Effects of Thiopental (Trapanal) on Coronary Blood Flow and Myocardial Metabolism in Man

Sonntag, H.; Hellberg, K.; Schenk, H.-D.; Donath, U.; Regensburger, D.; Kettler, D.; Duchanova, H.; Larsen, Reinhard

doi:10.1097/00132586-197602000-00014

Cited by 10 publications

(15 citation statements)

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“…First, no preload dependence was associated with LV systolic dysfunction, as reflected by the absence of relevant respiratory variations of LVOT Doppler velocity in SC patients who were all mechanically ventilated and with sinus rhythm (21). Second, thiopental, which has a marked negative inotropic effect, was not used more frequently in our SC patients (24,25). Third, severe metabolic acidosis, septic shock, or severe hypoxemia have been ruled out.…”

Section: Discussionmentioning

confidence: 96%

Prevalence and Risk Factors of Stress Cardiomyopathy After Convulsive Status Epilepticus in ICU Patients

Belcour

Jabot

Grard

et al. 2015

Critical Care Medicine

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Section: Discussionmentioning

confidence: 96%

Prevalence and Risk Factors of Stress Cardiomyopathy After Convulsive Status Epilepticus in ICU Patients

Belcour

Jabot

Grard

et al. 2015

Critical Care Medicine

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“…Concerns regarding the use of thiopentone in CAD patients originated from studies that had shown increase in heart rate and increase in myocardial oxygen uptake with thiopentone. [11] Reiz et al, however, postulated that this hemodynamic effect was probably related to a different administration technique -thiopentone 4 mg/kg was administered over 30 seconds…”

Section: Discussionmentioning

confidence: 99%

A randomized trial of anesthetic induction agents in patients with coronary artery disease and left ventricular dysfunction

et al. 2010

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The deleterious effects of anesthetic agents in patients suffering from coronary artery disease are well known. The risk increases when a patient has compromised ventricular function. There is a paucity of literature regarding the choice of the suitable agent to avoid deleterious effects in such patients. The use of etomidate and propofol has been considered superior to other intravenous anesthetic agents in these groups of patients. The aim of the present study is to compare the hemodynamic effects of anesthesia induction with etomidate, thiopentone, propofol, and midazolam in patients with coronary artery disease and left ventricular dysfunction. This randomized clinical trail was conducted at the All Indian Institute of Medical Sciences, New Delhi, India. Sixty patients with coronary artery disease and left ventricular dysfunction (ejection fraction < 45%) scheduled for elective coronary artery bypass surgery participated in this study. After stabilization baseline hemodynamic data stroke volume variation and systemic vascular resistance index were recorded for all patients (Flo Trac TM sensor with Vigileo cardiac output monitor used for hemodynamic monitoring). The patients were randomly alloted to one of the four groups and the intravenous induction agent was administered for over 60-90 seconds (Group E--Etomidate 0.2 mg/Kg; Group M--Midazolam 0.15 mg/Kg; Group T--Thiopentone 5 mg/Kg; Group P--Propofol 1.5 mg/Kg). Hemodynamic data were recorded at one minute intervals starting from induction till seven minutes after intubation,--the end point of the present study. There was a significant decrease in the heart rate in comparison to the baseline(-7 to -15%, P = 0.001), mean arterial pressure (-27 to -32%, P = 0.001), cardiac index (-36 to -38%, P = 0.001), and stroke volume index (-27 to -34%, P = 0.001) after induction in all four groups. The hemodynamic response was similar in all the four groups. There was no significant change in central venous pressure and stroke volume variation (SVV) during induction and intubation, while the effects on the systemic vascular resistance index (SVRI) were variable. The midazolam group was the most effective in preventing intubation stress (tachycardia,hypertension). The change from baseline values in heart rate (+ 4%, P = 0.12) and mean arterial pressure (-1%, P = 0.77) after intubation were not statistically significant in the midazolam group. The etomidate group was the least effective of all the four groups in minimizing stress response, with statistically significant increase from baseline in both heart rate (P = 0.001) and mean arterial pressure (P = 0.001) at 1 minute after intubation. All the four anesthetic agents were acceptable for induction in patients with coronary artery disease and left ventricular dysfunction despite a 30-40% decrease in the cardiac index. Clinician experience along with knowledge of the potential interactions (e.g., premedication, concurrent opioid use) is needed to determine hemodynamic stability during anesthetic induction in these patie...

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“…Animal experimentation has demonstrated that barbiturate therapy may effect brain damage postcirculatory ar rest [4,10,11] by reducing cerebral metabo lism [12,13], by possibly causing suppres sion of catecholamine-induced brain hyper metabolism postasphyxiai insult [14], by preventing destruction of cell membranes of active free radicals [15], by decreasing intra cranial pressure [2,16], and by improving the oxygen utilization coefficient [17], It was study evaluating the use of thiopental in adult patients after cardiac arrest, which also did not find evidence that treatment with thiopental resulted in any beneficial cerebral sparing effect [21],…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of Thiopental in the Asphyxiated Neonate

Garg

Goldberg²,

Woo-Ming³

et al. 1988

Dev Pharmacol Ther

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The pharmacokinetic properties of thiopental were studied in 10 asphyxiated neonates (mean ± SE; birth weight, 3,244 ± 212 g; gestational age, 40 ± 1 weeks) as part of a randomized, controlled trial which tested the ability of barbiturate therapy to decrease central nervous system damage secondary to perinatal asphyxia. Therapy was begun at a mean age of 2.3 h in all and was initially given as a loading dose of 15 mg/kg over 30 min followed by a constant infusion. The mean steady-state thiopental concentration was 13.4 ± 3.7 μg/ml (mean ± SD) and the average time to reach steady state was 7 ± 5 h. Mean elimination half-life, plasma clearance and volume of distribution for thiopental were 39 h (range 26-70), 66 ml/(h × kg) (range 31-172), and 3.6 liters/kg (range 1.1-6.7), respectively. Arterial blood pressure support was required in 8 of 10 patients. While it appears feasible to give thiopental to the asphyxiated neonate at the reported infusion rates, the risk-benefit ratio is increased by the frequent associated hypotension and need for pharmacologic blood pressure support.

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Effects of Thiopental (Trapanal) on Coronary Blood Flow and Myocardial Metabolism in Man

Cited by 10 publications

References 0 publications

Prevalence and Risk Factors of Stress Cardiomyopathy After Convulsive Status Epilepticus in ICU Patients

Prevalence and Risk Factors of Stress Cardiomyopathy After Convulsive Status Epilepticus in ICU Patients

A randomized trial of anesthetic induction agents in patients with coronary artery disease and left ventricular dysfunction

Pharmacokinetics of Thiopental in the Asphyxiated Neonate

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