thiopental and Uterine-Hemorrhage

Topics: Abortion, Therapeutic; Adult; Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthesia, Obstetrical; Ethers; Female; Gestational Age; Halothane; Humans; Hyperventilation; Meperidine; Nitrous Oxide; Pregnancy; Pulmonary Alveoli; Respiration; Thiopental; Uterine Hemorrhage

Electro-convulsive (ECT) therapy is frequently the treatment of choice in pregnant patients. It has been reported that administration of ECT in pregnancy is safe and effective. However, there are few controlled studies of the effects of ECT on pregnancy. The literature is not conclusive regarding ECT-related complications in pregnancy. We describe here the case of a primigravida with bipolar disorder who underwent nine sessions of ECT during pregnancy. The patient experienced vaginal bleeding after each session of ECT. Thiopental and succinylcholine were administered as an anesthetic (4 mg/kg thiopental) and muscle relaxant (1 mg/kg succinylcholine), respectively. ECT was discontinued and re-challenged after 20 days. The patient experienced bleeding after ECT again. Our case is somewhat unique because it demonstrates the potential maternal problem of vaginal bleeding as a result of ECT. In our case ECT led to vaginal bleeding and the bleeding stopped when ECT was ceased. Re-challenge was conducted. Although the safety of ECT administration in pregnancy has been discussed in many previous reports, its safety should be studied further.

Topics: Adult; Anesthetics, Intravenous; Bipolar Disorder; Electroconvulsive Therapy; Female; Gravidity; Humans; Pregnancy; Pregnancy Complications; Succinylcholine; Thiopental; Uterine Hemorrhage

A study was conducted to determine if uterine blood loss during therapeutic abortion could be kept to a minimum by utilizing relatively low concentrations of enflurane. The blood loss was compared to that observed when patients were anesthetized with a more routinely accepted nitrous oxide/narcotic technique. 34 healthy, unpremedicated, women undergoing elective suction abortion were studied. Patients ranged in age from 16-29 years and were at 8-13 weeks gestation. After informed consent was obtained, the patients were anesthetized with 1 of 2 anesthetic techniques. The 18 patients in Group 1 were given 50-100 mcg of fentanyl intravenously. Anesthesia was then induced with thiopental (4-5 mg/kg) and maintained with 70% nitrous oxide in oxygen. Additional thiopental was administered during the procedure in response to the patient moving, swallowing, breath holding, or exhibiting other signs of inadequate anesthesia. No additional fentanyl was required. The 16 patients in Group 2 had anesthesia induced with a small dose of thiopental (3-4 mg/kg) and maintained with 1% inspired enflurane and 66% nitrous oxide in oxygen. At no point was the concentration of inspired enflurane increased to more than 1%. Additional thiopental was administered in response to the same criteria as described for Group 1. There was no significant difference between the 2 groups in terms of the patient's gestational age or mean blood loss. Group 2 received approximately 1.7 mg/kg less thiopental than Group 1. No patient in Group 2 received fentanyl. The mean duration of anesthesia was 16.2 minutes for Group 1 and 17.4 minutes for Group 2. No patient in either group lost more than 180 ml of blood. There were no immediate postoperative complications, and all patients were discharged from the hospital approximately 2 hours after the procedure. Despite the fact that enflurane is known to relax uterine muscle, it has been shown that enflurane can be used safely for patients undergoing therapeutic abortion, in that it does not increase blood loss when compared to a nitrous oxide/narcotic technique. The use of enflurane in low concentrations as an anesthetic for outpatient abortion is advantageous because it obviates the need for narcotics or large doses of thiopental.

Topics: Abortion, Therapeutic; Adolescent; Adult; Enflurane; Female; Fentanyl; Humans; Nitrous Oxide; Pregnancy; Thiopental; Uterine Hemorrhage

During recent years, the use of steroid anesthesia has rapidly increased. In our hospital, a number of surgical procedures have been performed under Althesin anesthesia, and in some cases the peroperative bleeding seemed to be rather profuse. Blood loss was studied in 90 healthy women in the first trimester of pregnancy undergoing therapeutic abortion using different types of anesthesia. The patients were divided into three equal groups according to the duration of pregnancy. In each group, 10 patients underwent operation under local anesthesia, 10 under thiopental anesthesia and 10 under Althesin. In all three groups, blood loss was the smallest when local anesthesia was used (Fig 1). Amounting to only one third to one half of that occurring under thiopental anesthesia. Under thiopental anesthesia the blood loss gradually increased with increasing gestational age with moderate variations. Alternatively, in this investigation, Althesin anesthesia was characterized by pronounced blood loss, particularly in the ninth and tenth weeks of pregnancy, and in some cases by rather profuse bleeding. We find that Althesin anesthesia should be used for gynecological surgery only in departments which are equipped to control profuse bleeding and possible cardiovascular complications.. During recent years, the use of steroid anesthesia has rapidly increased. A number of surgical procedures have been performed under Althesin anesthesia, and in some cases the peroperative bleeding seemed to be rather profuse. Blood loss was studied in 90 healthy nulliparous women, ages 15-39 years, in the 1st trimester of pregnancy, undergoing therapeutic abortion with different types of anesthesia. The patients were divided into 3 equal groups of 10 persons according to duration of pregnancy. Group 1 patients underwent surgery under local anesthesia, group 2 under thiopental anesthesia, and group 3 under Althesin. Blood loss in all 3 groups was smallest when local anesthesia was used (only 1/3 - 1/2 of that occurring under thiopental anesthesia). With thiopental anesthesia, the blood loss gradually increased with increasing gestational age with only moderate variations. Alternatively, in this investigation, Althesin anesthesia was characterized by pronounced blood loss, particularly in group 2 (p 0.05) and particularly in weeks 9-10 of pregnancy. Althesin was also associated with a wide range in blood loss, especially in group 2 (40-300 ml). The occurrence of profuse hemorrhage, seen in those administered Althesin, may be hazardous to those with cardiovascular difficulty. Thus it should be used for gynecological surgery only in departments equipped to control profuse bleeding and possible cardiovascular complications.

Topics: Abortion, Therapeutic; Adolescent; Adult; Alfaxalone Alfadolone Mixture; Anesthesia, General; Anesthesia, Local; Anesthesia, Obstetrical; Female; Humans; Pregnancy; Pregnancy Trimester, First; Thiopental; Uterine Hemorrhage

Topics: Anesthesia, Obstetrical; Apgar Score; Blood Pressure; Delivery, Obstetric; Female; Halothane; Humans; Hydrocarbons, Halogenated; Infant, Newborn; Labor, Obstetric; Methyl Ethers; Obstetrical Forceps; Pregnancy; Succinylcholine; Thiopental; Uterine Hemorrhage; Uterus

Topics: Abortion, Induced; Adult; Anesthesia, Conduction; Anesthesia, General; Cervix Uteri; Diazepam; Female; Humans; Ketamine; Lidocaine; Methohexital; Nitrous Oxide; Oxygen; Pentazocine; Positive-Pressure Respiration; Pregnancy; Succinylcholine; Thiopental; Trichloroethylene; Uterine Hemorrhage

Topics: Abortion, Spontaneous; Adolescent; Adult; Atropine; Cervix Uteri; Curettage; Cyclopropanes; Dilatation; Ergonovine; Female; Humans; Meperidine; Middle Aged; Morphine; Nausea; Nitrous Oxide; Oxygen; Oxytocin; Postoperative Complications; Preanesthetic Medication; Pregnancy; Thiopental; Uterine Hemorrhage; Uterus; Vomiting