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[High-dose thiopental infusion in cerebral dysfunction following extracorporeal circulation]
Insights
Thiopentone infusion effectively treated convulsions in cardiac surgery patients when other drugs failed. However, it did not prevent cerebral dysfunction caused by prolonged low blood pressure.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Cerebral dysfunction and convulsions are serious complications after cardiopulmonary bypass.
- Existing anticonvulsant therapies (phenytoin, diazepam, clonazepam) may be insufficient in some cases.
Purpose of the Study:
- To evaluate the efficacy and safety of thiopentone (thp) infusion for managing cerebral dysfunction and convulsions in patients undergoing cardiac surgery with extracorporeal circulation.
- To investigate the causes of cerebral dysfunction in patients treated with thiopentone.
Main Methods:
- Retrospective analysis of 33 patients receiving thiopentone infusion for cerebral dysfunction or convulsions.
- Thiopentone administered as a slow injection (10-15 mg/kg) followed by continuous infusion (2-4 mg/kg/h) for 0.5-5 days.
- Comparison of outcomes and causes of cerebral dysfunction between survivors and non-survivors.
Main Results:
- Nine out of 33 patients died.
- Among 24 survivors, 18 had good recovery and 6 were moderately disabled.
- Embolization was the primary cause of cerebral dysfunction in survivors; prolonged hypotension was the main cause in non-survivors.
Conclusions:
- Thiopentone infusion can ameliorate convulsions and psychosyndromes, likely due to its anticonvulsive and potential ischemic effects.
- Thiopentone offers no protection against cerebral dysfunction resulting from prolonged hypoperfusion.
- The use of barbiturates like thiopentone for general cerebral protection is not justified based on known effects.
Abstract:
Thiopentone (thp) infusion was administered to 33 patients with cerebral dysfunction or convulsions out of 2986 patients operated on via extracorporeal circulation because of valvular disease, coronary insufficiency, septum defects and intrathoracic aortic aneurysms. If phenytoin, diazepam and clonazepam proved ineffective, thp 10-15 mg/kg was injected slowly, followed by infusion of 2-4 mg/kg/h for 0.5-5 days. 9 patients died. 18 survivors had a good recovery, 6 were moderately disabled. In the survivors embolisation of particulate matter prevailed as a cause of cerebral dysfunction while in nonsurvivors prolonged pre- and postoperative hypotension was the main cause, with one patient suffering a hemispheric infarction. The amelioration of convulsions and psychosyndromes in the survivors is compatible with the known anticonvulsive effect of thp and its alleged influence on cerebral focal ischaemia. However, in protracted cerebral hypoperfusion as a cause of cerebral dysfunction no protection can be expected from thp. The known effects of barbiturates do not justify the use of these substances for the purpose of cerebral protection.