic induction.. Prospective, randomized, crossover study.. University-affiliated medical center.. Nine ASA physical status I, II, and III patients undergoing a total of 31 ECTs.. ECT was administered soon (<210 sec) or later (between 210 sec and 360 sec) after anesthetic induction. In each individual patient, drug regimens and ECT machine settings were identical.. BIS immediately before the start of the ECT and the duration of the EEG seizure were recorded, as well as the time period between loss of consciousness and ECT administration.. There was no relationship between BIS level and seizure duration. Moreover, seizure duration was not dependent on the time of ECT administration in the time window between one and 6 minutes after loss of consciousness.. The hypnotic drug effect measured by the BIS is not correlated to the seizure duration obtained by ECT.

Topics: Aged; Anesthesia; Anesthetics; Anesthetics, Intravenous; Cross-Over Studies; Electroconvulsive Therapy; Electroencephalography; Etomidate; Female; Humans; Hypnotics and Sedatives; Male; Methohexital; Middle Aged; Prospective Studies; Seizures; Thiopental

The possible cerebral sparing effect of thiopental was evaluated in 32 severely asphyxiated neonates randomly assigned to either a thiopental treatment or control group. All infants had neurologic manifestations of asphyxia and required assisted ventilation. Thiopental was begun at a mean age of 2.3 hours and was given as a constant infusion that delivered 30 mg/kg over 2 hours. Treatment was continued at a lower dose for 24 hours. Seizure activity occurred in 76% of infants given thiopental and 73% of control infants at a mean age of 1.5 and 2.5 hours, respectively. Although initial arterial blood pressure was similar in both groups, hypotension occurred in 88% of treated and 60% of control infants. The amount of blood pressure support required was significantly greater (P less than 0.005) in the thiopental treatment group. Three infants died in the control group, and five in the treatment group. Developmental assessment was performed at a minimum of 12 months of age in 22 infants. There were no significant differences in neurologic, cognitive, or motor outcome between groups. Deteriorating performance over time was a consistent trend in both groups. These findings indicate that treatment of severe perinatal asphyxia with thiopental does not appear to have a cerebral sparing effect and may be associated with significant arterial hypotension.

Topics: Apgar Score; Asphyxia Neonatorum; Brain; Brain Ischemia; Child Development; Clinical Trials as Topic; Follow-Up Studies; Gestational Age; Humans; Infant, Newborn; Infusions, Parenteral; Intracranial Pressure; Neurologic Examination; Outcome and Process Assessment, Health Care; Random Allocation; Seizures; Thiopental

Electroconvulsive therapy (ECT) is a well-established treatment option in case of severe and treatment-resistant psychiatric conditions. In this retrospective study, we compared the 2 anesthetics propofol and thiopental in terms of seizure quality, cognitive adverse effects, and clinical outcome.. Data collection was performed retrospectively by a chart review, including patient files and medical records. A total of 64 patients (female = 60.9%) treated with ECT within the period of February 2019 to March 2020 were included. Of these, 35 (54.7%) received thiopental for ECT narcosis and 29 (45.3%) were treated with propofol.. Six hundred sixteen ECT treatments (mean number per case, 9.6) were performed in total. The mean electroencephalogram seizure duration (38.3 vs 28.1 seconds, t = 3.534, degrees of freedom [ df ] = 62, P < 0.001) and motor seizure duration (21.5 vs 12.0, t = 4.336, df = 62, P < 0.001) as well as postictal suppression index and heart rate increase were significantly higher in the thiopental group. Mean stimulation energy needed per session was higher in the propofol group (88.6% vs 73.0%, Mann-Whitney U test, P = 0.042). The ECT series was more likely to be interrupted due to cognitive adverse effects in the thiopental group ( P = 0.001, Pearson χ 2 = 10.514, df = 1). Number of patients achieving remission was significantly higher in the thiopental group (31.4% vs 6.9%, P = 0.015, χ 2 = 5.897, df = 1).. Thiopental led to better seizure duration and quality and was associated with a higher rate of remission. As a downside, thiopental was also associated with a greater risk of cognitive adverse effects.

Topics: Anesthesia; Anesthetics, Intravenous; Cognition; Electroconvulsive Therapy; Female; Humans; Propofol; Retrospective Studies; Seizures; Thiopental

Tranexamic acid is a well-known antifibrinolytic medication frequently prescribed to individuals with bleeding disorders. Following accidental intrathecal injection of tranexamic acid, major morbidities and fatalities have been documented. The aim of this case report is to present a novel method for management of intrathecal injection of tranexamic acid.. In this case report, a 400 mg intrathecal injection of tranexamic acid resulted in significant back and gluteal pain, myoclonus of the lower limbs, agitation, and widespread convulsions in a 31-year-old Egyptian male with history of left arm and right leg fracture. Immediate intravenous sedation with midazolam (5 mg) and fentanyl (50 μg) was delivered with no response in seizure termination. A 1000 mg phenytoin intravenous infusion and subsequently, induction of general anesthesia was performed by thiopental sodium (250 mg) and atracurium (50 mg) infusion, and the trachea of the patient was intubated. Maintenance of anesthesia was achieved by isoflurane 1.2 minimum alveolar concentration and atracurium 10 mg every 20 minutes, and subsequent doses of thiopental sodium (100 mg) to control seizures. The patient developed focal seizures in the hand and leg, so cerebrospinal fluid lavage was done by inserting two spinal 22-gauge Quincke tip needles, one on level L2-L3 (drainage) and the other on L4-L5. Intrathecal normal saline infusion (150 ml) was done over an hour by passive flow. After cerebrospinal fluid lavage and the patient's stabilization was obtained, he was transferred to the intensive care unit.. Early and continuous intrathecal lavage with normal saline, with the airway, breathing, and circulation protocol is highly recommended to decrease morbidity and mortality. The selection of the inhalational drug as a sedative and for brain protection in the intensive care unit provided possible benefits in management of this event with medication errors.

Topics: Adult; Atracurium; Humans; Injections, Spinal; Male; Saline Solution; Seizures; Thiopental; Tranexamic Acid

Most anesthetic drugs used for electroconvulsive therapy (ECT) have dose-dependent anticonvulsive effects, counter-acting seizure induction, lowering seizure quality. However, a consummate drug for ECT anesthesia has not yet been established. Therefore, in this study, we aimed to investigate the effects of etomidate, thiopental, propofol and co-administration of ketamine-propofol (ketofol) on seizure quality and hemodynamic safety.. Registries of 121 patients (1077 sessions) were retrospectively evaluated. The effects of anesthetics on ECT-related parameters (stimulation charge, central seizure duration, number of failed stimulation trials, mean arterial pressure, and peak heart rate) were analyzed via linear mixed-effects models.. Overall, the seizure duration decreased, and the stimulation charge increased in time with continuing sessions within a course of ECT. The decrease in seizure duration and the increase in required stimulation charge was significantly lower with etomidate and ketofol. Additionally, ketofol was significantly related to a lower number of failed stimulation trials compared to propofol. Ketofol and propofol use was associated with a significantly lower postictal mean arterial pressure.. Ketofol and etomidate were equivalently superior in the rate of decrease in seizure duration and the required elevation in stimulus charge, which would interpret into valuable clinical guidance, especially for "seizure resistant" patients, and their use may potentially lower ECT related cognitive side effects.

Topics: Anesthesia; Electroconvulsive Therapy; Etomidate; Humans; Propofol; Retrospective Studies; Seizures; Thiopental

Status epilepticus, when continued despite the administration of two antiepileptic drugs, is called refractory status epilepticus (RSE). The seizure-like phenomenon due to propofol is widely reported in the literature. However, RSE caused by propofol is rare and is a diagnostic dilemma.. A 44-year-old male patient presented with RSE during the intraoperative period and was under general anesthesia on propofol infusion. The seizure was resistant to benzodiazepines and phenytoin. Thereafter, the seizure subsided after the discontinuation of propofol infusion, and the patient was shifted to fentanyl and dexmedetomidine infusion for the maintenance of anesthesia. The postoperative follow-up was uneventful.. This article focuses on the management of intractable intraoperative seizure and highlights the need for the exploration of seizure characteristics caused by propofol.

Topics: Adult; Anticonvulsants; Humans; Male; Propofol; Seizures; Status Epilepticus; Thiopental

Eliciting a generalized seizure is essential to electroconvulsive therapy (ECT), but there is still a need to understand how patient and session variables interact to generate a seizure of adequate quality. Here, we investigate factors associated with motor seizure length as a measure of quality in a large database of patients who underwent ECT.. This is a retrospective cohort including data from all adult inpatients who underwent ECT at a university hospital in Brazil from 2009 to 2015. We used linear mixed models to investigate the effects of patient, session, and medication on seizure length.. Session information was available for 387 patients, a total of 3544 sessions and 4167 individual stimulations. Multiple stimulations were necessary in 12.4% of sessions. Median seizure length was 30 seconds. Seizure length was directly correlated with stimulus dosage and inversely correlated with the session number, patient age, prescription of anticonvulsants in the day before and β-blockers during the session, and the thiopental dose. Use of benzodiazepines was not associated with a shorter seizure duration, irrespective of dose.. We demonstrate here how motor seizure length evolves during a course of ECT. With a large number of sessions, we are able to integrate a host of factors in a prediction model. Seizure quality was influenced by a number of the studied factors, many of which are potentially modifiable and could be assessed before initiating and handled during treatment.

Topics: Age Factors; Anticonvulsants; Brazil; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Male; Middle Aged; Quality of Health Care; Retrospective Studies; Seizures; Thiopental; Time Factors

Topics: Anticonvulsants; Brain Diseases; Child, Preschool; Electroencephalography; Extracorporeal Membrane Oxygenation; Heart Diseases; Humans; Male; Seizures; Thiopental; Treatment Outcome

The time between anaesthetic induction and ECT stimulus administration has been hypothesised to significantly impact ictal EEG quality. In this study, our aim was to examine the effect of the time interval between anaesthetic induction and the ECT stimulus for ictal seizure quality in ECT sessions utilising thiopentone anaesthesia.. 413 EEG traces from 42 patients, collected retrospectively, were manually rated using a quantitative-qualitative structured rating scale (indices including seizure amplitude, regularity, post-ictal suppression and general seizure quality). Linear Mixed Effects Models were used to analyse the effect of the anaesthetic-ECT time interval on seizure quality indices, seizure duration and orientation scores after ECT, controlling for patient and ECT treatment factors.. The anaesthetic-ECT time interval had a significant impact on ictal EEG quality indices (p < 0.05), with longer times producing higher quality seizures. Seizure duration and orientation scores after ECT were not significantly influenced by the anaesthetic-ECT time interval. Age, anaesthetic dose, ECT type and ECT treatment number also had a significant impact on measures of seizure quality (p < 0.05).. The effect of ventilation technique was not explicitly measured. Only manual ratings of ictal quality were analysed.. The time between anaesthetic induction and ECT stimulus administration has a significant impact on the ictal EEG seizure quality observed, with thiopentone anaesthetic. These results are consistent with prior findings with propofol anaesthesia, and suggest a need for routine clinical monitoring of this time interval. This variable warrants consideration when interpreting ictal EEGs, which often informs subsequent dosing decisions.

Topics: Adolescent; Adult; Anesthetics, Intravenous; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Male; Middle Aged; Retrospective Studies; Seizures; Thiopental; Time Factors; Young Adult

To investigate the effect of delaying initiation of electroconvulsive therapy (ECT) after administration of anaesthetic agent and muscle relaxant.. A retrospective cohort study utilizing a case-based analysis comparing number of re-stimulations, length of seizures, number of ECTs per series and stimulation dosage before and after introducing a new treatment regimen. In 2013, ECT was initiated approximately 60-90 seconds after administration of thiopental and succinylcholine. This interval was increased to 120 seconds in 2014. Ninety-three patients were included (40 in 2013 and 53 in 2014). Outcome measures were length of seizure, number of re-stimulations, number of ECTs per series and stimulation dosage. Regression model analyses were conducted with entering year of treatment (2013 vs. 2014), sex and age as covariates.. We showed that a lowered frequency of re-stimulation was independently associated with the 2014 treatment regimen. No effect of treatment regimen on duration of seizures as measured clinically or by EEG, on number of treatments per series or on stimulation dosage was observed.. We found an association between an increased time interval from administration of thiopental and succinylcholine to ECT and a lowered risk of re-stimulations. The current study substantially strengthens the evidence on the benefits of delaying ECT after administration of anaesthetic agent and muscle relaxant.

