STUDY DESIGN: Prospective, randomized, double blind, placebo-controlled study.PURPOSE: To compare clonidine and pregabalin with placebo for the attenuation of postoperative pain after thoracolumbar spinal surgery and instrumentationOVERVIEW OF LITERATURE: Spine surgery is associated with moderate to severe postoperative pain that needs to be controlled to improve patient’s outcome. Alpha 2 agonists (e.g., clonidine) and gabapentenoids (e.g., pregabalin) are successfully used as part of a multimodal analgesic regimen.METHODS: Total 75 patients were enrolled and randomly allocated into three groups. Group P received pregabalin (150 mg), group C received clonidine (150 mcg), and group N received placebo 90 minutes preoperatively. A standard anesthesia protocol comprising fentanyl, thiopentone, vecuronium, nitrous oxide, and oxygen in isoflurane was used for all patients. Postoperative recovery profile, pain, time for first analgesic, 24-hour analgesic requirement, sedation, and hemodynamic parameters were noted.RESULTS: Recovery profile was similar in all three groups; however, the patients in group P and C were more sedated (p<0.05). Group N patients had a higher Visual Analog Scale (VAS) score (p<0.05) and the time for first analgesic was also lower (p=0.02). Postoperative (24-hour) analgesic requirement was maximum in group N, followed by that in group C and group P. The VAS score was highest in the control group; however, after 12 hours, it was similar in all groups.CONCLUSIONS: Postoperative pain and analgesic requirement is significantly attenuated by preoperative administration of a single dose of clonidine (150 mcg) or pregabalin (150 mg); pregabalin was more effective. Thus, their use offers a reasonable strategy for pain management in patients undergoing spine surgery.
Analgesics ; Anesthesia ; Clonidine ; Fentanyl ; Hemodynamics ; Humans ; Isoflurane ; Nitrous Oxide ; Oxygen ; Pain Management ; Pain, Postoperative ; Pregabalin ; Prospective Studies ; Spine ; Thiopental ; Vecuronium Bromide ; Visual Analog Scale

OBJECTIVE: The present study aimed to report the initial seizure threshold (IST) of a brief-pulse bilateral electroconvulsive therapy (BP-BL ECT) in Korean patients with schizophrenia/schizoaffective disorder and to identify IST predictors. METHODS: Among 67 patients who received ECT and diagnosed with schizophrenia/schizoaffective disorder based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, we included 56 patients who received 1-millisecond BP-BL ECT after anesthesia with sodium thiopental between March 2012 and June 2018. Demographic and clinical information was gathered from electronic medical records, and a multiple regression analysis was conducted to identify predictors of the IST. RESULTS: The mean age of the patients was 36.9±12.0 years and 30 (53.6%) patients were male. The mean and median IST were 105.9±54.5 and 96 millicoulombs (mC), respectively. The IST was predicted by age, gender, and dose (mg/kg) of sodium thiopental. Other physical and clinical variables were not associated with the IST. CONCLUSION: The present study demonstrated that the IST of 1-ms BP-BL ECT following sodium thiopental anesthesia in Korean patients was comparable to those reported in previous literature. The IST was associated with age, gender, and dose of sodium thiopental.
Anesthesia ; Diagnostic and Statistical Manual of Mental Disorders ; Electroconvulsive Therapy ; Electronic Health Records ; Humans ; Male ; Psychotic Disorders ; Schizophrenia ; Seizures ; Sodium ; Thiopental

Internal globus pallidus (GPi) deep brain stimulation (DBS) has been widely accepted as an effective treatment modality of medically refractory dystonia. However, there have been few studies regarding the safety issue of pregnancy and childbirth related with DBS. This report describes a female patient who was pregnant and delivered a baby after GPi DBS surgery. A 33-year-old female patient with acquired generalized dystonia underwent bilateral GPi DBS implantation. She obtained considerable improvement in both movement and disability after DBS implantation. Four years later, she was pregnant and the obstetricians consulted us about the safety of the delivery. At 38-weeks into pregnancy, a scheduled caesarian section was carried out under general anesthesia. After induction using thiopental and succinylcholine, intubation was done quickly, followed by DBS turn off. For hemostasis, only bipolar electrocautery was used. Before awakening from the anesthesia, DBS was turned on as the same parameters previously adjusted. After delivery, she could feed her baby by herself, because the dystonia of left upper extremity and hand was improved. Until now, she has been showing continual improvement and being good at housework, carrying for children, with no trouble in daily life. This observation indicates that the patients who underwent DBS could safely be pregnant and deliver a baby.
Adult ; Anesthesia ; Anesthesia, General ; Child ; Deep Brain Stimulation* ; Dystonia* ; Electrocoagulation ; Female ; Globus Pallidus ; Hand ; Hemostasis ; Housekeeping ; Humans ; Intubation ; Parturition ; Pregnancy* ; Succinylcholine ; Thiopental ; Upper Extremity

