Opioids are widely used as painkillers and anesthetics. Though we use opioids to relieve pain, these drugs can induce mood elevation, dependency, and withdrawal symptoms. This is why opioids are controlled-substances. Most physicians think that some substances should be controlled if they have opioid-like pharmacological properties, especially a long duration, preservation of respiration, and dependency. It is noteworthy that short-acting substances, such as midazolam and thiopental, are included in controlled substances. Their abuse is very dangerous because they frequently induce severe respiratory depression due to a narrow therapeutic window. Teaching point of this article is that designation of a new drug as a controlled substance requires scientific evidence of its link to dependency and/or withdrawal symptoms. However, this does not require abusers' convenience (long duration) or safety (maintenance of respiration). The authors present the addiction and abuse patterns of propofol as an reasons for the Korean Food and Drug Administration to designate propofol as a controlled substance. As a future study, an animal and/or a clinical model for dependency is needed to identify addictive substances. Though several neurotransmitters and their loci in the central nervous system have been studied, the precise mechanism for addiction is unknown. Also, it should be recognized that the potential for drug addiction and abuse could be masked in the early marketing period of a new drug. Physicians should monitor patients' responses carefully when they deal with the drug.
Aluminum Hydroxide ; Analgesics, Opioid ; Anesthetics ; Animals ; Carbonates ; Central Nervous System ; Controlled Substances ; Dependency (Psychology) ; Drug and Narcotic Control ; Marketing ; Masks ; Midazolam ; Neurotransmitter Agents ; Organothiophosphorus Compounds ; Propofol ; Respiration ; Respiratory Insufficiency ; Substance Withdrawal Syndrome ; Substance-Related Disorders ; Thiopental ; United States Food and Drug Administration

The purpose of this study was to determine the effectiveness of antihistamine therapy for withdrawal movements caused by rocuronium injection. One hundred seventy one ASA I-II adults undergoing elective surgery were randomly assigned to one of two groups. Patients in the control group (Group C) were premedicated with 2 mL normal saline, and those in the antihistamine group (Group A) were pre-medicated with 2 mL (45.5 mg) pheniramine maleate. After the administration of thiopental sodium 5 mg/kg, rocuronium 0.6 mg/kg was injected. Withdrawal movements were assessed using a four-grade scale. The administration of antihistamine reveals lower grade of withdrawal movement after rocuronium injection.
Adult ; Androstanols/*administration & dosage/adverse effects ; Anesthetics, Intravenous/administration & dosage ; Double-Blind Method ; Female ; Histamine H1 Antagonists/*pharmacology ; Humans ; Incidence ; Injections, Intravenous ; Male ; Middle Aged ; Movement/drug effects/physiology ; Neuromuscular Nondepolarizing Agents/*administration & dosage/adverse effects ; Pain/chemically induced ; Pain Measurement ; Pheniramine/*pharmacology ; Thiopental/administration & dosage

PURPOSE: Recently, the bispectral index monitor has been promoted as an objective measure of sedation depth during pediatric procedural sedation in the emergency department (ED). However, rectal administration of thiopental sodium for pediatric procedural sedation has not been validated. METHODS: Patients aged one to seven years and undergoing primary closure procedures for simple facial and hand laceration in the ED were enrolled. Procedural sedation was performed by rectal administration of thiopental sodium. The bispectral index score and the Ramsay Sedation Scale were recorded every 10 minutes during sedation. The investigator and treating physician were blinded to bispectral index scores, which were later correlated with the Ramsay Sedation Scales values. Receiver operator characteristic (ROC) curves were conducted to determine the ability of the bispectral index score to discriminate various thresholds of sedation depth. RESULTS: One hundred thirty paired measurements were obtained from 12 patients. The Spearman's correlation coefficient for paired measurements, was -0.906 (95% confidence interval: [-9.8] ~ [-8.1], p<0.001). ROC curve analysis demonstrated a high discriminatory power for bi-spectral index scores in predicting the level of sedation, with areas under the curve at least 0.95 for all Ramsay Sedation Scale thresholds. CONCLUSION: Bispectral index monitoring can serve as a useful, objective measure of sedation depth in pediatric procedural sedation with rectal administration of thiopental sodium in the ED.
Administration, Rectal ; Consciousness Monitors* ; Emergencies* ; Emergency Service, Hospital* ; Hand ; Humans ; Lacerations ; Research Personnel ; ROC Curve ; Thiopental* ; Weights and Measures

