Millions of injection of sodium thiopental have been clinically used since it was introduced by Lundy in 1934. As with other barbiturates, cutaneous allergic manifestation are rather frequently seen, but reports of anaphlyactic reactions are rare. Probably many cases have not been recognized or have been misdiagnosed. It is believed that some cases of unexplained collapse or even death after thiopental inductions are very possibly due to an unrecognized anaphylactic action. This report presents a case of anaphylactic action due to injection of sodium thiopental and the references were reviewed.
Anaphylaxis* ; Barbiturates ; Sodium ; Thiopental*

Three groups of healthy adults were premedicated with diaxepam or secobarbital and anesthetized with propanidid or thiopental. The concentration of serum potassium wes measured before induction and after succinylchaline iodide administration. The increases of potassium in diazepam-thiopental, diaxepam-propanidid and secobarbital propanidid groups were 0. 14, 0. 06, and 0. llmEq/L (3. 29, l. 38 and 2. 58%) respectively. Serum potassium changes were least in diazepam-propanidid group, but there were no significant differences among the 3 groups. The choice of induction agent is of importance for the changes in serum potassium which follow the subsequent injection of succinylcholine iodide. For instance, intravenous induction by barbiturate is followed by a lesser increase in serum potassium after succinylcholine injection than induction by halothane. As barbiturates are so commonly used as intravenous induction agents, we chose thiopental and succinylcholine iodide as standard with which to compare the other induction agents, propanidid and succinylcholine iodode. And also, we wanted compare two premedicants, secobarbital and diaepam. The results were as follows: (1) The thiopental-succinylcholine iodide group and the propaaidid-succinylcholine iodide group revealed no significant differences in serum potassium level. (2) There was a lesser increase in serum potoassium level after premedication with diazepam than premedicstion with secobarbital in the propanidid-succinylcholine iodide group. (3) Induction by propanidid succinylcholine iodide and premedication by diazepam are recommendable for least increasing the serum potassium level.
Adult ; Barbiturates ; Diazepam ; Halothane ; Humans ; Potassium* ; Premedication ; Propanidid ; Secobarbital ; Succinylcholine ; Thiopental

The capacity of hypothermia to protect the brain during a period of decreased or absent oxygen delivery(hypoxia) is well established both experimentally and clinically. And also experimentally, barbiturates, which are the most potent pharmacologic depressants of cerebral metabolism, do provide protection. A 25 year-old patien, who had suffered from hypoxic cerebral hypoxia was satisfactorily treated by a combination therapy with Thiopental Sodium and low-grade Hypothermia.
Adult ; Barbiturates ; Brain ; Humans ; Hypothermia* ; Hypoxia, Brain* ; Metabolism ; Oxygen ; Thiopental*

Barbiturates* ; Brain* ; Membranes* ; Phospholipids*

Barbiturates* ; Brain* ; Membranes*

Laboratory and clinical evidence indicates a potentially important role for barbiturates in the management of brain injury and intracranial hypertension. The present report describes our experience with the thiopental and mannitol therapy in 30 consecutive patients who were over 20mmHg of intracranial pressure(ICP) in severe head injuries and the other comatous conditions. The anothers have analyzed the effects of thiopental on outcome in comatous 30 patients by continuous monitoring of ICP. High dose barbiturate therapy was induced with an intravenous bolus of thiopental, 40mg/kg and the infusion of barbiturates intermittently continued until control of the ICP(below 20mmHg) was obtained. In those patients responding to thiopental, the daily mannitol requirement was reduced from 3.5 to 0.5mg/kg/day. Our overall results are presented; 1) In patients with intracranial mass lesions only very high ICP(>40mmHg) on barbiturate management was significantly associated with a poor neurological deficit and outcome from injury, while the patients with any increased in ICP above 20 to 29mmHg was associated with a moderate neurological disability and better outcome with thiopental and mannitol treatment. 2) In patients with surgical mass lesion ICP between 20 to 29mmHg was significantly associated good neurological picture and outcome, but the patients in ICP above 40mmHg, had a 75% motality. 3) Decreases in ICP over 20mmHg were seen in 75%of the patient who had managed with thiopental and mannitol. 4) Thiopental responders have returned to a good recovered and minimal deficit, but thiopental nonresponsiveness was associated with a completely unfavorable outcome:5 deaths, 1 vegetative survior.
Barbiturates ; Brain Injuries ; Craniocerebral Trauma* ; Head* ; Humans ; Intracranial Hypertension* ; Mannitol* ; Thiopental*

