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PubMed1986

Increased myocardial infarct size by thiopental after coronary occlusion in the dog.

The effect of a single dose (10 mg/kg) of intravenous thiopental (TP), during acute myocardial infarction, on infarct size was studied in conscious dogs randomized 10 minutes after left circumflex coronary artery occlusion to either the TP group (n = 10) or a control group given 0.9% saline solution (n = 10). During the first hour following therapy, myocardial blood flow (microspheres), arterial pressure, left atrial pressure, and arterial blood gases were similar in the two groups, but the heart rate (140 +/- 3 vs 110 +/- 3 bpm; p less than 0.001) and rate-pressure product (15,090 vs 12,210 bpm X mm Hg; p less than 0.025) were greater in the TP group. Infarct size (planimetry) and occluded bed size (postmortem coronary arteriography) measured 2 days later revealed that: the slope of the relation between infarct and occluded bed mass, as a percentage of the left ventricle (% LV) was greater with TP than with saline solution (1.10 vs 0.61; p less than 0.001); excluding hearts (four TP and three saline solution) with small occluded beds (less than 22% LV), infarcts were also larger with TP (n = 6) than with saline solution (n = 7), both as a percentage of the left ventricle (26.4 vs 12.2%; p less than 0.02) or occluded bed (61.5 vs 28.9%; p less than 0.005); and transmural and endocardial extents of the infarcts on topographic maps were greater with TP than with saline solution. In 12 other conscious dogs, increasing the heart rate between 10 and 70 minutes after left circumflex coronary artery occlusion to the average rate of the TP group (140 bpm) by atrial pacing resulted in infarcts larger than those in control dogs but similar to those in the TP group. Thus, TP therapy after left circumflex occlusion increased infarct size in dogs. This effect appeared to be due mainly to the increased heart rate, probably via increased myocardial oxygen demands.

Animals↗
PubMed1980

Membrane composition modulates thiopental partitioning in bilayers and biomembranes.

The nonspecific interaction of thiopental with erythrocyte ghosts, synaptic membranes, microsomes and mitochondria has been measured at 25 degrees C and pH 6.6. In cholesterol-depleted erythrocyte ghosts the partition coefficient decreases with increasing cholesterol content. In sonicated liposomes made from egg lecithin and cholesterol the partition coefficient also decreases with increasing cholesterol content. The dependence of the partition coefficient on cholesterol content in the biological membranes, on average, parallels that in the lipid bilayers. The partition coefficient in lipid bilayers made from lipids extracted from erythrocyte ghosts was comparable to that in the corresponding egg lecithin/cholesterol bilayer. The partition coefficients of all the biomembranes are consistently lower than those in the corresponding egg lecithin/cholesterol bilayer, the free energy of transfer between biomembrane and corresponding bilayer being -1 kcal/mol.

Animals↗
PubMed1984

The effect of urethane and thiopental sodium on platelet aggregation in vitro and in vivo.

The potential in vitro (heparinized or citrated PRP) and in vivo effects of urethane and thiopental sodium on arachidonic acid, collagen, or ADP-induced rat platelet aggregation has been investigated. Both anesthetics antagonized platelet aggregation in vitro at concentrations higher than those found in plasma during anesthesia. Neither anesthetic altered the piastrinopenia induced by intravenous administration of these aggregating agents. These findings suggest that both anesthetics are suitable for in vivo platelet aggregation studies.

Adenosine Diphosphate↗
PubMed1983

Neurohumorally induced cardiac dysrhythmias during nitrous oxide-oxygen-thiopental anesthesia.

Barbiturate, nitrous oxide, and oxygen are commonly used by the oral and maxillofacial surgeon to anesthetize the ambulatory oral surgery patient. The authors report three cases of ventricular dysrhythmia occurring from surgical stimulation during nitrous oxide-oxygen-thiopental anesthesia. These dysrhythmias were most likely mediated via direct neural stimulation of cardiac sympathetic nerves. Concomitant with adrenergic stimulation, a rise in the arterial plasma norepinephrine level was documented, along with an increase in the rate-pressure product. Immediate recognition and treatment of ventricular dysrhythmia is mandatory to preclude further serious cardiovascular complications or death.

Anesthesia, Dental↗
PubMed1988

Comparison of superoxide dismutase, thiopental, and nimodipine for maintenance of somatosensory evoked responses during aortic cross-clamping and declamping in dogs.

