Prescripciones de benzodiacepinas y barbitúricos en Costa Rica 2011-2015 / Benzodiazepines and barbiturates prescriptions in Costa Rica 2011-2015 / Prescriçãode benzodiazepinas e barbitúricos na Costa Rica 2011-2015 / Prescriptions de benzodiazépines et de barbituriques au Costa Rica 2011-2015

Resumen Objetivo Identificar la prescripción de benzodizepinas y barbitúricos psicotrópicos: Clobazam, Tiopental, Clonazepam, Lorazepam, Fenobarbital y Diazepam en la Caja Costarricense del Seguro Social (CCSS) en Costa Rica en el periodo 2011-2015. Materiales y métodos La población estuvo constituida por 1 488 989 prescripciones de psicotrópicos dentro de la CCSS en Costa Rica en el periodo de enero del 2011 a diciembre del 2015. El estudio es de tipo descriptivo retrospectivo. Resultados Del total analizado, casi la mitad (un 47,15%) corresponden a Clonazepam. Le siguen el Lorazepam y el Diazepam con un 22,80% y un 22,53%, respectivamente. Finalmente, Fenobarbital, Clobazam y Tiopental son las menos prescritas con un 7,07%, 0,24% y 0,22% respectivamente. En cuanto a la distribución por sexo las mujeres recibieron el 62,65% de las prescripciones, el restante 37,35% fueron para hombres. Conclusión Existe un aumento exponencial en el consumo de estos fármacos en el quinquenio en estudio. Las personas al final de su ciclo productivo (40 años o más) alcanzan los mayores porcentajes de consumo que luego decrecen alrededor de los 70 años o más; las mujeres son a quienes más se les prescriben este tipo de medicamentos. Por tanto, es necesaria una monitorización continúa que favorezca un uso adecuado de estos fármacos y evite generar potenciales problemas a la salud de la población especialmente a los adultos mayores.

Abstract Objective To identify the prescription of benzodiazepines and psychotropic barbiturates: Clobazam, Thiop ental, Clonazepam, Lorazepam, Phenobarbital and Diazepam at the Costa Rican Social Security Fund (CCSS) in Costa Rica in the period 2011-2015. Materials and methods The population was constituted by 1 488 989 prescriptions of psychotropics within the CCSS in Costa Rica in the period from January 2011 to December 2015. The study is of a retrospective descriptive type. Results Of the total analyzed, almost half (47.15%) corresponded to Clonazepam. It is followed by Lorazepam and Diazepam with 22.80% and 22.53%, respectively. Finally, Phenobarbital, Clobazam and Thiopental are the least prescribed with 7.07%, 0.24% and 0.22% respectively. In terms of gender distribution, women received 62.65% of prescriptions, while the remaining 37.35% were for men. Conclusion There is an exponential increase in the consumption of these drugs in the five-year period under study. People at the end of their productive cycle (40 years or more) reached the highest percentages of consumption, which then fell to around 70 years or more; women were prescribed this type of drug the most. Therefore, continuous monitoring is necessary in order to promote the adequate use of these drugs and avoid generating potential health problems in the population, especially among the elderly.