BACKGROUND: Rocuronium is suitable for short operations and rapidly controlling the airway on account of its rapid onset and intermediate action. However, the intravenous administration of rocuronium can cause pain and withdrawal movement in children. This study evaluated the effect of diluting rocuronium from 10 mg/ml to 1 or 0.67 mg/ml with 0.9% NaCl on the withdrawal response associated with the intravenous administration of rocuronium with the intubation dose. METHODS: Ninety pediatric patients undergoing general anesthesia were randomized into one of three groups; Group OR (only rocuronium 0.6 mg/kg, n = 30), Group SR10 (rocuronium 0.6 mg/kg diluted with 0.9% NaCl to 1 mg/ml, n = 30), Group SR15 (rocuronium 0.6 mg/kg diluted with 0.9% NaCl to 0.67 mg/ml, n = 30). After the loss of consciousness by a thiopental sodium 5 mg/kg injection, the patients from each group received the 0.6 mg/kg premixed rocuronium, respectively. Patients' withdrawal response to the injection were graded using a 4-point scale (Grade 0, 1, 2, 3). RESULTS: The incidence and the intensity of the withdrawal response were significantly lower in the SR10 and SR15 groups than in the OR group (P < 0.05). In the SR15 group, the intensity of the withdrawal response was under grade 2 in all patients. CONCLUSIONS: Diluting rocuronium to 0.67 mg/ml is a simple and effective method for preventing withdrawal movements during an intravenous rocuronium injection.
Administration, Intravenous ; Anesthesia, General ; Child ; Humans ; Incidence ; Intubation ; Thiopental ; Unconsciousness

BACKGROUND: Sevoflurane has been reported to potentiate the effect of rocuronium. We compared the effect of sevoflurane and propofol on intubating conditions and their corresponding hemodynamic changes, and also compared the intubation conditions at different intubation timing using the rocuronium. METHODS: Sixty patients were randomized into four groups: group P (P-60, P-90) received 10 mg/kg/hr of propofol after 2 mg/kg of bolus injection; group S (S-60, S-90) were inhaled with 8 vol% sevoflurane after injection of 50 mg of thiopental sodium. Intubation was attempted at either 60 seconds (P-60, S-60) or 90 seconds (P-90, S-90) after the rocuronium administration. Intubation conditions were assessed and evaluated as excellent, good, poor and inadequate. Single twitch responses were measured at every 30 seconds after rocuronium administration. Blood pressure and heart rate were measured before induction, before intubation and immediately after intubation. RESULTS: Excellent and good intubation conditions were obtained in 60% (n = 9) of group P-60, 73% (n = 11) of group S-60, 92% (n = 14) of group P-90 and 100% (n = 15) of group S-90. Single twitch responses were fewer in group P-90 and S-90 compared to those in group P-60 and S-60 (P < 0.01). Blood pressure and heart rate after intubation were elevated in all four groups. CONCLUSIONS: Intubation conditions were not significantly different between inhalation of sevoflurane and intravenous administration of propofol when using rocuronium. Prolonged interval between rocuronium administration and intubation resulted in improved intubation conditions.
Administration, Intravenous ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Inhalation ; Intubation* ; Propofol ; Thiopental