Paraplegia is a potential complication of aortic cross-clamping. The occurrence of this devastating sequela has caused increased interest in the use of somatosensory evoked responses (SER) to monitor spinal cord ischemia during aortic cross-clamping. This study was designed to examine changes in SERs during clamping and declamping of the canine aorta after injection of superoxide dismutase (SOD), thiopental (T), and nimodipine (N). In the control group, cross-clamping the aorta produced an increase in latency and a decrease in amplitude of the SER starting at two minutes. Isoelectric SERs were obtained after 16 minutes of aortic cross-clamping, but recovered with cross-clamp removal. When the aorta was clamped for more than 16 minutes in the control group, the isoelectric SERs obtained were irreversible. After the injection of SOD and T, SER latencies and amplitudes changed to a smaller degree with aortic cross-clamping and did not become isoelectric even after 20 minutes of clamping. During aortic cross-clamp removal in the control group, SERs initially improved and then showed signs of reperfusion ischemia, which disappeared after eight minutes. There were no significant SER changes due to reperfusion when SOD or T or the combination was given prior to aortic cross-clamping. There was no difference in SER changes from the control group during aortic cross-clamping and after release of cross-clamping when N was given. Nimodipine did not alter SER changes from aortic cross-clamping alone. In summary, SOD and T, alone or in combination, protect the spinal cord against ischemia during aortic cross-clamping and declamping.

Animals↗
PubMedDate not supplied

Gastroesophageal reflux during anesthetic induction with thiopental and succinylcholine.

The effects of patient physiology and the prior administration of a nondepolarizing muscle relaxant on the frequency of gastroesophageal reflux during induction with thiopental sodium and succinylcholine were investigated. Forty patients underwent anesthetic induction during continuous esophageal pH monitoring. Twenty patients had preoperative symptoms of gastroesophageal reflux, and 20 asymptomatic patients served as controls. Half the patients in each group received a small dose of nondepolarizing muscle relaxant prior to induction. Five patients (25%) with gastroesophageal reflux and none of the control patients showed significant decreases in esophageal pH during induction. Two of these patients received prior administration of a nondepolarizing drug. In all five patients, reflux occurred during laryngoscopy and intubation, suggesting the possibility that succinylcholine did not play a role in the generation of reflux. Preoperative gastroesophageal reflux symptomatology is associated with an increased frequency of reflux during induction, and the vulnerable period seems to occur after the achievement of neuromuscular blockade during laryngoscopy. Preinduction administration of a non-depolarizing muscle relaxant prior to succinylcholine use had no demonstrable effect on the frequency of reflux during induction, although the numbers studied were too small to be conclusive.

Adult↗
PubMed1996

A comparison of alfentanil, esmolol, lidocaine, and thiopental sodium on the hemodynamic response to insertion of headrest skull pins.

STUDY OBJECTIVES: To compare the effects of four techniques for preventing or blunting the hypertensive response to the insertion of Mayfield headrest skull pins: intravenous (IV) alfentanil (ALF), esmolol (ESM), thiopental sodium (TPL), and local anesthesia using plain lidocaine (Xylocaine; XYL). DESIGN: Randomized open study. PATIENTS: 40 adult patients undergoing intracranial or spinal surgery requiring the use of Mayfield headrest skull pins for head positioning and immobilization. INTERVENTIONS: 20 minutes after anesthetic induction, and 2 to 3 minutes prior to the insertion of headrest skull pins, one of three drugs was administered IV: ALF 10 mcg/kg, ESM 1 mg/kg, or TPL 1.5 mg/kg. The fourth drug, XYL, was administered by injection into the scalp. MEASUREMENTS AND MAIN RESULTS: Blood pressure and heart rate (HR) were recorded immediately prior to and after pin insertion with balanced general anesthesia, and at 30, 60, 120, and 180-second intervals after pin insertion. The measurements were compared with the immediate preinsertion values. In the ALF and XYL groups, there was no significant increase in mean arterial pressure (MAP) or HR for any of the measurement periods. MAP was elevated immediately on pin insertion and for up to 2 minutes in the TPL group, and for up to 3 minutes in the ESM group (p < 0.05). HR changes were seen in the TPL group for up to one minute (p < 0.05). Increases in systolic blood pressure were seen in the TPL and ESM groups for up to 3 minutes, and in diastolic blood pressure for up to 2 minutes (p < 0.05). No other significant changes were observed. CONCLUSIONS: IV ALF and local injection of XYL in the scalp prevent the hemodynamic response to the insertion of skull pins in anesthetized patients. Neither ESM nor TPL prevented the hypertensive response. Local anesthetic injection into the scalp requires coordination between the anesthesiologist and surgeon, it carries the risk of needle stick injury, and it must be repeated if the surgeon repositions the headrest. The rapid onset and short half-life of ALF, coupled with the absence of hemodynamic effects at the dose used, makes this drug an alternative to the use of XYL injection.

