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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
PubMed
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

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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.

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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.