Topics: Adult; Aged; Anesthetics; Cognition; Cohort Studies; Electroconvulsive Therapy; Female; Humans; Male; Middle Aged; Muscle Relaxants, Central; Retrospective Studies; Seizures; Thiopental; Time-to-Treatment

BACKGROUND Recurrent seizure in patients with magnesium sulfate-treated eclampsia is very rare and requires meticulous management due to poor prognosis. The development of eclamptic convulsions is considered a preventable obstetric situation. Magnesium sulfate has been the drug of choice in such cases. However, some cases are persistent and need more aggressive treatment. CASE REPORT First case: A 20-year-old, nulliparous woman was referred from a private midwifery practice with history of convulsion, 40 weeks of gestational age (GA), and in the active phase of labor. She had been treated with magnesium sulfate and nifedipine beforehand. Her fetus was tachycardic, so an emergency caesarean section was done and placental abruption was found. The day after the surgery, the patient had recurrent seizures despite receiving a maintenance dose of magnesium sulfate. The patient then received thiopental sodium and remained stable. Second case: A 19-year-old, nulliparous woman came to the hospital with 40 weeks of GA, prolonged premature rupture of the membrane (PROM), preeclampsia, and cephalopelvic disproportion (CPD). An emergency caesarean section was performed. Eighteen hours after surgery, the patient had convulsions despite receiving magnesium sulfate maintenance therapy. We repeated the loading dose of 2 g magnesium sulfate, but the seizures persisted. Hence, midazolam was given and the seizures remained controlled. Both babies were delivered without any significant complications. CONCLUSIONS We report 2 cases of GIP0-0 women with 40 weeks GA who had magnesium sulfate-resistant eclampsia and needed additional anticonvulsant drugs. These cases show the importance of comprehensive management and the need for alternative drugs in eclampsia.

Topics: Anticonvulsants; Cesarean Section; Drug Therapy, Combination; Eclampsia; Female; Humans; Magnesium Sulfate; Midazolam; Pregnancy; Recurrence; Seizures; Thiopental; Young Adult

Seizure duration in electroconvulsive therapy (ECT) is positively related with patients' outcome. This study sought to investigate the impact of anesthetic management on seizure duration, and the impact of selected drugs (theophylline, remifentanil, S-ketamine) on seizure duration.. Retrospective analysis of all patients undergoing ECT at our institution from January 2011 to April 2012 was performed based on electronic medical chart and review of existing quality improvement data. Patient data (N = 78), including gender, age, height, weight, and administered drugs, energy levels, and electroencephalic seizure duration were analyzed. Statistical analysis was performed using a generalized linear model.. A total of 78 patients (male = 39, female = 39, age 51 ± 12 years) were included. Average number of session was 10 ± 6 (1-30). In our patient population, theophylline administration was the only parameter, which significantly prolonged seizure duration, whereas S-ketamine, remifentanil, thiopental, age, sex, session or energy level had no significant effect.. Theophylline can be a useful adjunct for patients with inadequate seizure duration. If there is a concomitant beneficial effect on patients' outcome needs to be investigated in further studies.

Topics: Anesthetics, Intravenous; Dose-Response Relationship, Drug; Drug Therapy, Combination; Electroconvulsive Therapy; Electroencephalography; Etomidate; Female; Humans; Ketamine; Male; Middle Aged; Piperidines; Remifentanil; Retrospective Studies; Seizures; Theophylline; Thiopental; Time Factors

In order to optimise outcome to Electro Convulsive therapy (ECT), there has been a trend to utilise remifentanil as an adjunct to standard intravenous induction agents. This has allowed a reduction in the dose of anaesthetic agent, and usually an improved response to stimulation. However there have been no previous studies to ascertain whether this improvement is simply as a result of the reduced dose of anaesthetic agent or whether remifentanil itself might possess epileptogenic properties. This retrospective case-controlled study examined ECT outcomes, determined by EEG quality analysis, in patients who received ECT with or without remifentanil, where there was no dose reduction in the anaesthetic agent. There were no improvements seen in the measurements of any EEG parameter, including seizure duration. These observations suggest that remifentanil does not possess any intrinsic pro-convulsant activity and that any improvement in outcome seen with its use is as a result of dose reduction in the IV anaesthetic agent.

Topics: Adult; Aged; Case-Control Studies; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Male; Middle Aged; Piperidines; Propofol; Remifentanil; Retrospective Studies; Seizures; Thiopental

Induction agents used for electroconvulsive therapy (ECT) may alter seizure parameters. In this study, we aimed to investigate the effects of etomidate and thiopental on seizure-related variables.. Registries of patients who received ECT between 2010 and 2013 in a tertiary psychiatry clinic were evaluated retrospectively. The information of patients who were on the same induction agent and muscle relaxant during the whole treatment course was assessed. Primary outcome measures were total number of ECT sessions, mean peripheral and central seizure duration, cumulative stimulus intensity, and the number of adequate seizures per total number of stimuli. Secondary measures were maximum systolic-diastolic and mean blood pressure, peak heart rate, and the frequency of antihypertensive drug use during the sessions.. Although the total number of ECT sessions is similar between the etomidate (n = 43) and thiopenthal (n = 31) groups, the mean seizure duration per stimuli was significantly longer whereas the cumulative stimulus intensity was lower in the etomidate group. The number of adequate seizures obtained in relation with the number of stimuli was also significantly higher, indicating increased probability of eliciting an adequate seizure with etomidate. During threshold determination, the number of stimuli needed to provide an adequate seizure was marginally less with etomidate. No group difference was observed in hemodynamic changes and the frequency of antihypertensive use.. Etomidate use, compared with thiopental as an induction agent, is associated with longer seizure duration with less cumulative intensity. The use of etomidate reduces the number of failed trials and may prevent the application of unnecessary electrical stimuli with a possibly safe hemodynamic profile.

Topics: Adult; Aged; Anesthetics, Intravenous; Electroconvulsive Therapy; Etomidate; Female; Humans; Male; Middle Aged; Registries; Retrospective Studies; Seizures; Thiopental; Turkey

Topics: Adolescent; Anticonvulsants; Cerebrovascular Circulation; Female; Humans; Intracranial Arteriovenous Malformations; Intraoperative Complications; Oximetry; Seizures; Spectroscopy, Near-Infrared; Thiopental

Alpha lipoic acid is a powerful antioxidant widely used for the supplementary treatment of diabetic neuropathy. Intoxication with alpha lipoic acid is very rare. There is no reported dose of safety in children.. A 14-month-old previously healthy girl was referred to our hospital with the diagnosis of drug intoxication. She was admitted to the emergency department with lethargy and continuing involuntary movements for several hours after she had ingested an unknown amount of alpha lipoic acid. On admission she was lethargic and had myoclonic seizures involving all extremities. She had no fever and laboratory examinations were normal except for mild metabolic acidosis. The seizures were unresponsive to bolus midazolam, phenytoin infusion and levetiracetam infusion. She was taken to the pediatric intensive care unit with the diagnosis of status epilepticus. After failure of the treatment with midazolam infusion she was intubated and thiopental sodium infusion was started. Her myoclonic seizures were controlled with thiopental sodium infusion. After 48 h intubation and mechanical ventilation thiopental sodium was gradually reduced and then stopped. Following the withdraw of thiopental sodium, she was seizure free on her discharge on the 8th day.. Alpha lipoic acid and derivatives cause side effects in children like refractory convulsions. They are frequently rendered as vitamins by diabetic patients and are left at places where children can easily access them. Therefore, when faced with refractory convulsions in children who have had no disease before, intoxication by medicaments with alpha lipoic acid should be taken into consideration.

Topics: Anticonvulsants; Epilepsies, Myoclonic; Female; Humans; Infant; Levetiracetam; Midazolam; Piracetam; Respiration, Artificial; Seizures; Status Epilepticus; Thioctic Acid; Thiopental

In electroconvulsive therapy (ECT), the use of anesthetics without relevant anticonvulsant properties such as ketamine and etomidate may be favorable for seizure quality. Since there is a relative paucity of studies devoted to this issue, our aim was to compare different anesthetics for ECT regarding their impact on seizure quality and different seizure parameters. We retrospectively compared ketamine (n = 912 anesthesias), etomidate (n = 227 anesthesias), thiopental (n = 2,751 anesthesias), and propofol (n = 42 anesthesias) on their influence on general seizure quality and different seizure parameters by multivariate repeated measurement regression analyses. The use of ketamine and etomidate as anesthetics led to seizures that were overall higher in quality and also longer in motor seizure activity when compared to anesthesia with thiopental and propofol. Ketamine was most favorable concerning central inhibitory potential that was indirectly quantified by concordance and postictal suppression. The worst seizure quality was observed with propofol anesthesia; further, this substance had a negative impact on autonomic activation and seizure duration. Based on the data of this retrospective study, the use of ketamine or etomidate as anesthetic in ECT might be advantageous due to the induction of high-quality seizures.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Anesthetics; Autonomic Nervous System; Brain Waves; Electroconvulsive Therapy; Electroencephalography; Etomidate; Female; Humans; Ketamine; Male; Middle Aged; Motor Activity; Multivariate Analysis; Propofol; Retrospective Studies; Seizures; Severity of Illness Index; Thiopental; Young Adult

Precise control of anesthetic depth during electroconvulsive therapy (ECT) is crucial because most intravenous anesthetics have anticonvulsant effects. In this study, we investigated the association between anesthetic depth measured by the Alaris auditory evoked potential index (AAI) and seizure inducibility and seizure duration during ECT.. Sixty-four ECTs were evaluated in 12 consecutive patients. General anesthesia was performed with a thiopental-based method. The relationship between the pre-ictal AAI, seizure activity and seizure duration was analyzed, and a possible threshold pre-ictal AAI to induce a seizure duration of at least 25 seconds was calculated.. Forty-one of the 64 ECT stimuli successfully induced seizure activity that lasted longer than 25 seconds. Pre-ictal AAI was significantly correlated to seizure duration (r = 0.54, p < 0.001) and the threshold pre-ictal AAi value was calculated to be 26 (area under curve: 0.76, sensitivity: 70.3% and specificity: 73.9%, p < 0.001). ECT with a pre-ictal AAI ≧ 26 had a higher incidence of successful seizure activity ( p < 0.001) and a longer seizure duration (55 ± 35 v.s. 21 ± 27 seconds, p < 0.001).. Maintenance of a pre-ictal AAI value ≧ 26 was associated with an increased incidence of successful seizure activities and a longer seizure duration. This is the first report to investigate Alaris AEP monitoring during ECT.

Topics: Adult; Anesthesia, General; Anesthetics, Intravenous; Electroconvulsive Therapy; Evoked Potentials, Auditory; Female; Humans; Male; Middle Aged; Seizures; Thiopental; Time Factors

This study compares the data of (modified) electroconvulsive theraphy (ECT) applications from two different inpatient clinics in Turkey: Kocaeli Derince Training and Research Hospital (Clinic-I) and Kocaeli University (Clinic-II).. Recorded files of patients from the two clinics were compared in terms of ECT indications, number and duration of seizures, and anesthetic agents used (propofol vs. thiopental). ECT applications occurring between January 2011 and January 2013 were included in the study.. A total of 86 patients (9.5% of the inpatients) received ECT in Clinic-I and 103 patients (21.1% of the inpatients) in Clinic-II during the period studied. The yearly ECT rate (treated person rate per 10,000 per year) was 0.59/10,000 for Kocaeli (Turkey) as a whole. The overall number of ECT applications was 539 in Clinic-I and 999 in Clinic-II, and the average number of ECT sessions for each patient was 6.4 ± 2.33 in Clinic-I and 9.69 ± 4.66 in Clinic-II. The majority of indications were depressive disorders and insufficient response to medicine. Patients in the clinic which utilized thiopental as the anesthetic agent experienced more cardiovascular and respiratory side effects than the one which used propofol. The number of ECT sessions required was greater for patients with schizoaffective disorder than for others.. The administration of ECT was considered to be a reliable method of treatment in these clinics. With respect to specific anesthetic agents, propofol was found to have less hemodynamic side effects and shorter seizure durations than thiopental.

Topics: Adult; Anesthesia, General; Anesthesia, Intravenous; Anesthetics, Intravenous; Bipolar Disorder; Bradycardia; Depressive Disorder; Electroconvulsive Therapy; Female; Hemodynamics; Hospital Units; Humans; Male; Medical Records; Propofol; Retrospective Studies; Schizophrenia; Seizures; Thiopental; Time Factors; Treatment Outcome; Turkey

In ECT, the relative timing of seizure induction and anesthesia may critically impact on seizure quality when anesthetic agents with anticonvulsive properties such as barbiturates or propofol are used. Measuring the depth of anesthesia by bispectral index (BIS) monitoring and thereby identifying the optimal moment for seizure induction might enhance seizure quality.Seizures from 869 individual ECT -sessions with thiopental anesthetic from 118 patients were examined in this retrospective study. The associations of the BIS value at the moment of seizure induction with 7 established seizure parameters and with a novel model of seizure quality were tested by regression analyses.BIS value at induction correlated positively with seizure duration, central inhibition, coherence and maximal heart rate, but not with midictal amplitude. Higher seizure quality was related with a higher BIS value at the moment of seizure induction.The BIS value at seizure induction serves as an independent predictor of seizure quality, influencing most other established markers. BIS monitoring appears as a simple tool to identify the optimal moment for seizure induction.