Adrenergic beta-Antagonists↗
PubMed2006

Thiopental inhibits glycine receptor function in acutely dissociated rat spinal dorsal horn neurons.

Whole-cell patch-clamp was used to assess the modulatory effect of thiopental (Thio) on glycine (Gly) receptor in mechanically dissociated rat spinal dorsal horn neurons. It was found that Thio inhibited the amplitude, accelerated the desensitization and prolonged the deactivation of Gly-induced currents (IGly) in a concentration-dependent manner. In addition, a rebound current occurred after washout of the co-application of Gly and Thio in most neurons tested. Moreover, the inhibitory effect of Thio was not the result of cross-inhibition between Gly and GABAA receptors. Furthermore, taurine-induced currents, a low-affinity agonist for Gly receptors, were also markedly inhibited by Thio in a similar way to IGly. These results indicate that Thio suppresses Gly receptor function and suggest that Thio anesthetic actions might not be mediated by Gly receptors. We speculate that the weak muscle relaxation and the limited analgesic effects observed during Thio anesthesia may attribute to its inhibitory effects on Gly receptors.

Anesthetics, Intravenous↗
PubMed2005

Succinate and artificial maintenance of normal body temperature synergistically correct lethal disorders in thiopental coma rat.

Under modeling of thiopental coma influence of sodium succinate and (or) external warming for the support of normal body temperature (isothermal regimen) on the gas exchange, blood gas content, acid-base status and survival rate was studied in rats. In the absence of therapy hypothermia was developed (-9.4 degrees C), O(2) consumption decreased by a factor 5, oxygenation of arterial blood (pO(2)) did not change while that of venous blood increased, where with arteriovenous oxygen tension gradient decreased by half. Blood tension of carbon dioxide (pCO(2)) increased twice, respiratory and metabolic acidosis was developed. Survival rate under absence of a therapy was 42%, with isolated use of isothermal regimen or succinate therapy alike-50%; with their use in combination drastically increased up to 92%. Succinate increased arteriovenous gradient of pO(2), decreased deficit of buffer bases, increased bicarbonate concentration. At isothermal regimen accumulation of CO(2) in the blood was diminished, its excretion was increased, pH of blood approached normal values. Combined use of both therapy agents increased O(2) consumption and potentiated their positive influence on acid-base status. The implication is that hypothermia restrains effect of succinate in barbiturate coma; prevention of hypothermia in combination with succinate administration is highly effective method of experimental therapy of barbiturate intoxication.

Anesthetics, Intravenous↗
PubMed2001

Propofol and sodium thiopental protect against MK-801-induced neuronal necrosis in the posterior cingulate/retrosplenial cortex.

N-Methyl-D-aspartate (NMDA) antagonists act by an anti-excitotoxic action to provide neuroprotection against acute brain injury, but these agents can also cause toxic effects. In low doses they induce reversible neuronal injury, but in higher doses they cause irreversible degeneration of cerebrocortical neurons. GABAmimetic drugs protect against the reversible neurotoxic changes in rat brain. Here we show that two GABAmimetic anesthetic agents--propofol and sodium thiopental--protect against the irreversible neurodegenerative reaction induced by the powerful NMDA antagonist, MK-801.

Anesthetics, Intravenous↗
PubMed1996

Successive negative contrast in one-way avoidance: effect of thiopental sodium and chlorpromazine.

The successive negative contrast effect on one-way avoidance was induced by shifting rats from a large reward (30 s spent in the safe compartment after completion of the avoidance response, pre-shift phase) to a small reward (1 s, post-shift phase). Under these conditions, the previously learned avoidance response deteriorated (negative contrast) when compared to a control group for which 'safe time' remained constant throughout the experimental situation (1 s). Thiopental sodium at a dose of 5 or 10 mg/kg, but not at 1, 2, 15 or 20 mg/kg i.p., abolished the negative contrast effect, and did not affect performance of the one-way avoidance task. Similar results were found when rats were treated with diazepam (1 mg/kg i.p.). Chlorpromazine at a dose of 0.5 or 1 mg/kg i.p. did not affect negative contrast, although at higher doses (2 or 3 mg/kg) there was an increase in the number of trials needed to reach the criterion for learning the avoidance response. This increase was evident in both pre-shift and post-shift phases, although only in the experimental situations involving a low level of reinforcement (1 s in the safe compartment). On the basis of these results, we tentatively suggest that the successive negative contrast effect in one-way avoidance in rats can be considered a useful pharmacological animal model for research into anxiety.