Resumo Objectivo Identificar a prescrição de benzodiazepinas e barbitúricos psicotrópicos: Clobazam, Thiopental, Clonazepam, Lorazepam, Phenobarbital e Diazepam no Fundo de Seguraba Social da Costa Rica (CCSS), na Costa Rica, no período 2011-2015. Materiais e métodos A população foi constituida por 1 488 989 prescribes de psicotrópicos dentro do CCSS na Costa Rica, no período de Janeiro de 2011 a Dezembro de 2015. O estudo é de tipo descritivo retrospectivo. Resultados Do total analisado, quase metade (47,15%) correspondia ão Clonazepam. Segue-se Lorazepam e Diazepam com 22,80% e 22,53%, respectivamente. Finalmente, Phenobarbital, Clobazam e Thiopental são os menos prescritos com 7,07%, 0,24% e 0,22%, respectivamente. Em termos de distribuição por género, as mulheres receberam 62,65% das receitas, enquanto os restantes 37,35% foram para os homens. Conclusão Verifica-se um aumento exponencial do consumo destes medicamentos no periodo de cinco anos em estudo. As pessoas no final do seu ciclo produtivo (40 anos ou mais) atingiram as percentagens mais elevadas de consumo, que depois diminuíram para cerca de 70 anos ou mais; as mulheres foram as que mais receitaram este tipo de medicamentos. Por conseguinte, é necessário um acompanhamento continuo a fim de promover o uso adequado destes medicamentos e evitar a criação de potenciais problemas de saúde na população, especialmente entre os idosos.

Résumé Objectif Identifier la prescription de benzodiazépines et de barbituriques psychotropes : Clobazam, Thiopental, Clonazepam, Lorazepam, Phenobarbital et Diazepam, dans les établissements de la Caisse Costaricienne de Sécurité Sociale (CCSS), au Costa Rica, durant la période 2011-2015. Matériels et méthodes La population a été constituée de 1 488 989 prescriptions de psychotropes au sein de la CCSS au Costa Rica durant la période de janvier 2011 a décembre 2015. L'étude est de type descriptif rétrospectif. Résultats Sur le total des prescriptions analysées, pres de la moitié (47,15 %) correspondent au Clonazépam. Viennent ensuite le Lorazépam et le Diazépam (22,80 % et 22,53 % respectivement). Enfin, le Phénobarbital, le Clobazam et le Thiopental sont les moins prescrits (7,07%, 0,24% et 0,22% respectivement). En termes de distribution par sexe, les femmes ont reçu 62,65 % des prescriptions, les 37,35 % restants ont été destinés aux hommes. Conclusion On observe une augmentation exponentielle de la consommation de ces substances au cours des cinq années a l'étude. Les pourcentages de consommation les plus élevés correspondent aux personnes arrivant a la fin de l'étape du cycle de vie généralement la plus productive (40 ans ou plus) ; ils diminuent ensuite aux alentours de 70 ans ou plus. Les femmes reçoivent plus fréquemment ce type de prescriptions. Une surveillance continue est donc nécessaire afin de promouvoir l'utilisation adéquate de ces substances et d'éviter de générer d'éventuels problemes de santé dans la population, en particulier chez les personnes âgées.

La cura de sueño en la historia / Sleep therapy in history

Resumen A finales del siglo XIX comenzaron a utilizarse sustancias tales como los bromuros para inducir sueño profundo en personas con trastornos mentales. El uso de barbitúricos con el mismo fin fue reportado por Epifanio en 1913, pero fue Kläsi quien difundió con más éxito la administración de aquellos medicamentos, particularmente el Somnifen, y la denominó "cura de sueño prolongado" o "narcosis prolongada" (dauernarkose), a partir de la década de 1920. En 1934 se introdujo el Cloettal, una mezcla de barbitúricos y otros compuestos, en reemplazo del Somnifen. El uso de este procedimiento declinó con la aparición de otros métodos terapéuticos, pero continuó por varias décadas. En la Unión Soviética, la cura de sueño estuvo influida por la doctrina pavloviana, y se usó tanto para trastornos mentales como para padecimientos considerados psicosomáticos. El mayor desprestigio del método se dio en el Hospital de Chelmsford, en Australia, donde se reportaron 25 muertes asociadas a su uso durante el periodo 1963-1979. En el 2009, el Colegio Real de Psiquiatras de Australia y Nueva Zelanda concluyó que "la terapia de sueño profundo y la administración de barbitúricos endovenosos no tiene lugar en el tratamiento de trastornos psiquiátricos". Aun cuando en la actualidad no forma parte de ningún tratamiento convencional, la cura de sueño sigue siendo ofrecida y solicitada.