Topics: Adult; Aged; Anesthesia; Anesthesia, Intravenous; Anesthetics, Intravenous; Consciousness Monitors; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Male; Middle Aged; Propofol; Retrospective Studies; Seizures; Thiopental

There is increasing evidence that a greater degree of postictal suppression (the abruptness and magnitude of the EEG voltage drop at the end of the seizure) may be associated with better clinical response to electroconvulsive therapy. Retrospective studies have shown better postictal suppression when propofol is used for induction rather than the more commonly used methohexital. We report two patients in whom poor postictal suppression was rectified by switching from methohexital to propofol. The clinical significance of this improvement in postictal suppression is unclear, and prospective studies will be needed to clarify any clinical benefits.

Topics: Anesthesia, Intravenous; Anesthetics, Intravenous; Bipolar Disorder; Depressive Disorder, Major; Electroconvulsive Therapy; Female; Humans; Methohexital; Middle Aged; Propofol; Seizures; Thiopental; Treatment Outcome

We experienced a case of alachlor herbicide (Lasso) intoxication. A 57-year-old man was transported to our hospital by ambulance after ingesting 450 mL of Lasso. He was unconscious and had difficulty in breathing. Gastric lavage was performed after tracheal intubation and the patient was placed on mechanical ventilation. Activated charcoal and laxative were administrated. Even after admission, disturbance of consciousness persisted. He had liver and kidney disorders but these did not progress to multiple organ failure. He experienced convulsions from day 4 and was administered anticonvulsants. Convulsion was intractable and needed long-term treatment. His general condition improved until discharge. He was weaned from mechanical ventilation and recovered consciousness, but he still displayed tremors. The herbicide (Lasso) is a combination of alachlor and monochlorobenzene. Studies have shown that alachlor is neurotoxic and monochlorobenzene accumulates in the brain. In case of intoxication with the herbicide Lasso, treatment is required for ameliorating neurotoxic effects and intractable convulsion as well as liver and kidney disorders, gastrointestinal mucosal damage, hematopoietic disorder, and acute circulatory failure.

Topics: Acetamides; Anticonvulsants; Clonazepam; Gastric Lavage; Herbicides; Humans; Male; Middle Aged; Multiple Organ Failure; Respiration, Artificial; Seizures; Thiopental; Valproic Acid

We report the anaesthetic management of a term pregnant woman with active tuberculous meningitis, who had experienced seizures, had signs of raised intracranial pressure and required emergency caesarean section. Peripartum anaesthetic management of a patient with tuberculous meningitis is a rare event.

Topics: Adult; Androstanols; Anesthesia, Obstetrical; Anesthetics, Inhalation; Anesthetics, Intravenous; Anticonvulsants; Antihypertensive Agents; Cesarean Section; Emergencies; Female; Fentanyl; Humans; Intracranial Hypertension; Isoflurane; Labetalol; Midazolam; Neuromuscular Nondepolarizing Agents; Phenytoin; Pregnancy; Pregnancy Complications, Infectious; Rocuronium; Seizures; Thiopental; Tuberculosis, Meningeal

Electroconvulsive therapy (ECT) is still considered the most effective biological treatment strategy in psychiatric disorders. However, the clinical efficacy of ECT may be affected by stimulus variables and the concomitant use of psychopharmacological medication. Furthermore, most anaesthetics have anticonvulsant properties and therefore might additionally influence the efficacy of ECT.. In order to explore whether different anaesthetics might alter the effectiveness or safety of ECT we retrospectively analyzed 5482 ECT treatments in 455 patients. Anaesthetics were chosen according to clinical reasons and comprised thiopental, methohexital, propofol and etomidate.. Seizure duration was significantly affected by the anaesthetic medication with longest seizure activity during thiopental anaesthesia. In addition, postictal suppression, a further prospective parameter of ECT effectiveness, was significantly higher during propofol and thiopental anaesthesia. The clinical effectiveness was significantly better during propofol and thiopental anaesthesia. In contrast, the overall safety did not differ between the anaesthetic groups.. Our study supports the hypothesis that inducting anaesthetic agents have a different impact on seizure duration, ictal and postictal electrophysiological indices and clinical efficacy of ECT. Compared to thiopental, which has been established as a standard anaesthetic during ECT, also the modern anaesthetic propofol is a suitable inducting agent.

Topics: Aged; Anesthesia, Intravenous; Anesthetics, Intravenous; Electroconvulsive Therapy; Electroencephalography; Electromyography; Etomidate; Female; Humans; Male; Methohexital; Middle Aged; Propofol; Retrospective Studies; Seizures; Thiopental

Electroconvulsive therapy (ECT) is performed under anesthesia and muscle relaxation. Only well-generalized seizures seem to have the high "adequacy" or "quality" that have been claimed to reflect positive predictive power for the outcome of an ECT course. The induction of well-generalized seizures can be potentially influenced by several variables. One major variable is concurrent medication including anesthetic drugs, since most anesthetic drugs are potent anticonvulsives. We hypothesized a negative influence of anesthetics and benzodiazepines but a positive effect of antidepressants and antipsychotics concurrently applied during ECT on seizure adequacy.. We included inpatients (n = 41) with a DSM-IV-diagnosed major depressive episode treated with ECT (411 ECT sessions) during a period of 20 months (May 2005 to December 2006) in an open label and noncontrolled study. A repeated measurement regression analysis was performed with 8 seizure adequacy parameters as dependent variables. We indirectly quantified narcotic agent influence with bispectral index monitoring.. In contrast to the impact of psychiatric comedication, this measure of "depth of narcosis" prior stimulation turned out to influence most seizure adequacy parameters in a highly significant manner.. Thus, we concluded that the anticonvulsive properties of narcotic agents have much higher influence than concomitant psychotropic medication. Our data support the view that a significant influence of concurrent psychotropic drugs on seizure adequacy markers is missing, especially when directly compared with other confounders like stimulation energy, age, and depth of narcosis. The latter suggests to further prove the idea that lighter anesthesia is indeed an important tool to get patients faster into remission.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia, General; Anesthetics, Intravenous; Antidepressive Agents; Antipsychotic Agents; Combined Modality Therapy; Depressive Disorder, Major; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Male; Middle Aged; Psychotropic Drugs; Reaction Time; Seizures; Stupor; Thiopental; Treatment Outcome

We present a case of accidental injection of tranexamic acid instead of bupivacaine during spinal anesthesia. One minute after intrathecal injection of 3.5 mL of solution, the patient developed myoclonus of his lower extremities. Accidental intrathecal injection of the wrong drug was suspected and a used ampule of tranexamic acid discovered in the trash can. The ampules of tranexamic acid (500 mg/5 mL) and bupivacaine (5 mg/mL, Merck, Darmstadt, Germany) were similar in appearance. General anesthesia was induced. Ten hours later, the patient developed myoclonus of his upper extremities and face. His polymyoclonus was successfully treated with phenytoin, sodium thiopental infusion, sodium valproate and supportive care of the hemodynamic, and respiratory systems. The patient's condition progressively improved to full recovery.

Topics: Anesthesia, General; Anesthesia, Spinal; Anticonvulsants; Antifibrinolytic Agents; Critical Care; Humans; Male; Medication Errors; Middle Aged; Myoclonus; Orthopedic Procedures; Phenytoin; Seizures; Thiopental; Tranexamic Acid

Potentiation of GABA(A) receptor-mediated inhibitory neurotransmission contributes to the anesthetic action of thiopental. However, the inhibiting action of general anesthetic on excitatory neurotransmission also purportedly underlies its effects. The aim of the study was to elucidate the role of glutamate receptors (NMDA and AMPA receptors) in thiopental-induced anesthesia. Intracerebroventricular (i.c.v.) NMDA (50 ng) significantly increased the induction time of loss of righting reflex and decreased sleep time induced by intraperitoneal injection (i.p.) of thiopental (50 mg/kg). Furthermore, NMDA at 50 ng i.c.v. increased the 50% effective dose values for thiopental to produce loss of righting reflex and immobility in response to noxious tail clamp by 25% and 21% (p < 0.05), respectively. However, intrathecal (IT) administration of NMDA or both of i.c.v. or IT administration of AMPA did not show such antagonizing effects on thiopental action at subconvulsive dose. Finally, thiopental (25 mg/kg i.p.) inhibited convulsions induced by NMDA (0.4 microg i.c.v.) or bicuculline (0.6 microg i.c.v.). However, i.p. muscimol (1 mg/kg) blocked the convulsions induced by bicuculline, but not those induced by NMDA at 3 mg/kg. Similarly, i.p. MK-801 (0.1 mg/kg) antagonized NMDA-induced convulsions, but not bicuculline-induced convulsions at 0.3 mg/kg. Therefore, we suggest that the effects of the selective GABA(A) and NMDA receptors on convulsive behavior are special to their sites of action, and that the inhibitory action of thiopental on NMDA receptors is possibly not mediated by secondary effects of its GABA(A) receptors agonism. These results above indicate the involvement of NMDA receptors in thiopental-induced anesthesia in mice.

Topics: Analgesics; Anesthetics, Intravenous; Animals; Anticonvulsants; Behavior, Animal; Bicuculline; Dizocilpine Maleate; Female; GABA Agonists; GABA Antagonists; GABA-A Receptor Agonists; GABA-A Receptor Antagonists; Male; Mice; Movement; Muscimol; N-Methylaspartate; Pain Measurement; Receptors, AMPA; Receptors, N-Methyl-D-Aspartate; Reflex, Abnormal; Seizures; Thiopental

Topics: Anesthetics, General; Animals; Cerebral Cortex; Enflurane; Humans; Isoflurane; Models, Neurological; Seizures; Thiopental

Methohexital used to be the preferred anesthetic used in electroconvulsive therapy (ECT). Since 1999, there have been supply problems for this drug, and there has been no clear guidance regarding which anesthetic should be used preferably in ECT. Most clinics use thiopental or propofol, although these drugs may increase the seizure threshold. We investigated if etomidate improves seizure duration compared with thiopental in cases where eliciting seizures becomes problematic.. During our routine delivery of ECT at a general psychiatric hospital in Cardiff, UK, we observed 5 patients who had ECT courses with thiopental and did not achieve adequate seizure duration despite very high electric stimulation. They later relapsed and received second courses of ECT under etomidate. We compared the seizure duration and the electric charge needed to produce the seizures for a total of 46 pairs of ECT sessions given under the 2 anesthetics on the same patients.. The average electric stimulation dose required to induce seizures was reduced from 638 to 497 millicoulombs (95% confidence interval, 60-221; P = 0.001). Despite the lower dose, the length of observed seizure duration increased by 10.3 seconds (65%) and that of the electroencephalograph-recorded duration increased by 8.7 seconds (41%) (P < 0.001).. Etomidate has a distinct advantage over thiopental in producing seizures of adequate duration during ECT and should be used as the first-line measure in augmenting seizures in patients who have very high seizure thresholds.

Topics: Aged; Depression; Dose-Response Relationship, Drug; Electroconvulsive Therapy; Electroencephalography; Etomidate; Female; Humans; Male; Middle Aged; Seizures; Thiopental; Time Factors

Isoniazid is an anti-tuberculosis drug, used commonly for treatment and prophylaxis of tuberculosis. Acute isoniazid intoxication is characterized by a clinical triad consisting of metabolic acidosis resistant to treatment with sodium bicarbonate, seizures which may be fatal and refractory to standard anticonvulsant therapy, and coma. Treatment requires admission to the intensive care unit for ventilatory support, management of seizures and metabolic acidosis. Pyridoxine, in a dose equivalent to the amount of isoniazid ingested, is the only effective antidote. We report the successful treatment of two isoniazid intoxication cases: the case of a child developing an accidental acute isoniazid intoxication and an adult case of isoniazid intoxication with the intent of suicide.

