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PubMed1982

Comparative cardiovascular effects of midazolam and thiopental in healthy patients.

Midazolam, a water-soluble benzodiazepine that is shorter-acting, more potent, and less irritating to veins than diazepam, has been suggested for use for induction of anesthesia. The cardiovascular effects of an induction-sized dose (0.25 mg/kg) of midazolam in A.S.A. class I or II surgical patients (N = 11) sedated with morphine and N2O-O2 were compared in a double-blind fashion with a similar group of patients (N = 9) receiving thiopental (4.0 mg/kg). Consistent with earlier studies, patients given thiopental experienced downward trends from base line in mean arterial pressure, stroke volume, cardiac output, and heart rate; mean right atrial pressure increased slightly, whereas systemic vascular resistance did not change. Induction of anesthesia with midazolam was associated with more gradual and less pronounced hemodynamic alteration; the only significant changes from base line were decreases in mean arterial pressure 5 and 10 minutes after injection. When the two groups were compared, no significant differences were found. Midazolam is, then, as acceptable for induction of anesthesia as thiopental from a hemodynamic point of view in A.S.A. class I and II patients.

Adult↗
PubMed1981

Gas-chromatographic assay for thiopental in plasma, with use of a nitrogen-specific detector.

An accurate, sensitive, and specific gas-liquid-chromatographic procedure is described for determining concentrations of thiopental in human plasma. After a double extraction of 0.2 or 1.0 mL of plasma containing phenobarbital as an internal standard, thiopental and the internal standard are derivatized in a polar non-aqueous solvent system with iodomethane. The reaction mixture is then evaporated, the residue reconstituted with ethyl acetate, and 20 microL injected into a 3% OV-17 column of a gas chromatograph equipped with a nitrogen-phosphorus detector. Linearity and reproducibility over the concentration range 25 microgram/L to 10 mg/L in plasma are excellent. The sensitivity and wide range of linearity exhibited by this method permit thorough characterization of the disposition of thiopental after the usual induction doses of 3-4 mg/kg of body weight.

Blood Chemical Analysis↗
PubMed1995

Rectal thiopental sodium for sedation of pediatric patients undergoing MR and other imaging studies.

PURPOSE: To determine the efficacy and safety of rectal thiopental sodium as a sedation agent for pediatric imaging. METHODS: Four hundred sixty-two infants and children were sedated with rectal thiopental sodium for MR, CT, or nuclear imaging in 1992 and 1993. Patients received screening histories and physical examinations before sedation, and parents gave informed consent. Sedated patients were monitored by pulse oximetry and direct observation. Twenty-four-hour telephone follow-up to assess delayed side effects was performed successfully in 325 patients. RESULTS: Examinations were successfully completed in 96% of patients. The average time from drug administration to sedation was 12.2 minutes. The average time from sedation to discharge from radiology was 71.1 minutes. Eleven percent of patients had desaturation below the pulse oximetric baseline easily treated with oxygen and head positioning. Twenty-four-hour telephone follow-up in 325 patients revealed a 34% incidence of minor rectal irritation and diarrhea, sleepiness, nausea and vomiting, or ataxia. CONCLUSIONS: Rectal thiopental sodium is a safe and effective drug for pediatric sedation.

Administration, Rectal↗
PubMedDate not supplied

[Effects on the newborn infant of thiopental and propofol used in anesthetic induction in cesarean section].

OBJECTIVES: To compare the effects of an anesthetic induction dose of thiopental to that of propofol on the vitality of the neonate, as measured by Apgar score and the interval between extraction of the newborn and unassisted respiration. PATIENTS AND METHODS: One hundred ASA I-II women undergoing cesarean section were randomly assigned to two groups of 50. Anesthesia was induced with thiopental 4 mg/kg in one group; in the other group, propofol 2 mg/kg was used. Time intervals recorded were induction-to-extraction, uterine incision-to-extraction and extraction-to-unassisted respiration. An Apgar score was recorded 1, 5 and 10 min after birth. For statistical analysis, each group was divided into three subgroups, in accordance with the reason for performing the cesarean section: subgroup 1, elective cesarean; subgroup 2, emergency cesarean due to dystocia or failure; subgroup 3, emergency cesarean section due to acute fetal distress. RESULTS: Means of intervals for induction-extraction and uterine incision-extraction showed no significant differences. All induction-extraction intervals were under 10 min (4.94 +/- 1.55 min) and all uterine incision-extraction intervals were under 180 sec, with most staying under 90 sec (43.13 +/- 25.76 sec). No statistically significant differences were found for vitality between the two groups of neonates. CONCLUSIONS: If the induction-extraction interval is 10 min or less, both thiopental (4 mg/kg) and propofol (2 mg/kg) given in a single dose for induction of general anesthesia in all types of cesarean section are equally safe for the newborn infant.

