thiopental and Wounds-and-Injuries

Transcranial Doppler and, if possible, measurement of intracranial pressure (ICP) allow preoperative diagnosis of acute intracranial hypertension (ICH) after brain trauma. The main goal of the anaesthesiologist is to prevent the occurrence of secondary brain injuries and to avoid cerebral ischaemia. Treatment of high ICP is mainly achieved with osmotherapy. High-dose mannitol administration (1.4 to 2 g/kg given in bolus doses) may be considered a better option than conventional doses, especially before emergency evacuation of a cerebral mass lesion. Hypertonic saline seems as effective as mannitol without rebound effect and without diuresis increase. Haemostasis should be normalized before neurosurgery and invasive blood pressure monitoring is mandatory. For anaesthesia induction, thiopental or etomidate may be used. In case of ICH, halogenated and nitrous oxide should be avoided. Until the dura is open, mean arterial pressure should be maintained around 90 mmHg (or cerebral perfusion pressure around 70 mmHg). If a long-lasting (several hours) extracranial surgery is necessary, ICP should be monitored and treatment of ICH should have been instituted before.

Topics: Acute Disease; Anesthesia, General; Blood Pressure; Brain Injuries; Brain Ischemia; Case Management; Combined Modality Therapy; Comorbidity; Contraindications; Diuretics, Osmotic; Etomidate; Humans; Hyperventilation; Intracranial Hypertension; Jugular Veins; Mannitol; Monitoring, Intraoperative; Monitoring, Physiologic; Nitrous Oxide; Oxygen; Preoperative Care; Saline Solution, Hypertonic; Thiopental; Tomography, X-Ray Computed; Ultrasonography, Doppler, Transcranial; Wounds and Injuries

The physiology and pathology of different methods of capital punishment are described. Information about this physiology and pathology can be derived from observations on the condemned persons, postmortem examinations, physiological studies on animals undergoing similar procedures, and the literature on emergency medicine. It is difficult to know how much pain the person being executed feels or for how long, because many of the signs of pain are obscured by the procedure or by physical restraints, but one can identify those steps which are likely to be painful. The general view has been that most of the methods used are virtually painless, and lead to rapid dignified death. Evidence is presented which shows that, with the possible exception of intravenous injection, this view is almost certainly wrong.

Topics: Capital Punishment; Cause of Death; Female; Humans; Injections, Intravenous; Male; Pain; Pain Measurement; Pancuronium; Poisoning; Thiopental; Wounds and Injuries

Serum osteocalcin is a marker of bone formation. The concentration of osteocalcin is decreased with tissue injury. As glucocorticoids are known both to be increased in this situation and to diminish serum osteocalcin, we have hypothesized that they could be involved in this decrease.. We compared osteocalcin levels in two groups of patients undergoing abdominal surgery, one receiving thiopental, and the other etomidate, a glucocorticoid synthesis blocker. For comparative reasons, another protein decreased by glucocorticoids (osteoprotegerin) was measured in patients anaesthetized with thiopental.. Serum osteocalcin, cortisol and albumin were determined before and over the 24 h following surgery. Serum concentration of osteoprotegerin (OPG) and receptor activator of the nuclear factor kappaB ligand (RANKL) were also determined before and 24 h after surgery in a third group of nine patients who received thiopental for anaesthetic induction.. Cortisol levels were increased in the thiopental group, whereas, as expected, were decreased in etomidate patients. However, serum osteocalcin concentration decreased in a similar way in both groups. Serum OPG and RANKL levels were within the normal range at baseline and did not significantly change after surgery.. The decrease in serum osteocalcin induced by tissue injury is independent of the increase in cortisol secretion triggered by the latter. In addition, another pharmacologically proven effect of cortisol on bone metabolism, OPG inhibition, could not be demonstrated in the first 24 h following surgery, in spite of the physiological increase in endogenous cortisol secretion taking place in this period.

Topics: Abdomen; Adult; Anesthetics, Intravenous; Carrier Proteins; Etomidate; Female; Glucocorticoids; Glycoproteins; Humans; Hydrocortisone; Male; Membrane Glycoproteins; Middle Aged; Osteoblasts; Osteocalcin; Osteoprotegerin; RANK Ligand; Receptor Activator of Nuclear Factor-kappa B; Receptors, Cytoplasmic and Nuclear; Receptors, Tumor Necrosis Factor; Serum Albumin; Thiopental; Wounds and Injuries

Topics: Adult; Aged; Black People; Blood Glucose; Carbon Dioxide; Humans; Middle Aged; Nigeria; Oxygen; Potassium; Succinylcholine; Thiopental; Wounds and Injuries