Topics: Acidosis; Acute Disease; Adolescent; Anticonvulsants; Antitubercular Agents; Charcoal; Child; Coma; Diazepam; Female; Gastric Lavage; Humans; Intubation, Intratracheal; Isoniazid; Pyridoxine; Seizures; Sodium Bicarbonate; Suicide, Attempted; Thiopental; Vitamin B Complex

We investigated the sequence of the administration, the efficacy and the safety of antiepileptic drugs (AED) given intravenously for the treatment of status epilepticus and frequent seizures in children. Our institute has a recommended sequence of AED administration for treatment of status epilepticus: the first-line agent is diazepam (0.3 - 0.5 mg/kg administered intravenously, once or twice). The second-line drugs include midazolam (0.15 - 0.4 mg/kg intravenously, once or twice, and if necessary, followed by continuous infusion at 0.06 - 0.18 mg/kg/hour), lidocaine (1 - 2 mg/kg intravenously, once or twice, and if necessary, followed by continuous infusion at 2 - 4 mg/kg/hour) and phenytoin (10 - 20 mg/kg, infused slowly). For those patients who previously experienced a seizure which was refractory to diazepam but responsive to the second-line agent, it was recommended to use the second-line agent as a first-line agent. When seizures were refractory to the first and second-line agents, thiopental was administered (3 - 10 mg/kg intravenously, and if necessary, followed by continuous infusion at 2 -5 mg/kg/hour). The etiologies of 177 occasions of status epilepticus and frequent seizures were categorized into two groups:epilepsy (n = 95) and situation-related seizures (n = 82). Situation-related seizures included febrile seizures (n = 44), acute encephalopathy/encephalitis (n = 31) and benign infantile convulsions (n = 7). The ages of the patients ranged from 0.1 to 18.4 years (average +/- SD:3.69 +/- 3.15 years). Diazepam was administered as the first-line drug on 157 of 177 occasions (88.7%). On 116 occasions the second-line agents were administered. Midazolam and lidocaine were injected as the second-line agent on 54 (46.6%), and on 33 (28.4%) occasions, respectively, although both midazolam and lidocaine injections were off-label use for seizure control in Japan. Thiopental was used as the third to fifth-line agent. Effective ratios (effective occasions/total occasions) of each drug were the following: thiopental 19/21 (90.4%), midazolam 57/99 (57.6%), lidocaine 25/60 (41.7%), phenytoin 16/41 (39.0%), diazepam 59/164 (36.0%). Thiopental was statistically more effective than midazolam, lidocaine, diazepam or phenytoin (p < 0.01), and midazolam was statistically more effective than diazepam (p < 0.01) or phenytoin (p < 0.05). Administration of thiopental caused complications more frequently than the other agents (p < 0.01): The complications by thiopent

Topics: Adolescent; Anticonvulsants; Child; Child, Preschool; Diazepam; Drug Administration Schedule; Female; Humans; Infant; Lidocaine; Male; Midazolam; Phenytoin; Seizures; Status Epilepticus; Thiopental

We describe a patient who entered a stuporous state after receiving benzodiazepine treatment for generalized tonic-clonic status epilepticus. A diagnosis of generalized NCSE with tonic seizures was made on the basis of the clinical picture and response to barbiturate anaesthetic, although the EEG pattern was not typical of the changes previously described in tonic seizures-tonic status epilepticus. This report discusses the differential diagnosis of postictal stupor, nonconvulsive status epilepticus with tonic seizures and sedation caused by the emergency treatment of status epilepticus, and summarizes the literature on tonic seizures and tonic status epilepticus.

Topics: Adult; Anticonvulsants; Benzodiazepines; Coma; Diagnosis, Differential; Electroencephalography; Epilepsy, Complex Partial; Epilepsy, Generalized; Epilepsy, Tonic-Clonic; Female; Humans; Learning Disabilities; Phenobarbital; Seizures; Status Epilepticus; Thiopental; Valproic Acid

The prediction of seizure thresholds in electroconvulsive therapy (ECT) remains problematic. We examined the relationship between bispectral index (BIS) score and seizure duration in ECT performed under thiopental anesthesia in patients receiving their usual regimen of antidepressant medication for its potential as a predictor of seizure inducibility. One-hundred ECT treatments were evaluated in 16 adult patients diagnosed with depression. BIS scores were recorded at the preanesthetic and preictal periods and at recovery from ECT. Seizure duration was defined as the duration of the electroencephalogram seizure pattern. The relationships between preanesthetic and preictal BIS scores and seizure duration were evaluated. Effective seizure threshold was determined by receiver operator characteristic analysis, and the area under the curve (AUC) was calculated for seizure durations of more than 10 s, more than 20 s, and more than 30 s. The relationship between seizure duration and thiopental estimated effect-site and plasma concentrations was analyzed as well. Preictal BIS scores for seizures lasting longer than 30 s were significantly higher than those for seizures lasting <30 s. A preictal BIS score of 55 or more represents a strongly determinant condition for achieving seizures that last longer than 30 s (AUC, 0.937; receiver operator characteristic), as well as for briefer seizures that last more than 20 or 10 s (AUC: 0.938 and 0.959, respectively). There was no significant correlation between seizure duration and the estimated thiopental effect-site or plasma concentration. We conclude that during thiopental anesthesia, the minimum threshold for inducing seizures of any duration correlates with a preictal BIS score of 55. This threshold was independent of antidepressant regimen and thiopental dosage. We suggest that the preictal BIS score is useful in predicting the ictogenic threshold in ECT.. We found that the bispectral index (BIS) score serves as an indicator of seizure inducibility in electroconvulsive therapy (ECT) under thiopental anesthesia and that the relationship between BIS score and seizure duration was not linear, suggesting that the pharmacological mechanisms by which thiopental and propofol suppress ECT seizure activity are different.

Topics: Adult; Aged; Aged, 80 and over; Anesthesia, Intravenous; Anesthetics, Intravenous; Area Under Curve; Depression; Dose-Response Relationship, Drug; Electroconvulsive Therapy; Electroencephalography; Electrophysiology; Female; Humans; Male; Middle Aged; Predictive Value of Tests; ROC Curve; Seizures; Thiopental

To delineate a catastrophic childhood epileptic syndrome of unknown cause presenting with persistent intractable multifocal status.. Case note review.. Six children aged 5 months to 6 years presented with focal seizures that progressed within days to intractable multifocal seizures with or without secondary generalisation, which recurred every few minutes and persisted for weeks. One developed impaired consciousness shortly before seizures started. The two younger children showed mild developmental delay before onset but the others were normal. The seizures were unresponsive to all conventional anticonvulsants, steroids or pyridoxine and could only be controlled with doses of thiopentone sufficient to cause electrical suppression. MRI scans were initially normal but later showed focal cortical swelling followed by generalised atrophy. Two developed hepatomegaly, with a normal liver biopsy in one and steatosis in the other. No cause has been found even after neuropathological investigation. Three have died, two within 3 months of onset, while the three survivors have very severe neurological impairment and continued seizures.. The similarity of the clinical features suggests that this is a consistent clinical syndrome.

Topics: Anesthetics, Intravenous; Anticonvulsants; Atrophy; Brain; Child; Child, Preschool; Disease Progression; Electroencephalography; Epilepsy; Female; Hepatomegaly; Humans; Hypnotics and Sedatives; Infant; Liver; Magnetic Resonance Imaging; Male; Seizures; Thiopental

The aqueous extract of Centranthus longiflorus ssp. longiflorus (CLE) was investigated for sedative, anticonvulsant and behaviour modifying activity using thiopental sleeping, caffeine induced convulsion and forced swimming depression tests. When the effects of the aqueous extract of CLE (100 mg/kg) was compared to diazepam, it showed similar sedative and anticonvulsant effects to those produced by diazepam (5 mg/kg).

Topics: Adenosine; Animals; Anticonvulsants; Behavior, Animal; Caffeine; Central Nervous System Stimulants; Depression; Diazepam; Female; gamma-Aminobutyric Acid; Hypnotics and Sedatives; Male; Mice; Plant Extracts; Plants, Medicinal; Rats; Rats, Sprague-Dawley; Seizures; Sleep; Swimming; Thiopental; Turkey; Valerianaceae

The present study determined the pharmacological profile of barakol, a major constituent of Cassia siamea Lamk., in rodent behavioral and neurochemical tests. Barakol reduced spontaneous locomotor activity, increased the number of sleeping animals and prolonged the thiopental-induced sleeping time, indicating a sedative effect. As for interactions between barakol and convulsants (pentylenetetrazole (PTZ), picrotoxin, bicuculline and strychnine), only a high dose (100 mg/kg, i.p.) of barakol slightly prolonged the latency of clonic convulsion induced by picrotoxin. This suggests that the sedative effect may not be induced via the GABA or glycine systems. There was no evidence of an anxiolytic effect of barakol in the plus-maze test. However, barakol (25-100 mg/kg, i.p.) could suppress methamphetamine (1 mg/kg, i.p.)-induced hyper-locomotor activity in a dose-dependent manner, indicating an effect on the dopaminergic system. In a microdialysis study, the dose of barakol (100 mg/kg) that inhibited spontaneous locomotor activity in mice did not affect the basal levels of extracellular dopamine (DA) or its metabolites in the striatum. However, pretreatment with barakol (100 mg/kg, i.p.) decreased the maximal dopamine release and dopamine turnover induced by methamphetamine (1 mg/kg, i.p.). This finding indicates that the inhibitory effect of barakol on dopamine release may account for the blocking effect of barakol on the striatum-related behavior induced by methamphetamine.

Topics: Animals; Anticonvulsants; Benzopyrans; Bicuculline; Cassia; Diazepam; Dopamine; Dose-Response Relationship, Drug; Male; Maze Learning; Methamphetamine; Pentylenetetrazole; Phenalenes; Phytotherapy; Picrotoxin; Plant Extracts; Rats; Rats, Wistar; Seizures; Sleep; Strychnine; Thiopental

Stimulus dose titration for electroconvulsive therapy (ECT), the method to determine seizure threshold accurately, has not been commonly practiced. We describe our early experience of dose titration in 22 Chinese patients and compare seizure thresholds measured by dose titration with values predicted by the formula-based 'half-age'. Seizure thresholds, as measured by dose titration, varied fourfold among our sample and the average value was 105.5 mC or 16.7 J. At the titration session, 27% of patients had seizures after a single stimulation and 37% had seizures after two stimulations. Only one patient required four stimulations to induce a seizure. No patient had significant adverse events associated with the dose titration procedure. The 'half-age' method in average overestimated seizure thresholds by 44% when compared with that measured by dose titration and in 23% of our sample, the overestimation was more than 100%. The pros and cons of dose titration and 'half-age' prediction method will be discussed. Our early experience suggests that dose titration could be performed in the majority of patients receiving ECT.

Topics: Adult; Aged; Differential Threshold; Drug Administration Schedule; Electroconvulsive Therapy; Female; Humans; Hypnotics and Sedatives; Male; Middle Aged; Seizures; Thiopental

Topics: Ammonia; Autoanalysis; Chromatography, High Pressure Liquid; False Negative Reactions; Humans; Hypnotics and Sedatives; Infant; Male; Reagent Kits, Diagnostic; Seizures; Spectrophotometry, Ultraviolet; Thiopental

Topics: Anesthesia, General; Anesthetics, General; Apnea; Bradycardia; Epilepsy, Generalized; Epilepsy, Tonic-Clonic; Hernia, Inguinal; Humans; Hyponatremia; Infant, Newborn; Isoflurane; Male; Seizures; Thiopental

To determine efficacy of continuous diazepam infusion in the treatment of refractory status epilepticus in a retrospective study, we analyzed data of 62 children admitted consecutively to our Pediatric Intensive Care Unit with a diagnosis of refractory status epilepticus. The unit followed a standard treatment protocol for diazepam infusion; if it failed, thiopental infusion was used. The mean age of patients was 2.80 years (range, 1.5 to 11.5 yr). Thirty-six patients (60%) had acute infections of the central nervous system and 10 (16%) had idiopathic epilepsy. Diazepam infusion was used in 57 patients. This treatment controlled seizures in 86% of patients (49/57), on average within 40 minutes (median, 30 min; range, 10-120 min), at a mean infusion rate of 0.017 mg/kg/min (range, 0.01-0.03 mg/kg/min). The mean total duration of infusion was 68 hours (range, 12-220 hr). Diazepam infusion was associated with hypotension in one patient, respiratory depression requiring ventilatory support in 12% of patients (6/49), and death in 14% of patients (7/49). Thiopental infusion was used in nine patients, including eight in whom diazepam infusion had failed. Thiopental infusion controlled seizures in all nine patients, but all of them needed mechanical ventilation, and seven needed vasopressor support for hypotension; four patients (44%) died. We conclude that continuous diazepam infusion is a reasonably effective modality to control refractory status epilepticus in children and is associated with reduced need for ventilatory and vasopressor support.

Topics: Anticonvulsants; Child; Child, Preschool; Diazepam; Female; Humans; Infant; Infusions, Intravenous; Intensive Care Units; Male; Retrospective Studies; Seizures; Status Epilepticus; Thiopental

The physical compatibility of thiopentone and propofol mixtures was investigated. The investigations used were macroscopic and microscopic observations, zeta potential and oil droplet size measurements. There was no evidence of instability in the mixtures. The thiopentone-propofol mixture has the potential advantage of reducing the pain on injection, provides synergistic interaction, does not prolong recovery when used for induction of anaesthesia, may reduce the incidence of convulsions and is cost-effective.

Topics: Anesthesia Recovery Period; Anesthetics, Intravenous; Chemical Phenomena; Chemistry, Physical; Cost-Benefit Analysis; Drug Stability; Drug Synergism; Electric Conductivity; Electrochemistry; Emulsions; Humans; Incidence; Injections, Intravenous; Pain; Propofol; Seizures; Thiopental

A case of intraoperative convulsions occurring in a child with arthrogryposis multiplex congenita is presented. Arthrogryposis and the anaesthetic management of children with this condition is discussed. Factors which may have contributed to the convulsions are considered.

