Related Experiment Videos
Cardiac performance preserved despite thiopental loading
J G Stone1, W L Young, Z S Marans
1Department of Anesthesiology, Columbia University, College of Physicians and Surgeons, New York, New York.
Anesthesiology
|July 1, 1993
Summary
Thiopental loading in neurosurgical patients without heart disease undergoing cardiopulmonary bypass did not cause significant cardiac impairment. Patients were safely separated from bypass, indicating thiopental
Area of Science:
- Neurosurgery
- Cardiology
- Anesthesiology
Background:
- Cerebral artery aneurysm clipping often necessitates cardiopulmonary bypass and deep hypothermic circulatory arrest.
- Thiopental is frequently administered for cerebral protection during bypass, but can cause cardiac dysfunction in patients with pre-existing heart disease.
Purpose of the Study:
- To evaluate the cardiac response to thiopental loading in neurosurgical patients without significant heart disease undergoing cardiopulmonary bypass.
Main Methods:
- Twenty-four patients with giant cerebral aneurysms and minimal cardiac disease received fentanyl, nitrous oxide, and isoflurane anesthesia.
- Thiopental was titrated to achieve electroencephalographic burst-suppression before bypass and continued until after separation.
- Hemodynamic and echocardiographic measurements were taken pre- and post-bypass.
Main Results:
- Thiopental loading transiently increased heart rate and decreased stroke volume, but cardiac index, ejection fraction, and pressures remained stable.
- Thiopental plasma concentrations reached 28 ± 8 µg/mL.
- All patients were weaned from bypass without inotropic support, with post-bypass hemodynamics returning to baseline or showing improvement.
Conclusions:
- Thiopental loading to achieve electroencephalographic burst-suppression in patients with good preoperative ventricular function causes minimal cardiac impairment.
- This practice does not hinder separation from cardiopulmonary bypass in this patient population.