BACKGROUND: In emergency condition, failure in securing airway is a common and serious reason of pediatric death. Rapid intubation is required to minimize physiologic complication in children due to airway failure. Rapid loss of consciousness and rapid onset of neuromuscular blocking agent are necessary for the rapid sequence intubation. In this study, we compared the effects of thiopental sodium, ketamine, and propofol (drugs commonly used to induce anesthesia in children) on the onset time of rocuronium. We also compared the effects of these anesthesia induction drugs on intubation condition and their duration of action. METHODS: A total of 89 patients undergoing various elective surgeries were enrolled and allocated to the following three groups according to the anesthesia induction drug: 1) Group T, thiopental sodium; 2) Group P, propofol; and 3) Group K, ketamine. After loss of consciousness, neuromuscular monitoring was performed and rocurunium 0.6 mg/kg was administered. Onset time and duration of action of rocuronium were measured. Intubation condition was recorded with a tracheal intubation scoring system. Hemodynamic changes were observed before induction until 5 min after endotracheal intubation. RESULTS: The onset time of rocuronium in group K (39.9 s) was significantly faster than that in group T (61.7 s) or group P (50.7 s). There was no significant difference in duration of action of rocuronium or intubation condition among the three groups. CONCLUSIONS: Ketamine can decrease the onset time of rocuronium significantly compared to thiopental sodium or propofol.
Anesthesia ; Child* ; Emergencies ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Ketamine* ; Neuromuscular Blockade ; Neuromuscular Monitoring ; Propofol* ; Thiopental* ; Unconsciousness

The authors describe the successful perioperative management of a 3-year-old boy from Dubai with glucose-6-phosphate dehydrogenase (G6PD) deficiency, who underwent robot-assisted laparoscopic pyeloplasty for complete right ureteropelvic junction obstruction. G6PD deficiency is a genetic disorder predisposing patients to hemolytic anemia from oxidative stress. Important considerations in anesthetic management include avoiding oxidative stress, which can be caused by various conditions, and monitoring for hypercapnia, which can cause acidosis and hemolysis. Laparoscopic surgery is usually associated with hypercapnia and therefore an increased risk for respiratory acidosis. During surgery in this particular case, efforts were made to avoid carbon dioxide retention and to keep the patient warm. General anesthesia was induced with thiopental sodium, rocuronium, and fentanyl, and maintained with sevoflurane. There were no signs of hemolysis in the perioperative period and he was discharged owing to his improved condition.
Acidosis ; Acidosis, Respiratory ; Anemia, Hemolytic ; Anesthesia, General ; Carbon Dioxide ; Child, Preschool ; Fentanyl ; Glucose-6-Phosphate* ; Glucosephosphate Dehydrogenase Deficiency* ; Glucosephosphate Dehydrogenase* ; Hemolysis ; Humans ; Hypercapnia ; Laparoscopy* ; Male ; Oxidative Stress ; Perioperative Period ; Thiopental