Topics: Anesthetics, Inhalation; Anesthetics, Intravenous; Arthrogryposis; Fever; Fundoplication; Gastroesophageal Reflux; Humans; Infant; Intraoperative Complications; Intubation, Intratracheal; Male; Neuromuscular Nondepolarizing Agents; Nitrous Oxide; Seizures; Tachycardia, Sinus; Thiopental; Vecuronium Bromide

Rats treated with kainic acid develop limbic seizures and have elevated levels of circulating catecholamines resulting from an extensive stimulation of the adrenal gland. We investigated the levels of several constituents of chromaffin granules in rat adrenal medulla after injection of kainic acid. This treatment increased mRNA steady-state levels of enkephalin, neuropeptide Y and chromogranin B 2-6-fold. Elevated levels of these constituents were found as early as 2 h after treatment and lasted up to 24 h. Chromogranin A and secretogranin II mRNA levels, on the other hand, remained unchanged. Adrenal catecholamine concentrations were reduced by 80%. Pre-treatment of rats with thiopental prior to kainic acid prevented seizures, the decline in catecholamines and the elevation of enkephalin and neuropeptide Y mRNAs but not that of chromogranin B. On the other hand, the peripherally acting ganglionic blocker chlorisondamine did not protect from the kainic acid-induced up-regulation of chromogranin B mRNA, suggesting that chromogranin B mRNA may be regulated by a direct effect of kainic acid on chromaffin cells. The pattern of changes in mRNA expression differed from that seen after insulin hypoglycemia or reserpine treatment. Thus, stimulation of the splanchnic innervation in vivo by various means leads to an individual and independent regulation of granule constituents by quite different mechanisms.

Topics: Adrenal Medulla; Animals; Chromogranin A; Chromogranins; Enkephalins; Epinephrine; Gene Expression Regulation; Kainic Acid; Kinetics; Limbic System; Male; Neuropeptide Y; Norepinephrine; Protein Biosynthesis; Proteins; Rats; Rats, Sprague-Dawley; RNA, Messenger; Seizures; Thiopental; Transcription, Genetic

Pentylenetetrazol (PTZ) seizure threshold was determined in the rat during recovery from anesthesia induced by intravenous administration of propofol (20 mg/kg) or thiopentone (30 mg/kg). Seizure threshold values determined 10 min after the induction of anesthesia by either agents were significantly higher than those determined in control animals, indicating an anticonvulsant effect. With propofol, the initial rise in PTZ convulsive threshold declined rapidly during recovery from anesthesia and returned to control levels 40 min after drug administration. With thiopentone, the initial rise in convulsive threshold also declined during recovery phase but did not return to control levels at 90 min after drug administration. At no time during or after recovery from anesthesia induced by either anesthetic agents, did the PTZ conclusive threshold fall below control values. Thus, using the PTZ convulsive threshold, no proconvulsant effects were detected during the early phase of recovery from propofol or thiopentone induced anesthesia.

Topics: Anesthesia, General; Anesthetics, General; Animals; Behavior, Animal; Convulsants; Female; Motor Activity; Pentylenetetrazole; Postural Balance; Propofol; Rats; Rats, Sprague-Dawley; Reflex; Seizures; Thiopental

The purpose of the present study was to examine the effect of intravenous administration of propofol and thiopentone on picrotoxin-induced seizures using the picrotoxin convulsive threshold test in the rabbit. Neither propofol nor thiopentone at a dose of 1.25 mg/kg had any significant effect on picrotoxin seizure threshold. However, at higher doses (2.5, 5, 10 mg/kg) both propofol and thiopentone produced a significant and dose-dependent increase in the picrotoxin convulsive threshold. These findings suggest that propofol is an effective anticonvulsant against picrotoxin-induced seizures in the rabbit.

Topics: Animals; Anticonvulsants; Dose-Response Relationship, Drug; Injections, Intravenous; Male; Picrotoxin; Propofol; Rabbits; Seizures; Thiopental

Topics: Drug Overdose; Electroencephalography; Female; Humans; Injections, Spinal; Middle Aged; Morphine; Pentobarbital; Postoperative Complications; Seizures; Thiopental

The anticonvulsant effects of propofol and thiopental (thiopentone) were determined by measuring the durations of the various phases of maximal electroshock seizures in the rat. Five min. after intraperitoneal administration of subanaesthetic (6.25, 12.5 and 25 mg/kg) and 50 mg/kg doses of propofol, the 2 highest doses abolished both tonic hindlimb extensor phases (full and partial extension) in all rats and decreased the duration of the total tonic phases of the seizure. Although the lowest dose produced no effect, the 12.5 mg/kg dose decreased the duration of both the full and partial tonic extensor phases and increased the duration of tonic flexion, showing that even this low dose had anticonvulsant activity. Subanesthetic doses of thiopental (5, 10 and 20 mg/kg) produced similar changes in the maximal electroshock seizures except that even the lowest dose also significantly decreased the duration of total extension and total tonus. Postseizure depression was prolonged only by the highest dose of propofol. Thus, even low doses of either propofol or thiopental, that produced only minimal behavioural effects, had marked anticonvulsant effects against electrically induced convulsions in the rat. No evidence of enhanced convulsant maximal electroshock seizures patterns was observed at any dose.

Topics: Animals; Anticonvulsants; Behavior, Animal; Electroshock; Female; Propofol; Rats; Rats, Sprague-Dawley; Seizures; Thiopental

Thirty Sprague-Dawley rats were paralysed with pancuronium and their lungs ventilated mechanically with 70% nitrous oxide and 0.5% halothane in oxygen. Bupivacaine 2 mg kg-1 min-1 was infused continuously i.v. until the animals died. At the onset of seizures, animals were given an i.v. bolus of propofol 1 mg kg-1 (n = 10), thiopentone 2 mg kg-1 (n = 10) or lipid vehicle (n = 10). Administration of propofol or thiopentone was repeated each time seizures restarted and lipid vehicle administrations were repeated at 2-min intervals until the electroencephalogram became isoelectric. All animals developed seizures, arrhythmias, isoelectric EEG and asystole. Administration of lipid vehicle induced no obvious changes in ongoing epileptiform activity. The initial doses of thiopentone and of propofol stopped epileptiform activity in all animals, usually within 6 s after administration. The seizure-free period after the initial administration of thiopentone and of propofol lasted, on average, 0.98 min and 1.72 min, respectively. We conclude that propofol may have value in treating seizures induced by bupivacaine.

Topics: Animals; Blood Pressure; Bupivacaine; Electrocardiography; Electroencephalography; Heart Rate; Propofol; Rats; Rats, Sprague-Dawley; Seizures; Thiopental; Time Factors

The anticonvulsant effects of propofol administered intravenously against picrotoxin-induced seizure were studied and compared with those of diazepam and thiopental in the rat using picrotoxin-seizure threshold. Comparable doses of the three agents ranging between 1.25-20.0 mg/kg, produced dose-dependent increases in picrotoxin-threshold dose. At the lowest administered dose (1.25 mg/kg), there were no significant differences in picrotoxin-threshold dose among the three agents. Using 2.5 mg/kg dose, propofol and diazepam were equally effective and both were significantly more effective than thiopental in increasing picrotoxin-threshold dose. At higher doses of anticonvulsants (10.0 and 20.0 mg/kg), propofol was significantly more effective than both diazepam and thiopental. These results indicate that propofol is an effective anticonvulsant against picrotoxin-induced seizure, and this effect is significantly greater than diazepam and thiopental at doses producing clear sedative and behavioral effects.

Topics: Animals; Anticonvulsants; Diazepam; Female; Picrotoxin; Propofol; Rats; Rats, Sprague-Dawley; Seizures; Thiopental

The effect of intravenous ciprofloxacin (CPX) pretreatment on the kinetics and brain sensitivity for thiopental was studied in male rats using a previously developed electroencephalographic (EEG) threshold method. Thiopental was administered intravenously with constant infusion rate. Immediately after the appearance of the first burst suppression of 1 sec. or more (the "silent-second") in the EEG the infusion was stopped and the rats were killed by decapitation. The dose of thiopental needed to reach the criterion of silent-second was slightly reduced in ciprofloxacin pretreated rats when compared with saline pretreated controls. One rat that developed seizures after CPX pretreatment needed a considerably reduced dose of thiopental to induce the silent-second. The serum concentrations of thiopental were markedly reduced in the experimental group while no significant differences were found in the concentrations of thiopental in the different parts of the central nervous system (CNS), fat or muscle tissue. The kinetics of CPX were also affected. The experimental group (CPX + thiopental treated) had significant higher brain concentrations of CPX than the corresponding only CPX treated control group while no differences were found in the serum concentrations of CPX between the groups. As previously suggested, the distribution of thiopental in the CNS is not only dependent on its lipid solubility, but also as a weak organic acid, on the transport system for organic acids out of the CNS which both thiopental and ciprofloxacin seem to use and mutually compete for it.

Topics: Animals; Central Nervous System; Ciprofloxacin; Drug Interactions; Electroencephalography; Infusions, Intravenous; Male; Rats; Rats, Sprague-Dawley; Seizures; Thiopental; Tissue Distribution

The anticonvulsant effects of propofol, thiopental, and diazepam, administered intravenously, on pentylenetetrazol (PTZ) seizure threshold were studied and compared in the rabbit. The PTZ seizure threshold determined in various rabbit groups during the control phase of conducted experiments, was found to be in the range of 10.1 +/- 2.0 to 13.5 +/- 3.7 mg/kg. Intravenous administration of comparable doses of propofol, thiopental, and diazepam resulted in marked and significant increases in PTZ seizure threshold. At all administered doses (1.25-10.0 mg/kg), propofol was found to be more effective than thiopental in increasing the PTZ threshold dose. However, the anticonvulsant effects of diazepam were more marked than those of propofol, except at a dose of 10 mg/kg where both agents exhibited equipotent activities. These data demonstrate that propofol enjoys a considerable degree of anticonvulsant activity in the rabbit. This anticonvulsant action is greater than that of thiopental at doses ranging from 2.5 to 10 mg/kg and equipotent with diazepam at the 10 mg/kg dose.

Topics: Animals; Anticonvulsants; Behavior, Animal; Diazepam; Injections, Intravenous; Male; Pentylenetetrazole; Propofol; Rabbits; Seizures; Thiopental

The protective effects of subanesthetic and anesthetic doses of propofol and thiopentone against pentylenetetrazol (PTZ)- induced seizures were studied in the rat. Intraperitoneal administration of propofol and thiopentone at doses producing comparable levels of sedation prior to intravenous infusion of PTZ, resulted in a marker and significant increase in PTZ seizure threshold. However, at all doses, the effects of propofol on PTZ convulsive threshold were more profound. These data suggest that propofol is an effective anticonvulsant and affords a greater degree of protection than thiopentone against PTZ-induced seizures in the rat.

Topics: Animals; Anticonvulsants; Female; Pentylenetetrazole; Propofol; Rats; Rats, Inbred Strains; Seizures; Thiopental

AP159 [N-cyclohexyl-1,2,3,4-tetrahydrobenzo(b)thieno(2,3c)pyridine]-3- carboamide,hydrochloride) showed clear anti-conflict activity in rats in the absence of effects on muscle relaxation, potentiation of anesthesia (in mice) or anticonvulsant activity (in mice). This anti-conflict effect was antagonized by treatment with Ro15-1788. By contrast with the deficits produced by diazepam, AP159 did not impair passive avoidance. The latter drug also improved scopolamine-induced amnesia in the same task. AP159 did not inhibit 3H-flunitrazepam binding, but potently inhibited 3H-8OH-DPAT binding. This compound increased serotonin and 5HIAA content of the midbrain raphe nuclei and of the amygdala centralis. AP159 has been shown to be a novel non-BZP anxiolytic agent with no side effects in laboratory animals; it could be a clinically effective anxiolytic agent.

Topics: Aggression; Animals; Anti-Anxiety Agents; Avoidance Learning; Conflict, Psychological; Drinking Behavior; Ethanol; Flumazenil; Hydroxyindoleacetic Acid; Male; Mice; Mice, Inbred ICR; Mice, Inbred Strains; Motor Activity; Muscle Relaxants, Central; Postural Balance; Pyridines; Rats; Rats, Inbred Strains; Seizures; Serotonin; Thienopyridines; Thiopental; Thiophenes

1. The anticonvulsant effects of subanaesthetic doses of propofol and thiopentone against PTZ-induced seizures and mortality were examined in the rat. 2. Administration of propofol (50 mg/kg, i.p.) 5 min prior to PTZ treatment increased the 2 h CD50 and the 24 h LD50 of PTZ by 3.4-fold, whereas thiopentone pretreatment (20 mg/kg, i.p.) increased these values by more than five-fold. 3. Both propofol and thiopentone prolonged the latency to the onset of clonic seizure but the effects of the former were more marked. 4. The data demonstrate that propofol was more effective than thiopentone in providing complete protection against PTZ-induced seizures for the first 30-40 min of observation and that thiopentone, because of its sustained effects, was more effective in reducing the cumulative incidence of seizures and mortality over 2 and 24 h, respectively. 5. We conclude that propofol is a very effective anticonvulsant and provides complete protection of short duration against PTZ-induced seizures in the rat.