Most patients who require emergency airway control receive drugs to induce rapidly sufficient anesthesia for direct laryngoscopy and endotracheal intubation, but there are no protocols that outline the use of specific drugs in general use. Drugs should safely and rapidly produce (1) unconsciousness; (2) paralysis; and (3) blunt intracranial pressure (ICP) responses to airway procedures. Consequences to be considered include increased ICP, hemorrhagic shock, and a full stomach. To refine the use of drugs used for airway procedures in pediatric trauma patients, the authors reviewed all cases of emergency endotracheal intubation over a recent 12-month period (1) to see whether medications used met the goals of producing unconsciousness and paralysis and blunting ICP responses were met safely; and (2) to identify potential drug-related complications. From July 1, 1990, to June 30, 1991, 60 of 791 children (7.6%) required endotracheal intubation at the scene of injury, at the referring hospital, or in our emergency department (15; 25%). Ten patients died (16.7%). Three fourths were younger than 9 years of age. All except one suffered blunt injuries. Nearly all (95%) suffered head injuries, isolated in 39 of 57 (68.4%) and combined with injuries in other regions in 18 (31.6%). Fifteen patients were in apnea (25%); seven were both apneic and pulseless. Three fourths (45 of 60) had diminished levels of consciousness; one fourth (15 of 60) were awake. Immediate endotracheal intubation proceeded appropriately without drugs in all seven patients in cardiopulmonary arrest. Only eight of the remaining 53 patients (15.1%) received an optimal medication regimen. Many patients with head injury were inadequately protected against increases in ICP. Thiopental, an effective anesthetic agent that effectively lowers intracranial pressure, was not used in 25 of 35 stable patients with isolated head injury (71.4%). Intravenous lidocaine was not used in 38 of 50 head-injured patients in whom it would have been an appropriate adjunct to control increases in ICP (76%). Eight patients received paralyzing agents alone, without sedatives or narcotics. Medications were thought inadequate to relieve the pain and discomfort of laryngoscopy and endotracheal intubation in 32 of the 53 patients who should have received them (60.4%). No paralyzing agents were used in 36 of the 53 instances where it would have been appropriate (67.9%). In two of 11 instances (18.3%) where succinylcholine was

Topics: Adjuvants, Anesthesia; Adolescent; Anesthesia; Child; Child, Preschool; Clinical Protocols; Diazepam; Emergencies; Humans; Intubation, Intratracheal; Laryngoscopy; Lidocaine; Narcotics; Neuromuscular Nondepolarizing Agents; Succinylcholine; Thiopental; Wounds and Injuries

Topics: Adolescent; Adult; Anesthesia, Inhalation; Anesthesia, Intravenous; Cambodia; Diazepam; Halothane; Humans; Ketamine; Middle Aged; Thiopental; Warfare; Wounds and Injuries

Topics: Acute Disease; Adolescent; Adult; Aged; Brain Injuries; Female; Hemodynamics; Humans; Intracranial Pressure; Male; Middle Aged; Thiopental; Wounds and Injuries

Narcosis applied in emergency care is a possibility of offering pain relief to the emergency patient. Over and above this, however, it has become increasingly important to prevent pathophysiological changes resulting from the state of shock of the patient. Nevertheless, this measure should be restricted to skilled personnel only, provided of course that the emergency service in question is adequately equipped both technically and with suitable drugs. A decisive role is played by the drugs selected for this purpose. The article describes the pros and cons of various drugs administered via the intravenous route to induce narcosis. So far, there is no ideal drug for this purpose. It will always be necessary to arrive at a compromise and to adapt the drug to the individual situation and to the extent of basic damage suffered by the emergency patient.

Topics: Analgesia; Anesthesia, General; Carbon Dioxide; Diazepam; Emergencies; Etomidate; First Aid; Hemodynamics; Humans; Intracranial Pressure; Ketamine; Methohexital; Oxygen; Risk; Thiopental; Wounds and Injuries

Topics: Aged; Anesthesia, General; Catecholamines; Epinephrine; Female; Halothane; Humans; Male; Middle Aged; Neuroleptanalgesia; Norepinephrine; Shock, Surgical; Surgical Procedures, Operative; Thiopental; Wounds and Injuries

Topics: Anesthesia, Inhalation; Halothane; Heart Arrest; Humans; Hyperkalemia; Male; Military Medicine; Paraplegia; Succinylcholine; Thiopental; Wounds and Injuries

Topics: Anesthesia; Blood Circulation; Blood Pressure; Capillaries; Cyclopropanes; Ether; Halothane; Hematocrit; Humans; Methoxyflurane; Microcirculation; Morphine; Pathology; Pentobarbital; Shock, Hemorrhagic; Shock, Traumatic; Thiopental; Toxicology; Wounds and Injuries

Topics: Aldehyde-Lyases; Biliary Tract; Clinical Enzyme Tests; Intestines; Liver; Metabolism; Muscles; Pharmacology; Postoperative Complications; Rats; Research; Surgical Procedures, Operative; Tendon Injuries; Thiopental; Tubocurarine; Wounds and Injuries