BACKGROUND: Thiamylal sodium is a common anesthetic barbiturate prepared in alkaline solution for clinical use. There is no previously reported study on the effects of barbiturates on the inflammation and proliferation of vascular smooth muscle cells (VSMCs). Here, we examined the effects of clinical-grade thiamylal sodium solution (TSS) on the inflammation and proliferation of rat VSMCs. METHODS: Expression levels of interleukin (IL)-1α, IL-1β, IL-6, and toll-like receptors in rat VSMCs were detected by quantitative reverse transcription-polymerase chain reaction and microarray analyses. The production of IL-6 by cultured VSMCs or ex vivo-cultured rat aortic segments was detected in supernatants by enzyme-linked immunosorbent assay. VSMC proliferation and viability were determined by the water-soluble tetrazolium-1 assay and trypan blue staining, respectively. RESULTS: TSS increased expression of IL-1α, IL-6, and TLR4 in VSMCs in a dose-dependent manner, and reduced IL-1β expression. Ex vivo TSS stimulation of rat aorta also increased IL-6. Low concentrations of TSS enhanced VSMC proliferation, while high concentrations reduced both cell proliferation and viability. Expression of IL-1 receptor antagonist, which regulates cell proliferation, was not increased by TSS stimulation. Exposure of cells to the TSS additive, sodium carbonate, resulted in significant upregulation of IL-1α and IL-6 mRNA levels, to a greater extent than TSS. CONCLUSIONS: TSS-induced proinflammatory cytokine production by VSMCs is caused by sodium carbonate. However, pure thiamylal sodium has an anti-inflammatory effect in VSMCs. TSS exposure to VSMCs may promote vascular inflammation, leading to the progression of atherosclerosis or in-stent restenosis, resulting in vessel bypass graft failure.
Animals ; Aorta ; Atherosclerosis ; Barbiturates ; Carbon ; Cell Proliferation ; Enzyme-Linked Immunosorbent Assay ; Inflammation* ; Interleukin-1 ; Interleukin-6 ; Interleukins ; Muscle, Smooth, Vascular* ; Rats ; RNA, Messenger ; Sodium ; Thiamylal* ; Toll-Like Receptors ; Transplants ; Trypan Blue ; Up-Regulation

The purpose of this study was to evaluate the effects of thiopental versus propofol on cardiopulmonary functions, when used as an induction agent prior to isoflurane anesthesia in rhesus monkeys. Eight healthy rhesus monkeys weighing 3.72 to 5.7 kg, 4-5 years old, were used in the study. Anesthesia was induced with thiopental or propofol intravenous injection, and then maintained with isoflurane in oxygen for 45 minutes. Cardiopulmonary measurements were obtained before and 5, 15, 30, 45, and 60 minutes after induction. The induction doses of thiopental and propofol were 19.41±0.54 and 9.33±1.02 mg/kg, respectively. In both groups, the values of heart rate, respiratory rate, temperature, systolic blood pressure, mean blood pressure, diastolic blood pressure, pH, and lactate were decreased, while the values of partial pressure of carbon dioxide, partial pressure of oxygen, total carbon dioxide, bicarbonate, oxygen saturation, and base excess in the extracellular fluid were increased, as compared with baseline. Systolic blood pressure was significantly lower in thiopental group compare to propofol group. Induction time was very short in both agents but not revealed a significant difference between both groups. However, recovery time was extremely faster in the propofol group. Our results demonstrated that propofol provides a minor suppression in systolic arterial blood pressure than thiopental sodium. In addition, propofol have a fast recovery effect from the anesthesia as well. Furthermore, it is suggested that thiopental sodium could also be used to induce anesthesia instead of propofol, despite slight more suppression of cardiopulmonary function compared to thiopental sodium.
Anesthesia* ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Extracellular Fluid ; Heart Rate ; Hydrogen-Ion Concentration ; Injections, Intravenous ; Isoflurane* ; Lactic Acid ; Macaca mulatta* ; Oxygen ; Partial Pressure ; Propofol* ; Respiratory Rate ; Thiopental*