Topics: Animals; Dose-Response Relationship, Drug; Male; Pentylenetetrazole; Propofol; Rats; Rats, Inbred Strains; Seizures; Thiopental; Time Factors

1. Convulsive thresholds were measured with intravenous pentylenetetrazol in mice during the recovery phase after intravenous anaesthetic doses of propofol (10 and 20 mg kg-1), thiopentone (30 mg kg-1), methohexitone (10 mg kg-1), and etomidate 3 mg kg-1). 2. The convulsive threshold rose after each agent, indicating an anticonvulsant action for all the drugs tested; this declined to control values with initial half times of: 1.56 min (propofol 10 mg kg-1); 1.03 min (propofol 20 mg kg-1): 1.02 min (methohexitone); 3.35 min (etomidate); 13.7 min (thiopentone). 3. At no time during the recovery phase of any agent did the convulsive threshold fall below control values, which might indicate an epileptogenic effect of the drug. 4. The threshold was depressed below control values by intravenous administration of Ro 15-4513, a partial inverse agonist at the benzodiazepine receptor, thus indicating the ability of this pentylenetetrazol test to demonstrate a proconvulsant effect. 5. We conclude that the abnormal movements or convulsions associated with recovery from anaesthesia with short-acting intravenous anaesthetics may not be the result of an intrinsic proconvulsant action of the drugs.

Topics: Anesthesia, Intravenous; Animals; Anticonvulsants; Azides; Behavior, Animal; Benzodiazepines; Etomidate; Male; Methohexital; Mice; Movement; Pentylenetetrazole; Propofol; Seizures; Thiopental

Topics: Electroencephalography; gamma-Aminobutyric Acid; Humans; Isoniazid; Seizures; Thiopental

The successful treatment with thiopental (10 mg/kg, i.v.) of 9 severely asphyxiated newborns, under artificial ventilation, with neonatal seizures resistant to phenobarbital, is reported in this pilot study. The clinical and electroencephalogram control of seizures was prompt and resolute. No adverse effect on cardiovascular function (heart rate, blood pressure) was observed. The terminal half-life of thiopental averaged 9 h, the total plasma clearance 0.20 l/h/kg, and the steady-state volume of distribution 3.6 l/h/kg. The kinetic profile of the drug compared to phenobarbital and phenytoin in newborns suggests that its action is quicker and shorter lasting. Thus, from these findings, thiopental may offer a useful and handy approach for the safe and effective treatment of phenobarbital-resistant neonatal seizures.

Topics: Drug Evaluation; Drug Resistance; Female; Gestational Age; Half-Life; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Male; Phenobarbital; Seizures; Thiopental

Experiments were carried out in mice to assess the protection provided by thiopentone (Intraval, May and Baker) and propofol (Diprivan, I.C.I.) against epileptiform seizures induced by electroshock and pentylenetetrazol. Intraperitoneal administration of propofol 50 mg kg-1 and thiopentone 25 mg kg-1 produced similar peak behavioural effects of mild sedation and incoordination. However, at these doses propofol afforded a greater degree of protection against pentylenetetrazol than thiopentone and at greater doses both propofol and thiopentone caused marked protection. Both anaesthetics were effective also against electroshock seizures at sedative doses. We conclude that propofol has strong anticonvulsant properties.

Topics: Animals; Anticonvulsants; Behavior, Animal; Electroshock; Mice; Pentylenetetrazole; Propofol; Seizures; Thiopental

Propofol and thiopentone were compared as anaesthetic agents for electroconvulsive therapy in 31 patients on four occasions in a repeated measure crossover study. Discomfort on injection was significantly more common with propofol (51.6% of anaesthetics) compared to thiopentone (1.6% of anaesthetics). The duration of seizure was shorter with propofol in both treatments but there was significant drug-time interaction. Propofol gave a milder tonus and clonus during seizure when both treatments were considered together. The increase in systolic and diastolic arterial pressures and heart rate after treatment were significantly higher with thiopentone. Apnoea was significantly longer with propofol. The times to sitting up unaided and opening the eyes on command were the same for both drugs. The ability to walk 10 m 20 minutes after anaesthesia was significantly better with propofol (p less than 0.0001).

Topics: Anesthesia Recovery Period; Anesthesia, Intravenous; Blood Pressure; Electroconvulsive Therapy; Heart Rate; Humans; Propofol; Seizures; Thiopental; Time Factors

Thiopentone anaesthesia was used in the treatment of seizures in 19 infants and young children. Nine had a pre-existing seizure disorder without acute cerebral injury and 10 had status epilepticus secondary to an acute cerebral illness. Clinical details, drug levels and findings from serial multichannel electroencephalograms (EEG) and continuous 1 to 2 channel signal processed EEGs using a Cerebral Function Analysing Monitor (CFAM) were reviewed to evaluate the contribution of these techniques to clinical management. Initial EEGs showed discharges that were not generalised in 16/19 patients. This necessitated the use of 7 different montages for continuous monitoring. Three different CFAM patterns representing particular EEG paroxysmal findings were seen. Acute seizure control was achieved in all 19 patients. All patients with a pre-existing seizure disorder survived, although 4/10 with an acute cerebral illness died. During treatment, patterns of burst-suppression to electrocerebral silence (ECS) were eventually seen in 16/19 patients and repeat EEGs demonstrated concordant multi-channel findings in 8/8. Although increasing thiopentone levels (13 patients) correlated with deeper suppression of cortical electrical activity, there was marked inter-patient variability. Inotropic support was not required during the period of treatment even when ECS was induced. In young children a combination of multi-channel EEG and continuous 1 to 2 channel monitoring has advantages over either method used alone. In individual patients on-line monitoring can be easily incorporated in a protocol of controlled cortical suppression and drug titration for seizure control.

Topics: Child, Preschool; Electroencephalography; Female; Humans; Infant; Male; Monitoring, Physiologic; Seizures; Status Epilepticus; Thiopental

Local anaesthetic systemic toxicity is a rare but often dramatic complication of regional anaesthesia. Convulsions often follow warning signs, easily recognized when looked for; but they may occur from the first. They are rapidly followed by hypoxia and hypercapnia which greatly enhance the risk of severe cardiac depression, mainly with bupivacaine or etidocaine. Thiopentone is able to stop convulsions quickly, but may further depress the cardiovascular system. Diazepam has been shown to be effective in the treatment of local anaesthetic-induced convulsions. It gives less myocardial depression, but is much slower in effect. Midazolam, a new short-acting benzodiazepine, should be the best choice. Should tracheal intubation become necessary, suxamethonium can be used. Indeed, the principal use of these drugs is to make ventilation easier, so as to restore rapidly correct oxygenation. Severe cardiac depression, often leading to cardiac arrest, may occur from the first or after the appearance of convulsions. It generally follows a regional block carried out with bupivacaine. A few antiarrhythmic drugs have been used to treat ventricular arrhythmias, either in experimental studies (lidocaine, bretylium) or after clinical accidents (lidocaine). Their efficacy and innocuity have to be proved before they can be proposed to treat these accidents. Bradycardia only needs treatment with atropine when it causes severe haemodynamic disturbances. When cardiac arrest occurs, cardiopulmonary resuscitation must be carried out; its mainstays are: oxygen, sodium bicarbonate, adrenaline, calcium and perhaps glucagon. This must be continued for a long time, as late successes have been published.

Topics: Anesthetics, Local; Anti-Anxiety Agents; Arrhythmias, Cardiac; Benzodiazepines; Calcium Gluconate; Epinephrine; Glucagon; Heart Arrest; Heart Diseases; Humans; Seizures; Succinylcholine; Thiopental

Two cases are presented in which amidetrizoate (Urografin) was accidentally introduced into the intrathecal cavity. Intrathecal lavage and continuous administration of thiopentone were very successful in preventing further systemic deterioration.

Topics: Adult; Back Pain; Contrast Media; Epidural Space; Humans; Hypersensitivity, Immediate; Injections, Spinal; Male; Middle Aged; Radiography; Seizures; Thiopental

The anticonvulsive properties of pregnanolone (as an emulsion) were evaluated in mice and compared with similar properties of Althesin and thiopentone. Pregnanolone emulsion was found to antagonize convulsions induced by the GABA antagonists pentetrazole, bicuculline and picrotoxin and by the specific glycine receptor antagonist, strychnine. The drug was effective in all four convulsive tests at subanaesthetic doses with maximal activity appearing within less than 1 min. The anticonvulsive therapeutic indices of pregnanolone emulsion were superior when compared with the therapeutic indices of Althesin and thiopentone in all four tests. Pregnanolone emulsion might be a useful alternative drug in the management of convulsive states resistant to conventional therapy.

Topics: Alfaxalone Alfadolone Mixture; Animals; Anticonvulsants; Drug Evaluation, Preclinical; Emulsions; Male; Mice; Pregnanes; Pregnanolone; Seizures; Thiopental

The neurotoxic potential of intravenous administered benzylpenicillin (BPC) was studied in rabbits with intact blood-CNS barriers and rabbits with experimental E. coli meningitis. At onset of epileptogenic EEG activity or seizures, serum, CSF and brain tissue were collected for assay of BPC. Based on the fact that, in tissues, BPC seems to remain extracellularly, brain concentrations of BPC were expressed as brain tissue fluid (BTF) levels, calculated as 10x the concentration in whole brain tissue. Neurotoxicity could be precipitated in all rabbits. In normal rabbits BTF levels of BPC were considerably higher than those in CSF indicating a better penetration across the blood-brain barrier (BBB). BPC penetrated better to CSF and BTF in meningitic rabbits than in normal controls, suggesting some degree of damage of the BBB concomitant with meningeal inflammation. E. coli meningitis did not increase the neurotoxicity of BPC. In control rabbits the intracisternal injection of saline resulted in some degree of pleocytosis. Unmanipulated animals are therefore preferable as controls. Epileptogenic EEG-changes was the most precise of the two variables used for demonstration of neurotoxicity. EEG-changes were therefore used as neurotoxicity criterion in the following rabbit experiments. To evaluate the effect of uraemia alone and uraemia plus meningitis on the neurotoxity of BPC in rabbits, cephaloridine was used to induce uraemia. Meningitis was induced by intracisternal inoculation of a cephalosporin resistant strain of E. cloacae. Untreated rabbits were used as controls. Uraemia resulted in increased BTF penetration of BPC, possibly explained by permeability changes in the BBB and/or decreased binding of BPC to albumin. Uraemia did not result in increased penetration of BPC into the CSF of non-meningitic rabbits. Uraemic non-meningitic rabbits had the highest BTF levels of BPC at the criterion, indicating that cephaloridine-induced renal failure increased the epileptogenic threshold in these rabbits. The combination of uraemia and meningitis increased the neurotoxicity of BPC since the criterion was reached at considerably lower BTF levels of BPC. Meningitis, either alone or together with uraemia, did not increase the neurotoxicity in comparison to control rabbits. Higher BTF levels of BPC were found in meningitic rabbits than in controls with intact blood-CNS barriers at onset of EEG-changes. In all groups of rabbits there was a pronounced variability of BPC l

Topics: Acute Kidney Injury; Animals; Anti-Bacterial Agents; Blood-Brain Barrier; Brain; Carbapenems; Cilastatin; Drug Interactions; Electroencephalography; Enterobacteriaceae Infections; Female; Hippocampus; Imipenem; Male; Meningitis; Penicillin G; Rabbits; Rats; Rats, Inbred Strains; Seizures; Thiopental; Tissue Distribution; Uremia

The central nervous toxicity of local anaesthetics has long been thought to be limited to the generalized tonicoclonic convulsions which follow the appearance of such symptoms as sleepiness, tingling of the lips, slurred speech, numbness, etc. Also the central nervous system was considered to be more sensitive than the cardiovascular system. However, recent experimental studies would seem to indicate that at least the more potent local anaesthetics, such as bupivacaine, have deleterious effects on parts of the brain other than the cerebral hemispheres. This may point to an involvement of the central nervous system (the amygdala and vasopressor areas of the floor of the fourth ventricle) in the pathogenesis of the hypotension and arrhythmias which may be seen at the same time as central nervous system signs of systemic toxicity. This is important for the treatment of such accidents: should a convulsion occur alone, sodium thiopentone, a muscle relaxant and a benzodiazepine, with oxygen and assisted breathing, will be the treatment; should an arrhythmia occur, its treatment should also include an anticonvulsant drug, such as a benzodiazepine. The prophylactic use of benzodiazepines should also be encouraged.

Topics: Anesthetics, Local; Arrhythmias, Cardiac; Benzodiazepines; Brain Stem; Central Nervous System; Humans; Seizures; Thiopental

Thiopentone (thp) infusion was administered to 33 patients with cerebral dysfunction or convulsions out of 2986 patients operated on via extracorporeal circulation because of valvular disease, coronary insufficiency, septum defects and intrathoracic aortic aneurysms. If phenytoin, diazepam and clonazepam proved ineffective, thp 10-15 mg/kg was injected slowly, followed by infusion of 2-4 mg/kg/h for 0.5-5 days. 9 patients died. 18 survivors had a good recovery, 6 were moderately disabled. In the survivors embolisation of particulate matter prevailed as a cause of cerebral dysfunction while in nonsurvivors prolonged pre- and postoperative hypotension was the main cause, with one patient suffering a hemispheric infarction. The amelioration of convulsions and psychosyndromes in the survivors is compatible with the known anticonvulsive effect of thp and its alleged influence on cerebral focal ischaemia. However, in protracted cerebral hypoperfusion as a cause of cerebral dysfunction no protection can be expected from thp. The known effects of barbiturates do not justify the use of these substances for the purpose of cerebral protection.