Adult↗
PubMed1993

The reversal effect of low dose aminophylline on thiopental-induced sedation.

Fifty-two ASA (American Society of Anesthesiologists) class I-II female patients, from 22 to 66 years of age, undergoing D & C (dilatation and curettage) procedure, were randomly divided into 2 groups in a double-blind and placebo-controlled design to investigate whether aminophylline could reverse the sedative effect of thiopental. Patients of both groups were anesthetized with fentanyl (2 micrograms/kg, i.v.) and thiopental (4 mg/kg, i.v. and 1 mg/kg, i.v. repeated if necessary). Postoperatively, they were intravenously given aminophylline (2 mg/kg) or normal saline in an equal volume solution over 5 minutes. The results showed that patients in the aminophylline group were more sedated (p < 0.05) than in the saline group 5 minutes after reversal, but were less sedated (p < 0.05) at minute 20. No significant differences between groups were found at other times. The total time spent in the postanesthetic unit was shorter in the aminophylline group (92 +/- 27 min.) than in the normal saline group (109 +/- 30 min.) (p < 0.05). The serum theophylline levels in some cases in the aminophylline group ranged between 3.2 and 4.9 micrograms/ml (4.3 +/- 0.7 micrograms/ml, n = 10). No apparent side effects, including tachyarrhythmias, were noted. We conclude that low dose aminophylline (2 mg/kg, i.v.) can partially reverse thiopental-induced sedation with safety in the early phase of recovery and it can reduce the total time spent in the postanesthetic unit.

Adult↗
PubMed1993

[Interaction of midazolam and thiopental in amnestic effect].

Interaction of midazolam and thiopental in amnestic effect was studied in 30 adult patients who underwent elective surgery of lower extremities under epidural or spinal anesthesia in combination with oxygen, nitrous oxide and low concentration of sevoflurane. Combination of midazolam 2.0-3.0 mg (0.041 +/- 0.006 mg.kg-1) and thiopental 3-5 mg.kg-1 produced amnestic effect in 87% of patients. No side effects, such as decrease in O2 saturation, upper airway obstruction, cardiovascular depression and delayed emergence were observed with this small dose of midazolam. Administration of midazolam 2.0-3.0 mg before epidural, or spinal anesthesia in the operating room under observation of anesthesiologists, followed by thiopental 3-5 mg.kg-1, was safe and comfortable to the patients.

Adult↗
PubMed1996

[Difficult tracheal intubation and abnormal response to thiopental in a patient with arthrogryposis multiplex congenita].

Anesthesia was administered for six times to a patient with arthrogryposis multiplex congenita (AMC) at the age of 10 to 17 years. In the first four occasions of anesthesia, difficult tracheal intubation was encountered due to limited neck extension, inadequate mouth opening and the short epiglottis. On the fifth anesthesia, the patient remained conscious even after intravenous injection of thiopental 6.6 mg.kg-1, and enflurane in combination with nitrous oxide was administered to induce anesthesia. During the induction of the sixth anesthesia, excessive oral secretion and severe continued nausea were observed just after intravenous administration of thiopental 5.3 mg.kg-1. These were overcome by intravenous administration of ketamine 2.0 mg.kg-1. Problems such as difficulty in tracheal intubation and abnormal response to thiopental need special attention in patients complicated with AMC, particularly during induction of anesthesia.

Abnormalities, Multiple↗
PubMed1996

[Rapid induction of anesthesia with propofol--comparison with thiopental].

We investigated hemodynamic changes, induction time and the incidence of pain after rapid induction of anesthesia with propofol (Group P) in comparison with those after induction with thiopental (Group B). Anesthesia was induced with propofol 2.5 mg.kg-1 in Group P and thiopental 5 mg.kg-1 in Group B taking 20 seconds. When verbal response disappeared, tracheal intubation was performed with suxamethonium 1.2 mg.kg-1. The incidence of pain on injection, time from the start of injection of the drug to the disappearance of verbal response (induction time), blood pressure, heart rate, and rate pressure product (RPP) were monitored. The pain on injection was seen in 6 of 30 patients in Group P. This was significantly larger compared with 3 patients in Group B. The induction time was not different between the two groups. One minute after intubation, blood pressure, heart rate and RPP were significantly higher compared with those before induction in Group B. These were also significantly higher than those in Group P. Therefore, rapid induction with propofol is more useful compared with that with thiopental.