BACKGROUND AND OBJECTIVES: It has been suggested that nitric oxide (NO) and atrial natriuretic peptide (ANP) share a final common pathway for vascular smooth muscle relaxation. The aim of the present study was to determine the role of NO on the hypotensive and vasorelaxant effects of ANP. MATERIALS AND METHODS: Sprague-Dawley rats weighing 250-300 g each were anesthetized with thiopental (50 mg/kg IP). The femoral artery was cannulated and the arterial blood pressure and heart rate were continuously monitored in the anesthetized rats (n=19). ANP was administered into the jugular vein after L-NAME treatment. In vitro experiments were performed on intact and endothelium-denuded isolated thoracic aortic rings (n=51) in the presence of either L-NAME or methylene blue. RESULTS: Intravenous administration of ANP (5 ug/kg bolus and 0.2 ug/kg/min infusion) caused a decrease in the mean arterial pressure. L-NAME-pretreatment (1 mg/kg) suppressed the depressor response of ANP. In vitro, the ANP caused a dose-dependent relaxation, and the relaxation response to ANP was attenuated by L-NAME (10-4 M). Endothelium removal or methylene blue (10-5 M) also inhibited the ANP-induced vascular relaxation. CONCLUSION: These results suggest that the hypotensive and the vasorelaxant effect of ANP are, at least in part, NO-dependent.
Administration, Intravenous ; Animals ; Arterial Pressure ; Atrial Natriuretic Factor ; Endothelium ; Femoral Artery ; Heart Rate ; Jugular Veins ; Methylene Blue ; Muscle, Smooth, Vascular ; NG-Nitroarginine Methyl Ester ; Nitric Oxide* ; Rats* ; Rats, Sprague-Dawley ; Relaxation ; Thiopental

BACKGROUND: Sevoflurane has a low blood-gas partition coefficient, resulting in rapid induction and recovery. We compared the effects of sevoflurane with those of enflurane anesthesia on parturients and neonates during and after elective cesarean section. METHODS: Ninety-six parturients were divided into two groups: E (enflurane, n = 47) and S (sevoflurane, n = 49). After endotracheal intubation with intravenous administration of thiopental 4 mg/kg and succinylcholine 1.5 mg/kg, anesthesia was maintained with 50% nitrous oxide in oxygen and enflurane 1 vol% or sevoflurane 1 vol%. Maternal hemodynamic parameters, blood loss, and recovery were monitored. Neonatal outcome was evaluated by Apgar scores, umblical artery blood gas analysis and acid-base status. RESULTS: Recovery times were faster with sevoflurane anesthesia (P < 0.05). All patients in two groups developed transient hypertension and tachycardia after intubation, which returned to baseline in approximately 5 minutes. Maternal blood loss did not differ significantly between the two groups, and one patient in S group developed postoperative recall. Neonatal outcome was equally good in the two groups. CONCLUSIONS: Parturients anesthetized with sevoflurane for cesarean section recovered more rapidly compared with enflurane without any differences in hemodynamic parameters and neonatal outcome.
Administration, Intravenous ; Anesthesia* ; Arteries ; Blood Gas Analysis ; Cesarean Section* ; Enflurane* ; Female ; Hemodynamics ; Humans ; Hypertension ; Infant, Newborn ; Intubation ; Intubation, Intratracheal ; Nitrous Oxide ; Oxygen ; Pregnancy ; Succinylcholine ; Tachycardia ; Thiopental

PURPOSE: This study evaluated rectal administration of thiopental sodium provides an efficient and safe method of sedation for children in the emergency department. METHODS: A prospective, randomized, non-blind study was conducted for 18 months. Thiopental and midazolam were given by rectal administration. Chloral hydrate was given by either oral or rectal administration. Ketamine was given by intramuscular injection. The administration dose of thiopental was 25 mg/kg. We evaluated the induction time, the recovery time, the Ramsay scale, the sedative effects for the procedure and the adverse effects of each drug. RESULTS: Eighty-six (86) children were enrolled in this study. Thiopental was administered to 21 children, ketamine to 21 children, chloral hydrate to 21 children and midazolam to 23 children. The induction time for thiopental, chloral hydrate and ketamine groups were 7.6+/-4.0 min, 36.0+/-7.0 min and 7.4+/-3.8 min, respectively. The recovery time for thiopental, chloral hydrate and ketamine groups were 54.1+/-11.8 min, 76.2+/-11.4 min and 64.8+/-18.2 min, respectively. The differences in the induction time and the recovery time for each group are statistically significant (p<0.001). The Ramsay scale for thiopental, chloral hydrate, ketamine and midazolam groups were 5.4+/-1.0, 5.7+/-0.5, 6.0+/-0.2 and 1.7+/-0.7, respectively. In thiopental group, one child (4.7%) experienced desaturation and one child (4.7%) experienced a decrease in blood pressure, but, no child required hospitalization for any complication from these sedatives. CONCLUSION: Rectal administration of thiopental is efficacious and safe for sedation of pediatric patients in the Emergency Department.
Administration, Rectal ; Blood Pressure ; Child* ; Chloral Hydrate ; Emergencies* ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Hypnotics and Sedatives ; Injections, Intramuscular ; Ketamine ; Midazolam ; Prospective Studies ; Thiopental*