Topics: Adolescent; Adult; Aged; Aortic Aneurysm; Brain Ischemia; Dose-Response Relationship, Drug; Extracorporeal Circulation; Female; Follow-Up Studies; Heart Diseases; Humans; Infusions, Intravenous; Male; Middle Aged; Postoperative Complications; Seizures; Thiopental

The influence of arterial O2 and CO2 tensions on electroconvulsive seizure duration was investigated in five mongrel dogs under consistent anaesthetic conditions. Seizure durations were measured in a randomized protocol of nine possible combinations of arterial gas tension spanning increased, normal or decreased levels of PaO2 and PaCO2. Seizure duration was directly related to PaO2 (p less than 0.00001) and inversely related to PaCO2 (p less than 0.0001). A significant synergism was evident at the extremes of PaO2 and PaCO2, with seizure duration being greater than predicted for hyperoxia-hypocapnia and hypoxia-hypercapnia and shorter than predicted for hypoxia-hypocapnia and hyperoxia-hypercapnia. We conclude that arterial gas tensions strongly influence ECT-induced seizure duration and through this may influence the therapeutic efficacy of electroconvulsive therapy.

Topics: Animals; Blood Gas Monitoring, Transcutaneous; Dogs; Electroconvulsive Therapy; Hypercapnia; Hypoxia; Male; Respiration, Artificial; Seizures; Thiopental; Time Factors

Topics: Adult; Anesthesia, General; Female; Humans; Hypnotics and Sedatives; Infusions, Intravenous; Male; Middle Aged; Seizures; Thiopental

Topics: Blood Pressure; Cerebrovascular Circulation; Cesarean Section; Dexamethasone; Dihydralazine; Dobutamine; Dopamine; Eclampsia; Electrolytes; Female; Heart; Humans; Intracranial Pressure; Nitroglycerin; Phenytoin; Pregnancy; Seizures; Serum Albumin; Thiopental

Topics: Anti-Inflammatory Agents, Non-Steroidal; Child; Child, Preschool; Coma; Dexamethasone; Encephalitis; Female; Humans; Infant; Male; Phenobarbital; Positive-Pressure Respiration; Seizures; Thiopental

Topics: Adult; Coma; Female; Humans; Infusions, Parenteral; Seizures; Thiopental

Fibrinopeptides A and B (FAB) given intraperitoneally increased general activity of rats without affecting motor coordination. FAB depressed thiopental-induced sleeping time, prolonged the latency of pentetrazol convulsions, shortened the tonic phase of electrogenic convulsions. The peptides depressed the dopamine level in investigated brain areas of rats and increased the level of homovanillic acid. FAB accelerated the disappearance of dopamine after alpha-methyl-p-tyrosine injection. The data indicate tha FAB stimulate the central nervous system and this seems to be related to their interaction with the central dopaminergic system.

Topics: Animals; Brain Chemistry; Central Nervous System; Electroshock; Fibrinogen; Fibrinopeptide A; Fibrinopeptide B; Male; Motor Activity; Postural Balance; Rats; Rats, Inbred Strains; Seizures; Thiopental

The possibility of using pharmacological tests to determine side effects produced by adsorbed DPT vaccine and chemical typhoid vaccine was studied. Both vaccines were shown to be capable of prolonging sleep induced by hexenal or thiopental in experimental animals. The following difference in the action of these two preparations was revealed on the model of "chemical convulsions" induced by the injection of thiosemicarbazide: while immunization with DPT vaccine acitivated thiosemicarbazide-induced convulsive syndrome in mice, no such stimulating effect was observed after the injection of typhoid, vaccine. The study of pharmacological effects allowed to evaluate some aspects of the side effects producted by prophylactic preparations.

Topics: Animals; Bacterial Vaccines; Diphtheria Toxoid; Hexobarbital; Humans; Mice; Pertussis Vaccine; Seizures; Sleep Wake Disorders; Tetanus Toxoid; Thiopental; Thiosemicarbazones; Time Factors; Typhoid-Paratyphoid Vaccines

Two patients with previous cerebral damage and seizures and three patients with acute inflammatory cerebral lesions developed status epilepticus. They were unresponsive to standard anticonvulsants, but anesthetic barbiturates (thiopental and pentobarbital) stopped the seizures promptly.

Topics: Adult; Anticonvulsants; Brain; Female; gamma-Aminobutyric Acid; Glutamates; Humans; Injections, Intravenous; Male; Middle Aged; Oxygen Consumption; Pentobarbital; Seizures; Status Epilepticus; Thiopental

Topics: Anesthesia, General; Anesthesia, Obstetrical; Female; Humans; Pregnancy; Puerperal Disorders; Seizures; Thiopental

The results of studies with the (14C)deoxyglucose technique unequivocally establish that local energy metabolism in cerebral tissues is, as in other tissues, closely coupled to local functional activity. Stimulation of local functional activity increases the local rate of glucose utilization; reduced functional activity depresses it. Local cerebral blood flow is normally distributed among the cerebral structures in almost exact proportion to their rates of glucose utilization and changes together with local glucose consumption in response to altered local functional activity. These results demonstrate that the level of functional activity in the structural and functional components of the central nervous syetem regulates the local rate of energy metabolism, and local blood flow is adjusted to the local metabolic demand.

Topics: Animals; Brain; Cerebrovascular Circulation; Deoxy Sugars; Deoxyglucose; Electric Stimulation; Energy Metabolism; Macaca mulatta; Mathematics; Models, Biological; Rats; Seizures; Sensory Deprivation; Thiopental; Vision, Ocular

Six barbiturates with diverse time-action characteristics--thiopental, pentobarbital, butabarbital, phenobarbital, diphenylbarbiturate, and barbital--were evaluated for "anticonvulsant" and "neurotoxic" effects. For the former, the MES test, clonic seizures induced by pentylenetetrazol, 90 mg/kg, s.c., and maximal seizures produced by pentylenetetrazol, 200 mg/kg, s.c., were employed. For the latter, we used a rotorod technique. Time to peak activity in the MES test was employed as the time for other tests. Pentobarbital required at least neurotoxic doses to produce substantial "anticonvulsant" activity, its protective index ranging from 0.79 to 0.98 in the three tests. Among the drugs tested, phenobarbital and diphenylbarbiturate exhibited the most favorable protective indices, ranging from 2.71 to 3.41 for phenobarbital and from 3.85 to 5.0 for diphenylbarbiturate. Barbital, another drug with a prolonged duration of action, exhibited a range from 0.84 to 2.81. Although a prolonged duration of action is an important characteristic for antiepileptic activity, this property does not confer per se a favorable protective index.

Topics: Animals; Barbital; Barbiturates; Dose-Response Relationship, Drug; Male; Mice; Neuromuscular Diseases; Pentobarbital; Pentylenetetrazole; Phenobarbital; Seizures; Thiopental

Thiopental was administered for seizure control in 2 patients with uncontrollable seizures. Serum samples were collected from each patient and assayed for thiopental, and the resulting serum concentration--time data were analyzed pharmacokinetically. The biologic half-life in both patients was significantly longer than previously reported values. Based on the limited number of patients studied, it would appear that half-life and volume of distribution increase with the degree of obesity, while clearance remains unchanged. These pharmacokinetic characteristics would be worthy of consideration in cases where there may be prolonged use of thiopental, eg., for the control of uncontrollable seizures.

Topics: Adolescent; Adult; Epilepsy, Post-Traumatic; Female; Half-Life; Humans; Kinetics; Obesity; Seizures; Thiopental

Topics: Acoustic Stimulation; Anesthesia, General; Animals; Central Nervous System; Defecation; Exploratory Behavior; Rats; Seizures; Thiopental

Topics: Adolescent; Brain; Child Behavior; Clonazepam; Diagnosis, Differential; Electroencephalography; Epilepsy; Humans; Male; Psychotic Disorders; Seizures; Stress, Psychological; Thiopental; Videotape Recording

Topics: Adrenergic beta-Antagonists; Anesthesia; Animals; Anticonvulsants; Blood Pressure; Chickens; Heart Rate; Male; Propranolol; Rabbits; Seizures; Strychnine; Thiopental

Conray (meglumine iothalamate), the contrast media frequently used in shuntograms for diagnosing malfunctioning ventriculo-peritoneal shunts, will occasionally cause severe muscular spasms and seizures. In this article, the authors describe anesthetic and critical care management of a case with this complication.

Topics: Anesthesia, Inhalation; Anesthesia, Intravenous; Cerebrospinal Fluid Shunts; Child; Diazepam; Female; Humans; Hyperventilation; Iothalamate Meglumine; Muscle Spasticity; Pancuronium; Positive-Pressure Respiration; Seizures; Thiopental

The effect on arterial pressure, EEG, preganglionic sympathetic nervous activity and pulse rate of repeated intravenous administrations of lidocaine (3 mg/kg) was investigated in cats anaesthetized with nitrous oxide. A continuous high voltage, burst-suppression EEG indicating constant seizure activity was found, whereas arterial pressure and sympathetic nervous activity did not change significantly. Although the onset of EEG seizure activity did not change the mean sympathetic activity level, the pattern of firing changed dramatically as every EEG seizure triggered a burst of sympathetic impulses. Barostatic reflexes were active after lidocaine administration unless seizure activity occurred. Thiopental 5 mg/kg given intravenously to cats during continuous lidocaine-induced EEG seizures always abolished the seizure activity without excessive depression of arterial pressure.

Topics: Animals; Blood Pressure; Cats; Electroencephalography; Ganglia, Autonomic; Injections, Intravenous; Lidocaine; Pressoreceptors; Pulse; Seizures; Sympathetic Nervous System; Thiopental

This study assesses the effects of agents commonly used in anaesthesia on enflurane-induced seizure threshold and on established seizure activity, during steady state enflurane anaesthesia. EEG seizure activity was monitored in cats from chronic cortical and subcortical recording sites. Diazepam, thiopentone, methohexitone and ketamine all enhanced established EEG seizure challenge. This latter effect was most evident under conditions of lowered PaCO2. The effects of these intravenous agents on established enflurane seizure patterns exceeded in duration the expected EEG effect of the agent when used alone. The limited number of experiments, however, precluded statistical verification of our findings. The similarities between centrencephalic minor motor seizures and enflurane seizure pattern in terms of EEG and convulsive expression, including drug response, are noted.

Topics: Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthetics; Animals; Brain; Cats; Diazepam; Drug Synergism; Electrocardiography; Electroencephalography; Enflurane; Female; Ketamine; Methohexital; Methyl Ethers; Seizures; Thiopental

The effect of thiopentone 0.5 and 1.0 mg/kg on the enflurane-induced cortical spike discharge has been examined. Seven cats were anaesthetized with enflurane in oxygen and ventilation was controlled to maintain eucapnia during e.e.g. recording. End-tidal enflurane concentrations of between 1.2 and 2.2% provoked dose-dependent spontaneous spike discharges reproducibly. It was found that, during light enflurane anaesthesia, intravenous thiopentone could exacerbate e.e.g. signs of seizure activity. However, at a greater depth of anaesthesia spike activity was suppressed. The e.e.g. changes following thiopentone resembled the effects of still greater concentrations of enflurane.

Topics: Animals; Cats; Dose-Response Relationship, Drug; Enflurane; Female; Male; Methyl Ethers; Seizures; Thiopental

The influence of PGE1 and its precursor dihomo-gamma-linolenic acid on the central action of acetylcholine was studied. PGE, and dikomo-gamma-linolenic acid increased the depressive action of acetylcholine as evaluated with Lat's and thiopental sleeping time tests. PGE1 and its precursor diminished or eliminated the influence of acetylcholine on pentetrazol convulsions. Endogenous acetylcholine in excess inhibited hyperthermic effect of PGE1. The results show that PGE1 and its precursor may change the action of acetylcholine in the central nervous system.

Topics: Acetylcholine; Animals; Behavior, Animal; Body Temperature; Brain; Injections, Intraventricular; Linolenic Acids; Male; Movement; Parasympathetic Nervous System; Physostigmine; Prostaglandins E; Rats; Seizures; Sleep; Tetrazoles; Thiopental

Two cases are described and discussed in which penicillin powder applied to the theca at the end of laminectomy caused delayed convulsions.

Topics: Adult; Cyanosis; Diazepam; Female; Humans; Intermittent Positive-Pressure Breathing; Middle Aged; Oxygen; Penicillins; Postoperative Complications; Seizures; Spinal Cord; Surgical Wound Infection; Thiopental

A case is reported in which a major generalised convulsive seizure followed the administration of Althesin. The patient had no clinically demonstrable predisposition to epilepsy. The fits were rapidly controlled by the intravenous injection of thiopentone.