Adult↗
PubMed1997

Contrasting effects of urethane, ketamine, and thiopental anesthesia on ethanol-clonidine hemodynamic interaction.

In previous studies, we have shown that ethanol counteracts the hypotensive and sympathoinhibitory effects of clonidine in conscious rats but enhances these responses in alpha-chloralose anesthetized rats. This study investigated whether the latter finding pertains to other anesthetics that act by different mechanisms. The hemodynamic interaction between clonidine and ethanol was evaluated in conscious aortic barodenervated rats and in rats anesthetized with urethane, ketamine, or thiopental. The conscious aortic barodenervated rat was used because it exhibits a greater hypotensive response to clonidine compared with intact (sham-operated) rats. Starting from similar baseline values of blood pressure (BP) and heart rate, clonidine (30 micrograms/kg, iv) elicited similar decreases in BP in all groups of rats (conscious aortic barodenervated or anesthetized). Subsequent administration of ethanol (1 g/kg, iv) counteracted the hypotensive effect of clonidine in conscious aortic barodenervated rats and raised the BP to levels higher than the baseline (preclonidine) values. The pressor effect of ethanol persisted for at least 30 min. In contrast, preadministration of ethanol had no effect on the hypotensive effect of the subsequently administered clonidine. The antagonistic clonidine-ethanol hemodynamic interaction in conscious rats was not altered in urethane-anesthetized rats, both in terms of magnitude and duration. In ketamine-anesthetized rats, a short lasting (< 10 min) pressor effect of ethanol was observed. In contrast, ethanol augmented the hypotensive effect of clonidine in thiopental-anesthetized rats; the hypotensive effect of clonidine became slightly but significantly (p < 0.05) greater after ethanol compared with respective time control values. These findings suggest that the adverse hemodynamic effect of ethanol on centrally mediated hypotensive response is modified by different anesthetics. The antagonistic hemodynamic interaction, demonstrated in conscious rats, is replicated in urethane-anesthetized rats but weakened and reversed in ketamine- and thiopental-anesthetized rats, respectively. Therefore, urethane-anesthetized rats may be used in mechanistic studies on the antagonistic ethanol-clonidine hemodynamic interaction that cannot be undertaken, for technical reasons, in conscious rats.

Anesthetics, Dissociative↗
PubMed1997

[Effects of thiopental and sevoflurane on hemodynamics during anesthetic management of electroconvulsive therapy].

The effect of thiopental and sevoflurane (1 MAC, 2 MAC) on hemodynamics was assessed in a randomized study involving 38 adult patients undergoing electroconvulsive therapy (ECT). Blood pressure, heart rate and electrocardiogram (ECG) were monitored during the ECT procedure. After oxygenation, hypnosis was induced with a bolus injection of thiopenal (TPS) 4 mg.kg-1. Muscle relaxation was achieved by succinylcholine, 1 mg.kg-1 intravenously before ECT procedure. Ventilation was assisted using a face mask with 100% oxygen (TPS group), 1.7% sevoflurane (1 MAC group) or 3.4% sevoflurane (2 MAC group), plus 50% nitrous oxide and 50% oxygen. Thereafter, an electrical stimulus was administered. A total of 150 treatment sessions were evaluated. The rate pressure product increased in every group right after ECT, but the use of sevoflurane (2 MAC) significantly diminished the response compared with sevoflurane (1 MAC) and thiopental. In the sevoflurane (2 MAC) group, no ventricular arrhythmias were observed. In general, it seems that sevoflurane (2 MAC) is as effective as thiopental and sevoflurane (1 MAC) as an induction agent for ECT.

Adult↗
PubMed1998

Cardiorespiratory and anesthetic effects of propofol and thiopental in dogs.