Summary At the end of the 19th century, substances such as bromides began to be used to induce deep sleep in people with mental disorders. The use of barbiturates for the same purpose was reported by Epifanio in 1913, but it was Kläsi, in the early 1920s, who most successfully fostered the administration of such agents, particularly Somnifen, for what he called "sleep cure" or "prolonged narcosis" (dauernarkose). In 1934 Cloettal, a mixture of barbiturates and other compounds, was introduced to replace Somnifen. The use of this procedure declined with the appearance of other therapeutic methods, but continued for several decades. In the Soviet Union, sleep cure was influenced by the Pavlovian doctrine, and used for both mental disorders and conditions considered as psychosomatic. The method's greatest discredit occurred at Chelmsford Hospital in Australia, where 25 deaths associated with its use were reported during the period 1963-1979. In 2009, the Royal College of Psychiatrists of Australia and New Zealand concluded that "deep sleep therapy and the administration of intravenous barbiturates has no place in the treatment of psychiatric disorders". Even though, currently it is not part of any conventional treatment, sleep cure is still offered and requested.

Intoxicación por barbitúricos, una mirada toxicológica / Intoxication by barbiturates, a toxicological view / Intoxication par les barbituriques, une vue toxicologique / Intoxicação por barbitúricos, uma visão toxicológica

Resumen Objetivo: Actualizar los conocimientos acerca de las características desde el punto de vista toxicológico de las intoxicaciones por barbitúricos. Material y métodos: Se realizó un estudio donde se aplicó el método cualitativo, mediante una revisión bibliográfica y documental sobre el tema en fuentes de datos digitales. Se usaron los descriptores DeCs-MeSH: intoxicaciones, barbitúricos, tratamientos, hemoperfusión, toxicología. Se revisaron artículos publicados sobre el tema, a través de los buscadores habituales (Google, PubMed, Cochrane, Scielo, entre otros), teniendo en cuenta la calidad y la actualidad de ellos. Resultados: Tanto las dosis tóxicas como el comportamiento toxicocinético de estos fármacos son variables y dependen sobre todo del grupo al cual pertenezcan. Las intoxicaciones más frecuenten están relacionadas con los barbitúricos de acción prolongada. Debido a su alta liposolubilidad, los de acción ultracorta, pueden quedar acumulados en el tejido adiposo y al movilizarse estas reservas pueden ser fuente de toxicidad. Aunque no son comunes también hay que tener en cuenta la posible existencia de metabolitos activos. Conclusiones: Estos son fármacos en desuso debido a su estrecho margen terapéutico, la elevada dependencia y posterior tolerancia que provoca un aumento potencial de su toxicidad. Aun así, acompañados de una debida monitorización, pueden emplearse en situaciones concretas. Desafortunadamente todavía se producen numerosas muertes por sobredosis accidentales o con fines suicidas

Summary Object: To update the knowledge about the characteristics from the toxicological point of view of barbiturate intoxications. Materials and methods: A study was carried out where the qualitative method was applied, through a literature and documentary review on the subject in digital data sources. The DeCs-MeSH descriptors were used: intoxications, barbiturates, treatments, hemoperfusion, and toxicology. We reviewed articles published on the subject, through the usual search engines (Google, PubMed, Cochrane, Scielo, among others), taking into account the quality and topicality of them. Results: Both the toxic doses and the toxicokinetic behavior of these drugs are variable and depend mainly on the group to which they belong. The most common poisonings are related to long-acting barbiturates. Due to its high liposolubility, ultrashort action can be accumulated in the adipose tissue and these reserves can be a source of toxicity when mobilized. Although they are not common, one must also take into account the possible existence of active metabolites. Conclusion: These are drugs in disuse due to their narrow therapeutic margin, high dependence and subsequent tolerance that causes a potential increase in their toxicity. Even so, accompanied by a proper monitoring can be used in specific situations. Unfortunately, there are still many deaths due to accidental overdoses or suicide.

