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PubMed1995

Comparison of the recovery characteristics of midazolam, alone or antagonised with flumazenil, and thiopental in ASA III-IV patients.

Sixty non-premedicated male patients, physically ASA III-IV, 50-80 years of age, undergoing translumbar aorthography, were randomly allocated into three groups. Group A received midazolam (0.13 mg.kg-1), group B received thiopental (4 mg.kg-1), and group C midazolam (0.13 mg.kg-1) combined with flumazenil (6 micrograms.kg-1) at the end of the operation. Three minutes before the anaesthesia began, fentanyl (1.5 micrograms.kg-1) was administered to all the patients. An evaluation was made of the time they took to open their eyes spontaneously, of time-space orientation, comprehension-collaboration, hypnosedation, psychomotor performance and memory. In groups "C" and "B" spontaneous opening of the eyes took place before that of group "A". The recovery of orientation, comprehension and hypnosedation was fastest with thiopental, next with midazolam combined with flumazenil, and later with midazolam. Psychomotor performance in Trieger test was impaired for a shorter period with thiopental than in the other two groups. Recovery in group "C" was incomplete within the time, with the result that resedation was detected in 20% of the subjects.

Aged↗
PubMed2006

The preventive effects of thiopental and propofol on testicular ischemia-reperfusion injury.

BACKGROUND: Testicular torsion is a urological emergency that requires immediate surgical intervention to prevent testicular damage. The aim of the study was to investigate the preventive effects of thiopental and propofol as anesthetics on testicular ischemia-reperfusion injury. METHODS: Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. During 5 h, anesthesia was induced and maintained with thiopental in groups 1 and 2 and with propofol in groups 3 and 4. Groups 2 and 4 received left testicular ischemia (torsion) during 1 h and reperfusion (detorsion) during 4 h. Groups 1 and 3 (control groups) had no testicular torsion and detorsion. At the end of 5 h, animals were killed and both ipsilateral and contralateral testes were removed for histopathologic examination and measurement of tissue MDA (malondialdehyde) and NO (nitric oxide) levels. RESULTS: In the contralateral testes of all the groups, MDA and NO measurements were not different from ipsilateral testes of the control groups. Between the groups 1 and 3, there were no differences in MDA and NO levels. Although torsion/detorsion of testes in group 4 caused significantly increased levels of tissue MDA and NO values compared with group 3, ischemia-reperfusion in group 2 caused a further increase in these levels compared with group 4. The ipsilateral testes in the control groups did not show any morphological changes. Testicular torsion/detorsion in rats with thiopental anesthesia (group 2) caused significantly greater histopathologic injury levels than rats with propofol anesthesia (group 4). CONCLUSION: Our results suggest that propofol as an anesthetic agent may prevent testicular damage by scavenging reactive oxygen and nitrogen species and inhibiting lipid peroxidation in an animal model of testicular torsion and detorsion.

Anesthetics, Intravenous↗
PubMed1990

Haloperidol as a pre-medicant for thiopental anaesthesia in the dog.

Haloperidol was administered intravenously at the dose rate of 0.87 mg/kg body weight five minutes prior to thiopental anaesthesia in 5 clinically healthy dogs, aged 10-12 months and weighing 11.5 +/- 0.96 kg. Animals required only 4.36 +/- 0.24 ml of the 5% thiopental sodium to achieve surgical anaesthesia which lasted for 37.5 +/- 4.3 minutes. There was adequate muscle relaxation and loss of pedal and palpebral reflexes during thiopental anaesthesia. Five minutes after administration of haloperidol, there was no appreciable change in the various cardiopulmonary dynamics with the exception of a hypocapnoea and a mild hypotension. During thiopentone anaesthesia, a mild hypotension and arterial hypoxemia was evident. This combination of anaesthesia was also employed in 14 clinical cases varying from fractures of long bones (4), mammary tumours (3), ear haematoma (4), venereal granuloma (2) and abdominal hernia (1). The combination proved extremely useful for orthopaedic surgery as the muscle relaxation was adequate and the reduction of the fractured ends was relatively easy.

Anesthesia↗
PubMed1979

Pharmacokinetic properties of thiopental in two patients treated for uncontrollable seizures.

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.

Adolescent↗
PubMed1994

Comparison of the effects of propofol and thiopental on the pattern of maximal electroshock seizures in the rat.

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.

Animals↗
PubMed1982

Solubilization of hexokinase activity by an effect of thiopental on the mitochondrial membrane.