OBJECTIVE: To compare cardiorespiratory and anesthesia effects of IV administered propofol and thiopental in dogs. ANIMALS: 6 healthy mixed-breed dogs. PROCEDURE: Each dog was anesthetized with isoflurane, then a thermistor catheter was inserted in the pulmonary artery. After a minimum of 2.5 hours of recovery, a catheter was placed in a cephalic vein for administration of lactated Ringer's solution and drugs. Propofol (8 mg/kg of body weight) or thiopental (19.4 mg/kg) was administered to each dog in a randomized crossover design study. All dogs were intubated and allowed to breathe 100% oxygen spontaneously. Heart rate and rhythm; systolic, diastolic, and mean arterial blood pressures; respiratory rate; end-tidal carbon dioxide concentration; tidal volume; and reflexes (toe web pinch, palpebral response, and jaw tone) were measured before and every 2 minutes for the first 10 minutes, then at 15, 30, and 60 minutes after drug administration. Cardiac output was determined at 0, 2, 6, 10, 15, 30, and 60 minutes, and blood samples were collected at 0, 2, 10, and 30 minutes. Time to endotracheal extubation, head lift, and ability to sit sternally and walk unaided were recorded. RESULTS: 3 of 6 dogs in each group were apneic after drug administration. Reflexes were decreased similarly for both anesthetic agents, but were not completely lost. Time to sternal position and walking unaided were significantly shorter in response to propofol. CONCLUSION: Anesthesia was rapid; however, respiratory depression and apnea were major adverse effects associated with propofol and thiopental. Propofol has the advantage of inducing rapid, coordinated anesthesia recovery.

Anesthetics, Intravenous↗
PubMed1976

Anaesthesia for cardioversion: immediate haemodynamics in patients anaesthetized with thiopental or althesin.

Immediate haemodynamic changes during electrical cardioversion were compared in 30 patients anaesthetized either with thiopental or with Althesin. The systolic arterial pressure, heart rate, stroke and cardiac indices were measured before atropine premedication, after atropine, during anaesthesia, and 3 and 10 minutes after defibrillation. The stroke index was estimated by transthoracic impedance method. Both anaesthetics caused a significant but similar decrease in systolic arterial pressure. The cardiac index remained relatively stable in both groups during all stages of the procedure. Atropine induced an expected increase in heart rate and a decrease in stroke index. while both variables tended to approach the baseline values after cardioversion with no difference between thiopental and althesin groups. No significant difference in the haemodynamic response to cardioversion was seen in patients with heart volumes exceeding 650 ml/m2 BSA as compared to those with smaller hearts. It is concluded that both thiopental and althesin can be considered as safe anaesthetics for cardioversion.

Adult↗
PubMed1988

The use of EEG spectral analysis after thiopental bolus in the prognostic evaluation of comatose patients with brain injuries.

The value of EEG data and evoked potentials (EP), combined with the patient's clinical status, are important parameters used to document decerebration, but their reliability is at its best when the decerebration is nearly complete. Based on spectral analysis of the EEG we compiled criteria for the cerebral function with application of agents known to alter the normal EEG. We found very distinct and different pattern responses in spectral analysis of the EEG after the bolus injection of 100-500 mg Thiopental, correlating well with the patient's prognosis. In a study with 40 patients, those who showed a significant increase of power in all frequencies, especially a short lasting increase in beta (3-7 min) survived in 84%. On the other hand, all the patients who had a decrease of absolute power in all frequency band died, even when brainstem reflexes and various pain reactions were still present. Spectral analysis after Thiopental bolus injection also permits a very immediate assessment of slight improvements or deteriorations in the clinical course.

Adolescent↗
PubMed1995

Variability of thiopental clearance in routine critical care patients.

Thiopental was administered to neurosurgical patients as a drug for cerebral protection for up to 9 days either by continuous infusion (seven subjects) or repeated intravenous bolus (nine subjects). The efficient levels of thiopental measured at steady state ranged between 5 and 63 mg.l-1. Steady-state clearance evidenced considerable interindividual variability. Overall mean plasma clearance was lower than 1 ml.min-1.kg-1 for one subjects, ranged between 1 and 2 ml.min-1.kg-1 for six subjects, between 2 and 3 ml.min-1.kg-1 for seven subjects and was up to 5 ml.min-1,kg-1 for one subject. Extreme values for apparent daily clearance were 0.268 ml.min-1.kg-1 and 5.40 ml.min-1.kg-1. Daily intersubject CV gradually increased from day to day, increasing from 37% on day 1 to 51% on day 7. During the treatment for seven subjects, variations were minimal and clearance was considered to be constant; the maximum variation of clearance expressed as a percentage of the initial value was lower than 21% over a period longer than 3 days. For the other subjects, clearance was not stable with time. A decrease in clearance was evidenced for four subjects over a period of 7 days and more; the maximum variation of clearance was greater than -35%. An increase in clearance was noted for three subjects after 2 days of treatment; the maximum variation of clearance was greater than +44%. Evaluation of clearance at steady state made it possible to analyse interindividual variability and its clinical implications.