BACKGROUND: This study was performed to compare the incidence of emergence agitation (EA) between inhalation and intravenous anesthesia induction in children after sevoflurane anesthesia. METHODS: In this prospective and double-blind study, 100 children aged 3 to 7 years were enrolled. Subjects were randomly assigned to the sevoflurane (Group S) or thiopental (Group T) anesthesia induction groups. Anesthesia was induced using 8% sevoflurane and 4-6 mg/kg thiopental in Groups S and T, respectively. Anesthesia was maintained with nitrous oxide and sevoflurane. The children were evaluated at 5 and 20 min after arrival in the postanesthesia care unit (PACU) with a four-point agitation scale and the Pediatric Anesthesia Emergence Delirium scale. The incidence of EA and administration of the rescue agent were recorded. RESULTS: The incidence of EA was significantly lower in Group T compared to Group S at 5 min after PACU arrival (3/49 patients, 6% vs. 12/47 patients, 26%, P = 0.019). However, there was no difference between the two groups at 20 min after PACU arrival (23/49 vs. 19/47 patients in Group T vs. Group S, P = 0.425). The overall incidence of EA was 60% (28/47 patients) in Group S and 41% (20/49 patients) in Group T (P = 0.102). The number of children who received propofol as a rescue agent was significantly lower in Group T (Group S: 14/47 vs. Group T: 5/49, P = 0.031). CONCLUSIONS: Intravenous anesthesia induction with thiopental reduced the incidence of EA in the early PACU period compared to inhalation induction with sevoflurane in 3- to 7-year-old children undergoing sevoflurane anesthesia.
Anesthesia* ; Anesthesia, Intravenous ; Child ; Delirium ; Dihydroergotamine* ; Double-Blind Method ; Humans ; Incidence ; Inhalation ; Nitrous Oxide ; Pediatrics ; Propofol ; Prospective Studies ; Thiopental*

OBJECTIVE: The potassium disturbance associated with thiopental continuous infusion in neurosurgical patients is well known. However, the effect of propofol continuous infusion on serum potassium levels has not been investigated extensively. METHODS: We reviewed the medical records of 60 consecutive patients who received coma therapy or deep sedation for intracranial pressure control using either thiopental or propofol between January 2010 and January 2012. RESULTS: The overall incidence of hypokalemia (K<3.5 mmol/L) was comparable between thiopental and propofol groups (89.2% vs. 82.6%). But, the incidence of moderate to severe hypokalemia (K<3.0 mmol/L) was significantly higher in thiopental group (51.4% vs. 13.0%, p=0.003). The lowest potassium level (2.9 mmol/L vs. 3.2 mmol/L, p=0.020) was lower in thiopental group. The patients in the thiopental group required greater potassium replacement than the propofol group patients (0.08 mmol/kg/h vs. 0.02 mmol/kg/h, p<0.001). On multivariate analysis, thiopental [odds ratio, 95% confidence interval, 7.31 (1.78-27.81); p=0.005] was associated with moderate to severe hypokalemia during continuous infusion. The incidence of rebound hyperkalemia (K>5.0 mmol/L, 32.4% vs. 4.3%, p=0.010) and the peak potassium concentration (4.8 mmol/L vs. 4.2 mmol/L, p=0.037) after the cessation of therapy were higher in thiopental group. On multivariate analysis, thiopental [8.82 (1.00-77.81); p=0.049] and duration of continuous infusion [1.02 (1.00-1.04); p=0.016] were associated with rebound hyperkalemia once therapy was discontinued. CONCLUSION: Propofol was less frequently associated with moderate to severe hypokalemia after induction and rebound hyperkalemia following the cessation of continuous infusion than thiopental.
Coma ; Deep Sedation ; Humans ; Hyperkalemia ; Hypokalemia ; Incidence ; Intracranial Hypertension ; Intracranial Pressure ; Medical Records ; Multivariate Analysis ; Potassium* ; Propofol* ; Thiopental*

A reninoma is an uncommon, benign, renin-secreting juxtaglomerular cell tumor that causes secondary hypertension in young patients. This hypertension is treated by tumor resection. Except for increased levels of plasma renin and angiotensin I and II, the other physical and laboratory examinations and electrocardiographs were within normal limits upon admission of a 19-year-old woman with a reninoma. For percutaneous computed tomography-guided radiofrequency ablation, general anesthesia was induced by thiopental sodium and rocuronium bromide and maintained with servoflurane (2-4 vol%) and oxygen. The operation ended uneventfully in hemodynamic stability. However, the patient complained of dizziness while sitting 5 hours after the operation, and hypotension was diagnosed. After aggressive normal saline (1 L) infusion over 30 min, the hypotension was corrected and the patient recovered without any other surgical complications. Here, we report the anesthetic management of a patient who underwent percutaneous computed tomography-guided radiofrequency ablation for reninoma destruction, particularly focusing on postoperative hypotension.
Anesthesia, General ; Angiotensin I ; Catheter Ablation* ; Dizziness ; Electrocardiography ; Female ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Oxygen ; Plasma ; Renin ; Thiopental ; Young Adult