In thiopental anesthesia of rats cerebral mitochondrial hexokinase activity was solubilized. This solubilization was also observed when the period necessary for the removal of the rat brain was shortened to 15 s by brain blowing. The influence of the drug on the binding of hexokinase activity to mitochondria of brain, liver and neuroblastoma cells was studied in vitro. Solubilization of hexokinase activity was achieved in all systems at therapeutically relevant thiopental concentrations. On the other hand, chlorpromazine as a highly lipophilic drug only solubilized hexokinase activity at concentrations being already lytic to the membrane. Thus, it is concluded that thiopental solubilize hexokinase activity by affecting the mitochondrial membrane, and that this effect is not only dependent on the lipophilic character of a drug.

Anesthesia↗
PubMed1989

Influence of anesthetics on cerebral blood flow velocity in infancy. Effects of halothane versus thiopental-fentanyl.

We studied the effects of 2 anesthetic protocols on blood flow velocity of the middle cerebral artery, measured with a pulsed Doppler sonograph in infants. A first group of 10 infants (mean age 64 days) was anesthetized with halothane and nitrous oxide. A second group of 10 infants (mean age 88 days) was anesthetized with thiopental-fentanyl i.v. and nitrous oxide. Heart rate, mean arterial blood pressure (MABP) and mean velocity (MV) decreased during both types of anesthesia. Decrease of MV was of the same magnitude in the 2 groups but MABP decreased more under halothane. After skin incision MABP and MV increased in both groups but MV followed MABP more closely under halothane than under thiopental. These results suggest cerebral blood flow (CBF) reduction after both inductions but by a different mechanism. In spite of cerebral arteriolar dilation with halothane, CBF decreases by means of severe reduction of MABP: CBF is pressure-passive and autoregulation seems to be impaired. In contrast, thiopental induces cerebral arteriolar constriction but CBF is less dependent of MABP changes.

Anesthetics↗
PubMed1990

Thiopental efficacy in phenobarbital-resistant neonatal seizures.

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.

Drug Evaluation↗
PubMedDate not supplied

Failure of thiopental to modify global anoxic injury.

To corroborate thiopental protection from cerebral anoxia after cardiopulmonary arrest, 23 sedated, curarized, adult dogs were asphyxiated by plugging the endotracheal tube. Cardiopulmonary resuscitation (CPR) was started 7 minutes after electrocortical silence. Twelve animals received no other treatment (controls), 10 regained consciousness and spontaneous respirations, but remained decerebrate, blind, unable to drink or feed. Two dogs returned to a normal neurologic state. Ten dogs were treated with thiopental after CPR, 7 received 15 mg/kg the first minute, followed by 23 mg/kg over 1 hour; 3 received 60 mg/kg in the first 3 minutes, followed by 30 mg/kg over 1 hour. Except for 1 dog in the low-dose group that recovered neurologically, thiopental-treated dogs showed no neurological or survival improvement over the controls.

Animals↗
PubMedDate not supplied

Correlation of oxygen uptake and cardiovascular dynamics during N2O-fentanyl and N2O-thiopental anesthesia in the dog.

The relationship between changes in wholebody O2 consumption (VO2) and cardiovascular dynamics during changing levels of N2O-fentanyl and N2O-thiopental anesthesia was determined in 24 dogs. Dose-dependent reductions in VO2, mean blood pressure, and cardiac output occurred with infusion of fentanyl and thiopental. Painful stimuli increased VO2 during light anesthesia but not during deeper levels of anesthesia. Deep levels of N2O-fentanyl and N2O-thiopental anesthesia may protect the patient with limited cardiac reserve by reducing VO2 and preventing increases in VO2 caused by painful stimuli.

Anesthesia, Inhalation↗
PubMed1990

Influence of thiopental, etomidate, and propofol on regional myocardial function in the normal and acute ischemic heart segment in dogs.

The effects of 30-min infusions of thiopental (20, 30, 40, 50, 60, and 70 mg.kg-1.h-1), etomidate (2.4, 3.6, 7.2, 9.6, 12, and 14.4 mg.kg-1.h-1), and propofol (6, 9, 12, 15, 18, and 21 mg.kg-1.h-1) on regional hemodynamic variables in the normal and acute ischemic heart segment were studied in dogs using ultrasonic segment length gauges. The three agents were associated with a dose-dependent decrease in end-diastolic length, indicating a decrease in left ventricular filling. This effect was most pronounced for propofol. At the doses tested, etomidate did not significantly alter regional myocardial function. Thiopental, however, was associated with a dose-dependent decrease in systolic shortening, which was significantly greater in the ischemic segment. These findings confirm the hemodynamic stability seen with etomidate and show that thiopental depresses myocardial function more in the acute ischemic heart than in the normal heart. The decrease in systolic shortening associated with propofol was similar in the normal and in the acute ischemic heart segment.