Animals↗
PubMed1994

Thiopental sodium cerebral protection during carotid endarterectomy: perioperative disease and death.

PURPOSE: This study reports our experience with thiopental sodium (Pentothal) cerebral protection, without intraluminal shunting, during carotid endarterectomy. Only those complications that occurred during surgery or within 30 days of operation have been addressed. METHOD: A prospective, unselected, consecutive series of 621 carotid endarterectomies was done during a 7-year period, with electroencephalography-monitored, high-dose Pentothal for cerebral protection. RESULTS: Five ischemic strokes (0.8%), completion of two strokes-in-evolution (0.3%) and four strokes caused by cerebral hemorrhage (0.6%) occurred in 11 patients in the perioperative (30-day) period, for a combined cerebral morbidity-mortality rate of 1.7%. Four reversible ischemic neurologic deficits (0.6%) and two transient ischemic attacks (0.3%) in six patients produced a transient deficit rate of 0.9%. Symptomatic coronary artery disease coexisted in 37% of the patients but resulted in only five acute myocardial infarctions (0.7%), one of which was fatal (0.1%). Other perioperative complications in 10 patients (1.5%) were associated with the operative procedure. There were no complications directly attributable to the high-dose Pentothal. Prospective data collection has allowed definition of the disease and cause of all cerebral complications. CONCLUSION: The complications in this series have been related to surgical and clinical management problems rather than failure of cerebral protection. Cerebral protection with high-dose Pentothal under electroencephalographic control has been effective and complication free.

Aged↗
PubMed2005

Insignificant effect of desflurane-fentanyl-thiopental on hepatocellular integrity--a comparison with total intravenous anaesthesia using propofol-remifentanil.

BACKGROUND AND OBJECTIVE: Inhalational anaesthetics have been associated with hepatotoxicity. Even desflurane, with its low solubility in blood and tissues, and its minimal hepatic biotransformation, is known to affect hepatic integrity. The effects of propofol on hepatic function are, however, a matter of controversy. Alpha-glutathione S-transferase (alpha-GST), a sensitive and specific biomarker for hepatic integrity, was measured to assess the influence of total intravenous anaesthesia (TIVA) with propofol vs. anaesthesia with desflurane. METHODS: Forty-two patients scheduled for elective prostatectomy were randomly allocated to receive either desflurane, fentanyl and thiopental (desflurane group) or propofol and remifentanil (TIVA group). Depth of anaesthesia was guided by bispectral index. Plasma concentrations of alpha-GST and aminotransferases were measured before induction of anaesthesia (TO), at the end of surgery (T1), as well as 2 h (T2) and 24 h (T3) postoperatively. Haemodynamic parameters and bispectral index values were documented. RESULTS: alpha-GST increased significantly in the desflurane group from TO (3.0 +/- 2.2 microg L(-1)) to T1 and T2 (5.5 +/- 4.3 and 5.6 +/- 3.7 microg L(-1), respectively), whereas no changes were seen in the TIVA group. alpha-GST values above the normal upper limit (> 7.5 microg L(-1)) were seen in 24% of the patients receiving desflurane. Aminotransferases remained unchanged in both groups throughout the study period. CONCLUSIONS: The use of propofol as part of a TIVA regimen seems to have no influence on hepatocellular function during and after surgery. In contrast, patients receiving desflurane showed a transient slight, but significant, increase of alpha-GST to above the normal upper limit after anaesthesia, although this was without further clinical relevance.

Alanine Transaminase↗
PubMedDate not supplied

Thiopental vs. etomidate for rapid sequence intubation in aeromedicine.

INTRODUCTION: Although there is a general agreement that rapid sequence intubation (RSI) is the preferred technique for intubation in aeromedical care, several pharamacological regimens have been employed without clear evidence of which is superior. HYPOTHESIS: This study was designed to compare the use of etomidate (ETOM) with that of thiopental (THIO) as an adjunctive agent used with succinylcholine (SCh) for RSI in an urban, aeromedical system. METHODS: This was a retrospective, before-and-after study utilizing computer-assisted chart review. Adult patients who received THIO for RSI over a two-year period were compared to adult patients who received ETOM for RSI over a similar period, after a change in protocol, which mandated ETOM rather than THIO for all intubations. RESULTS: No difference was found in any of the primary endpoints. Stabilization time (13.1 vs. 12.9 minutes), number of intubation attempts (1.1 vs. 1.2), successful first intubation attempts (90% vs. 82%), overall successful intubations (100% vs. 96%), and intubation time (18.4 vs. 21.7 seconds) were similar for all comparisons of THIO vs. ETOM (all p > 0.05). CONCLUSION: This study found no clinically relevant differences between the use of ETOM or THIO as adjuncts with SCh for RSI in the aeromedical setting.