Topics: Adult; Anesthetics; Cyanosis; Drug Combinations; Female; Humans; Hydroxysteroids; Oxygen; Pregnanediones; Seizures; Thiopental

In view of the observation of tonic-clonic convulsions after the use of Propanidid in certan patients, a study was undertaken of the effects of this drug (7 mg/kg) on the EEG of 2 volunteers with a known history of epilepsy. Both subjects developed tonic-clonic convulsions and showed typical alterations of the EEG pattern even before the onset of hyperventilation. These EEG alterations were producible also during complete relaxation. The convulsions were easily stopped by the administration of short-acting barbiturates. Similar observations reported in the literature are briefly discussed. The conclusion is drawn that Propanidid should not be given to patients with a known history of epilepsy or any other convulsive disease.

Topics: Electroencephalography; Epilepsy; Humans; Male; Propanidid; Seizures; Thiopental

Topics: Animals; Autoradiography; Brain; Carbon Radioisotopes; Cats; Cerebral Cortex; Cerebrovascular Circulation; Dementia; Deoxyglucose; Glucose; Haplorhini; Humans; Lactates; Motor Cortex; Oxygen Consumption; Photic Stimulation; Pyruvates; Rats; Seizures; Temperature; Thiopental; Visual Cortex

Topics: Adult; Blood Pressure; Central Nervous System; Cyanosis; Gallamine Triethiodide; Heart Rate; Herniorrhaphy; Humans; Injections, Spinal; Male; Oxygen; Pulse; Seizures; Sweating; Thiopental

Topics: Aggression; Analysis of Variance; Anesthesia; Animals; Apomorphine; Avoidance Learning; Behavior, Animal; Catalepsy; Chlorpromazine; Drug Synergism; Electroshock; Emotions; Escape Reaction; Ethanol; Exploratory Behavior; Humans; Lithium; Locomotion; Male; Mescaline; Methamphetamine; Mice; Rats; Seizures; Sleep; Thiopental; Vocalization, Animal

Topics: Amnesia; Analgesics; Animals; Anticonvulsants; Anxiety; Appetite; Ataxia; Behavior, Animal; Benzodiazepinones; Blood Pressure; Chlorobenzenes; Dose-Response Relationship, Drug; Drug Interactions; Haplorhini; Heart Rate; Humans; Mice; Morphine; Muscle Relaxants, Central; Muscles; Rats; Seizures; Sleep; Structure-Activity Relationship; Thiopental; Tranquilizing Agents

Topics: Adolescent; Adult; Anesthesia, Inhalation; Anesthesia, Intravenous; Electroencephalography; Female; Hallucinations; Humans; Ketamine; Limbic System; Male; Nitrous Oxide; Preanesthetic Medication; Seizures; Thalamus; Thiopental; Time Factors

Topics: Anesthesia, General; Gallamine Triethiodide; Humans; Male; Middle Aged; Posture; Respiration, Artificial; Seizures; Thiopental

Topics: Adolescent; Adult; Anesthesia, Dental; Brain Damage, Chronic; Carbon Dioxide; Child; Child, Preschool; Electroencephalography; Epilepsy; Female; Halothane; Humans; Injections, Intramuscular; Injections, Intravenous; Ketamine; Male; Methohexital; Movement Disorders; Oxygen; Partial Pressure; Seizures; Thiopental

Topics: Acidosis; Acute Kidney Injury; Anemia; Anesthesia; Anesthesia, Epidural; Anesthesia, Spinal; Antihypertensive Agents; Arrhythmias, Cardiac; Heart Failure; Hepatitis; Humans; Hyperkalemia; Hypertension; Hypocalcemia; Hyponatremia; Kidney Failure, Chronic; Nausea; Preanesthetic Medication; Seizures; Thiopental; Uremia; Vomiting

Topics: Anesthesia; Animals; Brain; Cell-Free System; Chlorpromazine; gamma-Aminobutyric Acid; Hexobarbital; In Vitro Techniques; Methionine; Microsomes; Nerve Tissue Proteins; Pentylenetetrazole; Rabbits; Seizures; Semicarbazides; Sulfur Radioisotopes; Thiopental

Topics: Adolescent; Adult; Cognition Disorders; Electroconvulsive Therapy; Female; Humans; Injections, Intravenous; Male; Methaqualone; Middle Aged; Respiration; Seizures; Succinylcholine; Thiopental

Topics: Aminobutyrates; Analgesics; Animals; Barbiturates; Cats; Cerebral Cortex; Drug Synergism; Hexobarbital; Hypoxia; Lethal Dose 50; Mice; Morphine; Piperidines; Rabbits; Rats; Seizures; Thiopental; Thiosemicarbazones; Visual Cortex

Topics: Androstanes; Anesthesia, Inhalation; Aortic Aneurysm; Atropine; Autopsy; Blood Pressure; Calcium; Carbon Dioxide; Cerebrospinal Fluid Proteins; Gluconates; Glucose; Hematocrit; Humans; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Nitrous Oxide; Oxygen; Oxygen Consumption; Phenytoin; Piperidines; Postoperative Complications; Potassium; Respiration, Artificial; Seizures; Sodium; Thiopental; Urea

Topics: Anticonvulsants; Central Nervous System Stimulants; Diazepam; Heart Rate; Humans; Methods; Seizures; Thiopental

Topics: Animals; Barbiturates; Cobalt; Electrodes; Electroencephalography; Gelatin; Hippocampus; Male; Motor Cortex; Rats; Seizures; Sleep; Thalamus; Thiopental

Topics: Adolescent; Apnea; Female; Humans; Intubation, Intratracheal; Isoniazid; Middle Aged; Peritoneal Dialysis; Phenytoin; Poisoning; Renal Dialysis; Respiration, Artificial; Seizures; Shock, Septic; Thiopental

Topics: Adaptation, Biological; Analgesics; Anesthesia; Animals; Anticonvulsants; Apomorphine; Avoidance Learning; Azepines; Behavior, Animal; Central Nervous System; Chlordiazepoxide; Chlorpromazine; Cricetinae; Diazepam; Dogs; Drug Synergism; Drug Tolerance; Electric Stimulation; Female; Guinea Pigs; Haplorhini; Male; Mice; Morphine; Oxazoles; Rats; Seizures; Thiopental; Tranquilizing Agents; Tremorine

Topics: Adult; Aminobenzoates; Atropine; Bis-Trimethylammonium Compounds; Blood Pressure; Electrocardiography; Heart Conduction System; Humans; Hypertension; Male; Medication Errors; Meperidine; Preanesthetic Medication; Procaine; Pupil; Reflex, Pupillary; Seizures; Succinylcholine; Tachycardia; Thiopental

Topics: Ampicillin; Animals; Chlordiazepoxide; Diazepam; Electroencephalography; Oxacillin; Penicillin G; Rabbits; Seizures; Thiopental

Topics: Animals; Cerebral Cortex; Electroencephalography; Hyperbaric Oxygenation; Oxygen; Seizures; Thiopental

Topics: Action Potentials; Animals; Anticonvulsants; Cats; Cerebral Cortex; Denervation; Depression, Chemical; Electric Stimulation; Models, Biological; Phenobarbital; Phenytoin; Procaine; Seizures; Thiopental

Topics: Amobarbital; Anesthesia; Diazepam; Electroconvulsive Therapy; Epilepsy; Humans; Methohexital; Reaction Time; Seizures; Statistics as Topic; Thiopental

Topics: Curare; Epilepsy; Humans; Intubation, Intratracheal; Oxygen Inhalation Therapy; Seizures; Thiopental

Topics: Adult; Anemia, Hemolytic; Australia; Blood Chemical Analysis; Blood Platelet Disorders; Chlorpromazine; Diuresis; Eclampsia; Female; Fetal Death; Fetal Heart; Heart Rate; Hemoglobinuria; Hemolysis; Humans; Mannitol; Pregnancy; Pregnancy Complications, Hematologic; Promethazine; Seizures; Thiopental; Urinary Catheterization

Topics: Adult; Anesthesia, Endotracheal; Atropine; Coma; Female; Halothane; Humans; Kidney Transplantation; Male; Nephrectomy; Nitrous Oxide; Postoperative Complications; Respiration, Artificial; Seizures; Succinylcholine; Thiopental; Toxiferine; Transplantation, Homologous

Topics: Animals; Anticonvulsants; Blood Pressure; Cocaine; Depression, Chemical; Heart; Higher Nervous Activity; Mescaline; Mice; Muscle Contraction; Pentylenetetrazole; Quinazolines; Seizures; Strychnine; Thiopental

Topics: Animals; Central Nervous System; Chemistry, Organic; Diuresis; Heart Rate; Intestines; Male; Muscle, Smooth; Organic Chemistry Phenomena; Pentobarbital; Rabbits; Rats; Respiration; Seizures; Sleep; Theophylline; Thiopental; Vasomotor System

Topics: Anesthesia; Animals; Arousal; Behavior, Animal; Brain Stem; Cats; Electromyography; Electrophysiology; Movement; Posture; Pyramidal Tracts; Seizures; Sensory Receptor Cells; Sleep; Temporal Lobe; Thiopental

Topics: Amobarbital; Anticonvulsants; Ethanol; Humans; Paraldehyde; Pentobarbital; Phenytoin; Seizures; Succinylcholine; Thiopental

Topics: Dogs; Electrocardiography; Electroencephalography; Paralysis; Pharmacology; Procaine; Research; Respiration; Seizures; Succinylcholine; Thiopental; Toxicology

Topics: Humans; Lidocaine; Positive-Pressure Respiration; Seizures; Succinylcholine; Thiopental; Toxicology

Topics: Blood Circulation; Emergencies; Heart; Hyperbaric Oxygenation; Hypoxia, Brain; Oximetry; Oxygen; Physiology; Respiration; Seizures; Shock; Thiopental; Toxicology

Topics: Acetylcholine; Anesthesia; Atropine; Cholinesterase Inhibitors; Isoflurophate; Mice; Neostigmine; Pentylenetetrazole; Pharmacology; Phenobarbital; Physostigmine; Research; Seizures; Strychnine; Thiopental; Toxicology

Topics: Animals; Body Temperature Regulation; Chlordiazepoxide; Chlorpromazine; Electroshock; Ether; Guinea Pigs; Hexobarbital; Meprobamate; Morphine; Nalorphine; Nikethamide; Pharmacology; Phenobarbital; Research; Respiration; Seizures; Sleep; Thiopental

The occurrence of audiogenic seizures in mice has been used as the basis of a method for measuring the antagonism between sodium thiopentone and bemegride or leptazol. Thiopentone in doses of 8 and 16 mg./kg. protected all the mice against the occurrence of audiogenic seizures. Bemegride and leptazol were administered in doses having molecular concentrations which bore a simple relationship to the doses of thiopentone. Bemegride was four times as powerful as leptazol in antagonizing the protective effect of thiopentone, and comparison of their regression lines showed that both analeptics acted in the same way. The antagonistic effect of bemegride occurred with doses less than its normal convulsant dose, but the doses of leptazol needed to antagonize thiopentone were within the convulsant range, and it increased the severity of any audiogenic seizures.

Topics: Animals; Bemegride; Central Nervous System Stimulants; Convulsants; Drug Antagonism; Epilepsy, Reflex; Mice; Noise; Seizures; Thiopental

Topics: Bemegride; Central Nervous System Stimulants; Ether; Ethers; Seizures; Thiopental

Topics: Administration, Intravenous; Anesthesia; Anesthesia, Intravenous; Anesthesiology; Humans; Seizures; Thiopental

Topics: Electroconvulsive Therapy; Humans; Mental Disorders; Seizures; Succinylcholine; Thiopental

Topics: Anesthesia; Anesthesiology; Anesthetics; Animals; Iodine; Iodine Radioisotopes; Phosphorus; Rabbits; Radioisotopes; Seizures; Thiopental

Topics: Barbiturates; Eclampsia; Female; Humans; Pregnancy; Seizures; Sodium; Thiopental

Topics: Barbiturates; Eclampsia; Female; Humans; Pregnancy; Seizures; Sodium; Thiopental

Topics: Barbiturates; Eclampsia; Female; Humans; Pregnancy; Seizures; Thiopental

Topics: Barbital; Eclampsia; Female; Glucose; Pregnancy; Seizures; Sodium; Sodium Chloride; Sodium Chloride, Dietary; Thiopental

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

Topics: Eclampsia; Female; Pregnancy; Seizures; Thiopental

Topics: Seizures; Thiopental

Topics: Curare; Electric Stimulation Therapy; Humans; Seizures; Thiopental; Tubocurarine

Topics: Curare; Electricity; Seizures; Thiopental

Topics: Seizures; Thiopental

Topics: Anesthesia; Anesthesiology; Barbital; Curare; Magnesium; Magnesium Sulfate; Pentylenetetrazole; Seizures; Sodium; Thiopental

Topics: Barbital; Barbiturates; Convulsive Therapy; Fear; Seizures; Sodium; Therapeutics; Thiopental

Topics: Anesthesia; Anesthesiology; Barbital; Ether; Ethers; Iatrogenic Disease; Seizures; Sodium; Thiopental