Animals↗
PubMed1993

Muscle pain after outpatient laparoscopy--influence of propofol versus thiopental and enflurane.

The incidence and pattern of postoperative muscle pains was studied in 155 healthy women undergoing outpatient laparoscopic surgery who were assigned randomly to one of five treatment groups. Group 1 (control) received thiopental and succinylcholine, 1 mg/kg, followed by enflurane and nitrous oxide. Group 2 received d-tubocurarine, 3 mg, followed by succinylcholine, 1.5 mg/kg, but was otherwise similar to Group 1. Groups 3 and 4 were similar to Group 1, but received propofol instead of thiopental, and Group 4 also received a variable-rate propofol infusion instead of enflurane. Finally, Group 5 was similar to Group 3, but received atracurium instead of succinylcholine. Muscle fasciculations were often observed in Groups 1, 3, and 4, but were attenuated in Group 2 and absent in Group 5. Overall, postoperative shoulder pain occurred in 81%, 72%, and 29% of patients on the first, second, and third postoperative days, respectively. The incidence of this symptom did not differ among the five groups. Neck pain occurred less frequently than shoulder pain in each group, and also occurred less often in Group 5 than in Group 1. Muscle stiffness occurred less often than muscle pain, and also occurred less frequently in Group 5 than in Group 1. In conclusion, succinylcholine contributes to neck pain and muscle stiffness after laparoscopic procedures. Compared to thiopental and enflurane, the use of propofol for induction and/or maintenance of anesthesia failed to alter the incidence of postlaparoscopic muscle pain or stiffness.

Adult↗
PubMed1993

Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol.

Excitatory movements have been observed during induction of anesthesia with etomidate, thiopental, methohexital, and propofol. We studied the frequency of these excitatory effects and correlated movements with electroencephalographic (EEG) findings in 67 unpremedicated patients (mean age 66.1 yr, range 45-82 yr). Excitatory effects, including myoclonus, tremor, and dystonic posturing, occurred in 86.6% of patients receiving etomidate; 69.2% of the patient responses were myoclonic. Multiple spikes appeared on the EEG in 22.2% of the etomidate patients. The frequency of excitatory effects was 16.6% after thiopental, 12.5% after methohexital, and 5.5% after propofol. None of the patients receiving thiopental, methohexital, or propofol developed myoclonic or seizure activity. In most patients, the excitatory movements were coincident with the early slow phase of the EEG which corresponds to the beginning of deep anesthesia. We conclude that perhaps caution should be exercised when administering etomidate to patients with a history of seizures as the myoclonic activity is associated with seizure activity. The incidence of excitatory movements after administration of propofol is very low.

Aged↗
PubMed1994

Propofol and thiopental anesthesia: a comparison of the incidence of dreams and perioperative mood alterations.

The purpose of this study was to investigate perioperative mood profiles and the incidence of dreams in patients receiving anesthesia with either propofol (n = 29) or thiopental (n = 27) in combination with nitrous oxide. The study was a prospective, randomized, and double-blind investigation of female patients undergoing outpatient dilation and curettage. Recall of dreams was assessed 1 h postoperatively and the following day by using a questionnaire designed for surgical patients. Mood profiles were quantified using the Multiple Affect Adjective Check List-Revised (MAACL-R), a self-administered questionnaire which was completed preoperatively and 1 h postoperatively. Our results indicate that postoperatively, all patients were significantly less anxious than preoperatively (P < 0.0001). In the postoperative period, patients receiving propofol exhibited sensation-seeking tendencies (i.e., active, adventurous, aggressive, daring, energetic, enthusiastic, merry) when compared to the thiopental patients (P < 0.02). The incidence of dreams was small and equal in both groups. We conclude that patients anesthetized with propofol and nitrous oxide, as compared to patients anesthetized with thiopental and nitrous oxide, were more likely to demonstrate adventurous tendencies in the postoperative period.

Adult↗
PubMed1980

Alterations in cerebral blood flow, oxygen metabolism, and electrical activity produced by high dose sodium thiopental.