Adolescent↗
PubMed1996

Effects of diazepam, baclofen and thiopental on the silent period evoked by transcranial magnetic stimulation in humans.

The cortical silent period evoked by magnetic transcranial stimulation and the peripheral silent period were studied in healthy subjects after intravenous injection of diazepam, baclofen or thiopental. None of the drugs tested changed the peripheral silent period. But, unexpectedly, diazepam significantly shortened the cortical silent period, the inhibitory effect lasting about 30 min. In experiments using paired transcranial stimuli, the conditioning shock inhibited the test response to a similar extent with and without diazepam. Although baclofen did not change the cortical silent period, it reduced the size of the H reflex in the forearm muscles. Thiopental also left the duration of the cortical silent period unchanged. These findings show that the cortical silent period can be modified pharmacologically. Diazepam possibly shortens the silent period by modulating GABA A receptors at a subcortical site.

Adult↗
PubMed1982

Comparative physiologically based pharmacokinetics of hexobarbital, phenobarbital and thiopental in the rat.

A physiologically based pharmacokinetic model, which is an extension of the Bischoff-Dedrick multiorgan model, was developed to described the kinetics of barbiturates (hexobarbital, phenobarbital, and thiopental) in the rat. The model is composed of 11 organ or tissue compartments. The brain compartment was featured as a nonflow-limited organ for some low lipid soluble barbiturates. Michaelis-Menten constants for drug metabolism (Km, Vmax) were determined from in vitro experiments using liver microsomes. Binding of drugs to plasma and tissue proteins was measured in vitro using an equilibrium dialysis method. Distribution of drugs to red blood cells was measured in vitro with thiopental exhibiting a concentration dependent distribution. Penetration rates of the barbiturates into the brain were predicted on the basis of their lipid solubilities. A set of mass balance equations included terms for the inflow and outflow of drug carried by the perfusing blood, drug metabolism, protein binding, and penetration rate into the brain as well as blood flow rate and tissue mass. Solution of the system of equations yielded the time courses of drugs in each organ. However, predicted time course of drugs in plasma and brain were not in good agreement with those observed. Therefore, the tissue to plasma distribution ratios evaluated from in vivo experiments were substituted for the in vitro values, resulting in fairly good agreement between predicted and observed values.

Animals↗
PubMed1993

Postmortem concentrations of thiopental in tissues: a sudden death case.

High-performance liquid chromatography was employed to determine the concentration of thiopental in body fluids and tissues in an individual who had died due to intravenous injection of the clinical dose. The blood concentration of thiopental was 0.6 mg/l. Among the 10 tissues examined, the brain and thymus showed the highest level of the drug; 11.9 mg/kg and 7.66 mg/kg, respectively. The results are discussed in the light of the relevant literature.

Adult↗
PubMedDate not supplied

Comparative studies on the influence of decapitation, ketamine and thiopental anesthesia on rat heart mitochondria.

The influence of decapitation, ketamine and thiopental anesthesia on some properties of rat heart mitochondria was compared. Polarographic analysis were performed, oxygen consumption rates, respiratory control index, ADP : O ratio and oxidation of exogenous NADH were determined. Electronmicroscopic and gasometric examinations were also conducted. Mitochondrial fractions from hearts of decapitated rats oxidized at a generally faster rate and mitochondria from such hearts exhibited a significantly lower RCI value. These differences can be explained through the action of uncoupler(s) present in the decapitated group. A hypothesis linking decapitation with the uncoupling effect of fatty acids released intracellularly during catecholamine-stimulated lipolysis is discussed. No differences in the ADP : O ratio and electronmicroscopic details between the groups were found. Gasometric determinations in both anesthetized groups did not show any marked dysfunction of the respiratory system. It is concluded that decapitation leads to some changes in the functional integrity of rat heart mitochondria. Ketamine and thiopental anesthesia can be used with equal success for the isolation of mitochondria from the heart.

Adenosine Diphosphate↗