BACKGROUND: Thiopental sodium and midazolam are frequently used to induce anesthesia. It has been known that barbiturates enhance the binding of benzodiazepines to the benzodiazepine receptors and also enhance the anesthetic effect of benzodiazepines. As a results, the combined effect of a barbiturate and a benzodiazepine should be more than the sum of the separate effects of the two drugs. The purpose of this study was to evaluate hypnotic interaction between the two drugs during induction period. METHODS: The effect of midazolam on the induction dose-response curve for thiopental sodium was studied in unpremedicated 240 ASA physical status I and II female patients. As an endpoint of hypnosis, ability to open eyes on command was used. Dose-response curves for thiopental sodium, midazolam, and their combination were determined with a probit procedure and compared with a isobolographic analysis. RESULTS: For hypnosis, significant(P<0.05) synergistic interaction was found between the two drugs. The dose of thiopental sodium required to produce hypnosis was reduced by 64% in the presence of equi-effective dose of midazolam. CONCLUSIONS: The interaction between thiopental sodium and midazolam for hypnosis is synergistic.
Anesthesia* ; Anesthetics ; Barbiturates ; Benzodiazepines ; Female ; Humans ; Hypnosis ; Hypnotics and Sedatives ; Midazolam* ; Receptors, GABA-A ; Thiopental*

OBJECTIVE: Barbiturate coma therapy (BCT) is a useful method to control increased intracranial pressure (IICP) patients. However, the complications such as hypotension and hypokalemia have caused conditions that stopped BCT early. The complications of low dose BCT with Bispectral(TM) index (BIS) monitoring and those of high dose BCT without BIS monitoring have been compared to evaluate the efficacy of low dose BCT with BIS monitoring. METHODS: We analyzed 39 patients with high dose BCT group (21 patients) and low dose BCT group (18 patients). Because BIS value of 40-60 is general anesthesia score, we have adjusted the target dose of thiopental to maintain the BIS score of 40-60. Therefore, dose of thiopental was kept 1.3 to 2.6 mg/kg/hour during low dose BCT. However, high dose BCT consisted of 5 mg/kg/hour without BIS monitoing. RESULTS: The protocol of BCT was successful in 72.2% and 38.1% of low dose and high dose BCT groups, respectively. The complications such as QT prolongation, hypotension and cardiac arrest have caused conditions that stopped BCT early. Hypokalemia showed the highest incidence rate in complications of both BCT. The descent in potassium level were 0.63 +/- 0.26 in low dose group, and 1.31 +/- 0.48 in high dose group. The treatment durations were 4.89 +/- 1.68 days and 3.38 +/- 1.24 days in low dose BCT and high dose BCT, respectively. CONCLUSION: It was proved that low dose BCT showed less severe complications than high dose BCT. Low dose BCT with BIS monitoring provided enough duration of BCT possible to control ICP.
Anesthesia, General ; Barbiturates ; Coma ; Heart Arrest ; Humans ; Hypokalemia ; Hypotension ; Incidence ; Intracranial Hypertension ; Intracranial Pressure ; Potassium ; Thiopental

The effects of halothane or isoflurane, alone and in combination with propofol or thiopental were investi Rated for their effects on intracranial pressure QCP) in the rabbit, with inducing artificially-increased ICP with intracranial balloon. The higher the end-tidal concentrations of either halothane or isoflurane, the lower the mean arterial pressures(MAP) and cerebral perfusion pressures(CPP). However, the ICP was not influenced by the depth of anesthesia for either inhalation anesthetics. The mean ICPs at 1.5 MAC of halothane and isoflurane were 14+/-2 and 20+/-2mmHg, respectively. With the increase of intracranial volume using 0.7 ml-saline balloon, the ICPs were increased to 193 and 205% in halothane and isoflurane anesthesia, respectively. The ICPs were returned to the levels prior to balloon inflation by the injection of thiopental or propofoL The authors conclude that propofol could be used to reduce ICP under halothane or isoflurane anesthesia if it is ascertained to have the characteristics of balanced coupling between cerebral metabolism and blood flow like barbiturates do and either halothane or isoflurane with increasing the concentrations may decrease MAP without significant change of ICP.
Anesthesia* ; Anesthetics, Inhalation ; Barbiturates ; Halothane* ; Inflation, Economic ; Intracranial Pressure* ; Isoflurane* ; Metabolism ; Perfusion ; Propofol* ; Thiopental*

Barbiturates* ; Brain* ; Cholesterol* ; Membranes* ; Phospholipids*