Adolescent↗
PubMed1991

[Thiopental concentrations in the whole blood of pregnant and non-pregnant patients in the first minutes following injection. Forensic aspects].

Thiopentone concentrations in blood following injection of the induction solution (Thiopental, 2.5%) may be critical in the context of lethal complications arising during induction of anaesthesia and thereby the toxicological aspects of this drug can become an issue in forensic considerations. The study was designed to find out whether the dose of injected thiopentone may be calculated from blood levels measured in nine pregnant and ten non-pregnant patients. The doses injected ranged from 4-5 mg per kg body weight. The drug was administered as a single bolus dose to the patients undergoing Caesarean section. In the non-pregnant group the first dose of thiopentone was given over 25 s. After that repeated doses of 50 mg were injected over 2s every 20s until the eyelid reflex was ceased. Blood samples for determination of thiopentone were withdrawn from an indwelling catheter inserted to a large cubital vein in the arm opposite that used for the injection and thiopentone levels were measured from blood after column extraction (Extrelut) using spectrophotometry. Venous peak values were found 40-115s after injection in the Caesarean group (mean: 20.3 micrograms kg-1) and were higher than in the non-pregnant patients (97-190s, mean: 17.8 micrograms kg-1). No correlation was found regarding venous peak levels (mgkg-1 blood) and induction dose (mgkg-1 body weight), neither in the pregnant nor in the non-pregnant group. Our findings would suggest that the injected thiopentone dose cannot be calculated from the concentration of the drug in the blood. Forensic conclusions concerning the onset of lethal complications during the induction of anaesthesia cannot be drawn on the grounds of venous thiopentone concentrations.

Adult↗
PubMed1999

Anaesthetic effects of pregnanolone in combination with allopregnanolone, thiopental, hexobarbital and flurazepam: an EEG study in the rat.

The anaesthetic interactions of the steroid, 3 alpha-hydroxy-5 beta-pregnan-20-one, in male rats were investigated in different fixed binary combinations with the steroid allopregnanolone (3 alpha-hydroxy-5 alpha-pregnan-20-one), two barbiturates (thiopental and hexobarbital) and the benzodiazepine, flurazepam. Anaesthetic effects were determined using an EEG threshold method. Interactions were assessed using an isobolographic method. The interaction between the two steroids, pregnanolone and allopregnanolone, showed an anaesthetic effect significantly less than additive (antagonistic). The interactions between pregnanolone and the two barbiturates and the benzodiazepine showed an anaesthetic effect significantly greater than additive (potentiation) in all tests performed. These results could be explained by a pharmacodynamic interaction at the hypothetical GABA-benzodiazepine-barbiturate-steroid complex in the CNS.

Anesthetics, Combined↗
PubMed1999

Low-dose succinylcholine facilitates laryngeal mask airway insertion during thiopental anaesthesia.

We have assessed the optimal dose of succinylcholine to provide satisfactory conditions for insertion of a laryngeal mask airway (LMA) without causing myalgia during induction of anaesthesia with thiopental. We studied 60 adult patients, allocated randomly to one of three groups: group 1 (n = 20) received normal saline, group 2 (n = 20) received succinylcholine 0.25 mg kg-1 and group 3 (n = 20) received succinylcholine 0.5 mg kg-1. Insertion of the LMA was performed 1 min after administration of succinylcholine or saline. Insertion conditions were significantly better in group 3 compared with groups 1 and 2. The incidence of adverse responses on insertion was significantly higher in groups 1 and 2 than in group 3. Four of 20 patients (20%) in group 3 complained of myalgia, which was higher than that in group 1 (0%) and group 2 (10%), but there were no significant differences between groups on the day of operation. On day 3 after operation, seven patients (35%) in group 3 complained of myalgia, which was significantly higher than that in group 1 (5%) and group 2 (20%). Time from administration of succinylcholine to resumption of spontaneous respiration was significantly longer in groups 2 (194.9 (SD 50.4) s) and 3 (234.2 (34.3) s) than in group 1 (84.7 (32.4) s). There was also a significant difference between groups 3 and 2 for duration of apnoea.

Adult↗