ABSTRACT
Carotid endarterectomy is the preferred treatment for a patient with transient ischemic attacks (TIAs) in whom carotid artery stenosis is present. This patient was a 58-year-old male associated with 60 kg in body weight and 172 cm in height. He was scheduled for elective carotid endarterectomy in ASA physical status III. For premedication, he was administered triflupromazine (Veprin ) 10 mg and glycopyrrolate 0.2 mg IM 1 hour prior to induction. Induction was established with thiopental sodium, succinylcholine after preoxygenation. N2O/O2 (2:1), isoflurane and pancuronium were administered for maintenance. For monitoring, ECG, EEG, direct arterial pressure, ETCO2, CVP and rectal temperature were performed. A primary goal of the intraoperative management is the prevention of the cerebral ischemia. He was challenged to maintain adequate cerebral perfusion without causing myocardial ischemia. The EEG is the reliable indication of cortical function during general anesthesia. No signs of the cerebral ischemia were occurred at the time of the carotid occlusion. Minute ventilation was kept mild hypo-or normocapnia. He had no new neurologic deficits and myocardial ischemia, and discharged on 14 day postoperation.
Subject(s)
Humans , Male , Middle Aged , Anesthesia, General , Arterial Pressure , Body Weight , Brain Ischemia , Carotid Stenosis , Electrocardiography , Electroencephalography , Endarterectomy, Carotid , Glycopyrrolate , Ischemic Attack, Transient , Isoflurane , Myocardial Ischemia , Neurologic Manifestations , Pancuronium , Perfusion , Premedication , Succinylcholine , Thiopental , Triflupromazine , VentilationABSTRACT
Carotid endarterectomy is the preferred treatment for a patient with transient ischemic attacks (TIAs) in whom carotid artery stenosis is present. This patient was a 58-year-old male associated with 60 kg in body weight and 172 cm in height. He was scheduled for elective carotid endarterectomy in ASA physical status III. For premedication, he was administered triflupromazine (Veprin ) 10 mg and glycopyrrolate 0.2 mg IM 1 hour prior to induction. Induction was established with thiopental sodium, succinylcholine after preoxygenation. N2O/O2 (2:1), isoflurane and pancuronium were administered for maintenance. For monitoring, ECG, EEG, direct arterial pressure, ETCO2, CVP and rectal temperature were performed. A primary goal of the intraoperative management is the prevention of the cerebral ischemia. He was challenged to maintain adequate cerebral perfusion without causing myocardial ischemia. The EEG is the reliable indication of cortical function during general anesthesia. No signs of the cerebral ischemia were occurred at the time of the carotid occlusion. Minute ventilation was kept mild hypo-or normocapnia. He had no new neurologic deficits and myocardial ischemia, and discharged on 14 day postoperation.
Subject(s)
Humans , Male , Middle Aged , Anesthesia, General , Arterial Pressure , Body Weight , Brain Ischemia , Carotid Stenosis , Electrocardiography , Electroencephalography , Endarterectomy, Carotid , Glycopyrrolate , Ischemic Attack, Transient , Isoflurane , Myocardial Ischemia , Neurologic Manifestations , Pancuronium , Perfusion , Premedication , Succinylcholine , Thiopental , Triflupromazine , VentilationABSTRACT
BACKGROUND: The purpose of this study is to delineate hemodynamic changes resulting from endotracheal intubation under the effects of thiopental sodium and propofol using the thoracic electrical bioimpedance device. METHODS: Thirty healthy adult patients, scheduled for elective surgery under general anesthesia were randomly assigned to receive thiopental sodium 5 mg/kg (Group I, N=15), or propofol 2 mg/kg (Group II, N=15) for induction. Endotracheal intubation was performed following injection of succinylcholine 1 mg/kg. Anesthesia was maintained with enflurane 1.5-2.0% and 50% nitrous oxide in oxygen. Cardiovascular parameters were measured before induction of anesthesia, at the time of pre-intubation and immediate, 1, 2, 3 and 5 minutes after intubation. RESULTS: The mean arterial pressure was significantly decreased in the propofol group compared to that of the thiopental sodium group just after the post-intubation period (p<0.05). The heart rate were decreased in both groups but there were no significant changes in heart rate and cardiac output between group I and II. In group I, systemic vascular resistance was decreased but there was no significant changes between two groups. CONCLUSION: The data suggest that the usual doses of propofol could prevent the increase in mean arterial pressure following intubation due to systemic vascular maintenance. But the intubation of anesthesia using thiopental sodium could not prevent the increase in mean arterial pressure following intubation.