BACKGROUND: In intravenous administration of a depolarizing neuromuscular blocker, succinylcholine is reported to produce activation of the electroencephalogram and increase cerebral blood flow and intracranial pressure. In this point, rocuronium was recently introduced as a non-depolarizing relaxant, and recommended as a safe alternative to succinylcholine. The purpose of this study was to evaluate the effects of rocuronium and succinylcholine on cerebral blood flow velocities during anesthetic induction. METHODS: Forty patients were randomly assigned into two groups. Group 1 was administrated rocuronium 0.6 mg/kg and group 2 was administrated succinylcholine 1 mg/kg for tracheal intubation after each group had intravenous administration of thiopental 5 mg/kg. The author observed changes of mean arterial pressure, arterial carbon dioxide tension, and middle cerebral arterial blood flow velocities at 5 times: before induction (control), 30 sec after thiopental administration, 30 sec, 60 sec and 90 sec after muscle relaxant administration. RESULTS: Mean arterial pressure decreased more at 30 sec after thiopental administration compared with the control (P<0.05). Middle cerebral arterial blood flow velocities were reduced at 30 sec after thiopental administration and 60 sec after rocuronium administration compared with the control (P<0.05). Middle cerebral arterial blood flow velocities were reduced at 30, 60, 90 sec after rocuronium administration compared with succinylcholine administration (P<0.05). CONCLUSIONS: We conclude that rocuronium has little effects on increasing cerebral blood flow. These result suggest that rocuronium have a less effect on increase in cerebral blood flow during neurosurgical anesthesia.
Administration, Intravenous ; Anesthesia ; Arterial Pressure ; Blood Flow Velocity* ; Carbon Dioxide ; Electroencephalography ; Humans ; Intracranial Pressure ; Intubation ; Neuromuscular Blockade ; Succinylcholine* ; Thiopental

BACKGROUND: Even though propofol having many clinical merits, a vascular pain during intravenous administration of it could maKe us choose other induction agents. One of many METHODS to decrease vascular pain, the use of propofol preserved in a cold temperature (1 4degeesC) was introduced and Known to be effective. The purpose of this study was to compare vascular pain of cold propofol with that of thiopental as induction agents. METHODS: Sixty adult patients for elective surgery were randomly assigned to the two groups according to receiving thiopental (Group I, n = 30) or propofol (Group II, n = 30), then they were divided randomly into two subgroups according to the selection of vascular size; vein on the dorsum of hand or antecubital fossa. As an induction agent, 2.5% thiopental (5 mg/Kg) or cold 1% propofol (2 mg/Kg) were given intravenously during 40 sec. The severity of vascular pain (classified by 4 points verbal category system) and the incidences of pain were compared according to the induction agents and the selection of vascular size. The incidences of moderate to severe pain according to the selection of induction agents were compared. RESULTS: There was no significant difference in the severity, incidence of pain or incidence of moderate to severe pain in both groups, There was no significant difference in the incidence of pain according to the vascular size. CONCLUSIONS: As cold propofol was given slowly (during 40 sec), the vascular pain was not significant to hinder the selection of propofol as an induction agent compared with that of thiopental.
Administration, Intravenous* ; Adult ; Cold Temperature ; Hand ; Humans ; Incidence ; Propofol* ; Thiopental* ; Veins