High dose barbiturate therapy is being used with increasing frequency in the management of a widening spectrum of neurological disorders. Accurate regulation of the barbiturate dose is essential to maximize cerebral vasoconstriction and reduce brain metabolism while avoiding the cardiovascular depressant side effects of the drug. The purpose of this study was to determine whether the electroencephalogram (EEG) could be used to regulate administration of the agent. In nine mongrel dogs cerebral blood flow (CBF) was determined using the radioactive microsphere technique. After the determination of control CBF, a slow infusion of sodium thiopental was begun. CBF determinations were repeated when the periods of burst suppression in the EEG over several minutes averaged 30, 60, 120, and 240 seconds. CBF and oxygen metabolism showed a nearly identical pattern of a precipituos drop from control levels reaching a plateau at burst suppression between 30 and 60 seconds. Changes in cerebrovascular resistance were of a similar but opposite nature. Significant increases in heart rate occurred with burst suppression of 30 seconds, whereas the arterial pressure and cardiac index decreased with burst suppression between 30 and 60 seconds. In this study cerebral metabolic depression and vasoconstriction from sodium thiopental reached a plateau when sufficient barbiturate was administered to produce EEG burst suppression of between 30 and 60 seconds. At this level there was no important cardiovascular depression. Administration of additional barbiturates significantly decreased systemic arterial pressure and cardiac output, but produced no further decrement in the cerebral metabolic rate of oxygen or the CBF. There was no predictable relationship between cerebral metabolism or cardiovascular function and blood levels of sodium thiopental.

Animals↗
PubMed1989

Changes in plasma cortisol concentration by ages in dogs under ketamine and thiopental anesthesia.

In order to examine the change in adrenocortical responses with age in dogs, 36 healthy beagle dogs were divided by age into 6 groups and were treated with ketamine or thiopental. The plasma cortisol concentrations were determined before and after the treatment. The concentrations prior to the induction of anesthesia were 2.23 +/- 0.44 micrograms/dl (mean +/- SD) in pups (2 to 3 months old), 4.35 +/- 2.04 micrograms/dl in adults (2 years old), and 3.40 +/- 1.25 micrograms/dl in aged dogs (8 to 10 years old). This result indicated the following order of plasma cortisol levels in dogs: pups less than aged dogs less than adults. The plasma cortisol concentrations after ketamine administration tended to increase. This suggested that the adrenocortical function in the dog was stimulated by ketamine. In the ketamine treated dogs, significant differences were demonstrated among the age groups. Namely, a significantly lower response was noted in pups compared to adults or aged dogs (p less than 0.001). On the other hand, the plasma cortisol levels after the thiopental treatment showed a temporary slight increase in aged dogs but tended to decrease in pups and adults. Thiopental was found to have a suppressive effect on the adrenocortical function in dogs in contrast to ketamine.

Adrenal Cortex↗
PubMed2000

[Comparative non-randomized study with midazolam versus thiopental in children with refractory status epilepticus].

We evaluated the use of midazolam versus thiopental in 50 children with refractory status epilepticus (RSE), admitted in a pediatric intensive care unit. The study consisted of two groups of patients: Group A - Midazolam, a prospective study, and Group B - Thiopental, a historical group. These patients already had previous medication with benzodiazepin and diphenylhydantoin and other drugs. When there was no effective control of the seizures, the patients of Group A received midazolam of 200 microg/kg intravenous in bolus, being followed by continuous intravenous infusion at the rate 0. 25-15 microg/kg/min. Group B received thiopental 1 mg/kg intravenous in bolus followed by continuous intravenous infusion at the rate of 10-120 microg/kg/min. In relation to the time of seizure control and effectiveness, there was no statistical significance for the two groups. The Midazolam Group had significantly less complications during the treatment: less cyanosis (p=0.00006), and they did not need respiratory support (p<0.00001). When the therapy with midazolam was ceased, 12.5% of the patients from this group showed psychological disorders such as mental confusion, aggressive behavior, restlessness, hallucinations and agitation.

Adolescent↗
PubMed1988

Electrophysiological properties of respiratory laryngeal motoneurons and effects of thiopental.

Transmembrane potentials of the respiratory laryngeal motoneurons were recorded in decerebrate, vagotomized and paralyzed cats. Twenty inspiratory and thirteen postinspiratory neurons were identified. Periodic membrane potential (MP) fluctuations as well as patterns of postsynaptic potentials (PSPs) were characterized in each type of neurons by measuring the input resistance and injecting Cl- to reverse inhibitory PSPs. On the basis of PSP patterns, two subtypes of inspiratory neurons could be distinguished. Thiopental (2-3 mg/kg, i.v.) produced depolarization together with reduction of firing in most laryngeal neurons. Excitatory and inhibitory PSPs were both depressed and MP fluctuations became smaller in each phase of the respiratory cycle. Elevation of the firing threshold and separation of IS-SD spikes often occurred after thiopental. These results suggest that thiopental depresses the laryngeal motoneuron through inhibition of synaptic transmission and of spike generation.

Animals↗