Résumé Objectif: Mettre à jour les connaissances sur les caractéristiques du point de vue toxicologique des intoxications aux barbituriques. Matériels et méthodes: Une étude a été réalisée où la méthode qualitative a été appliquée, à travers une revue documentaire et documentaire sur le sujet dans les sources de données numériques. Les descripteurs DeCs-MeSH ont été utilisés: intoxications, barbituriques, traitements, hémoperfusion, toxicologie. Nous avons revu les articles publiés sur le sujet, à travers les moteurs de recherche habituels (Google, Pub Med, Cochrane, Silo, entre autres), en tenant compte de la qualité et de l'actualité de ceux-ci. Résultats: Les doses toxiques et le comportement toxicocinétique de ces médicaments sont variables et dépendent principalement du groupe auquel ils appartiennent. Les empoisonnements les plus fréquents sont liés aux barbituriques à longue durée d'action. En raison de sa liposolubilité élevée, une action ultracourte peut être accumulée dans le tissu adipeux et ces réserves peuvent être une source de toxicité lorsqu'elles sont mobilisées. Bien qu'ils ne soient pas communs, il faut également tenir compte de l'existence possible de métabolites actifs. Conclusions: Ce sont des médicaments en désuétude en raison de leur marge thérapeutique étroite, de leur dépendance élevée et de leur tolérance subséquente qui entraîne une augmentation potentielle de leur toxicité. Même ainsi, accompagné d'un suivi approprié peut être utilisé dans des situations spécifiques. Malheureusement, il y a encore beaucoup de décès dus à des surdoses accidentelles ou à des suicides.

Resumo Objetivo: Atualizar o conhecimento sobre as características do ponto de vista toxicológico das intoxicações por barbitúricos. Materiais e métodos: Foi realizado um estudo onde o método qualitativo foi aplicado, através de uma literatura e revisão documental sobre o assunto em fontes de dados digitais. Os descritores DeCs-MeSH foram usados: intoxicações, barbitúricos, tratamentos, hemoperfusão, toxicologia. Revisamos artigos publicados sobre o assunto, através dos mecanismos de pesquisa habituais (Google, PubMed, Cochrane,Scielo, entre outros), levando em consideração a qualidade e a atualidade deles. Resultados: As doses tóxicas e o comportamento toxicocinético dessas drogas são variáveis e dependem principalmente do grupo ao qual pertencem. Os envenenamentos mais comuns estão relacionados a barbitúricos de ação prolongada. Devido à sua alta lipossolubilidade, a ação ultrital pode ser acumulada no tecido adiposo e essas reservas podem ser uma fonte de toxicidade quando mobilizadas. Embora não sejam comuns, é preciso também ter em conta a possível existência de metabolitos ativos. Conclusões: Trata-se de drogas em desuso devido à sua estreita margem terapêutica, alta dependência e subsequente tolerância que provoca um aumento potencial da sua toxicidade. Mesmo assim, acompanhado de um monitoramento adequado pode ser usado em situações específicas. Infelizmente, ainda há muitas mortes devido a sobredosagem acidental ou suicídio.

Drugs of Physical Harm in Pregnancy: Nature Vs Nurture-A Silent Battle.

Drug misuse is a major social, legal, and public-health challenge in the modern world. Drug misuse affects society, family, individual users and offsprings. Using illicit substances during pregnancy is common. A study in UK inner-city clinic demonstrated 16% of the women had taken one or more illicit substances. Screening newborns in a high-risk urban population of USA revealed 44% of 3010 babies tested positive for opiates, cocaine or cannabis. Maternal drug abuse jeopardize maternal health and results in poor foetal outcome. Here we will discuss mainly about antenatal, postnatal, foetal consequences and management of maternal drug abuse. Four drugs i.e Heroin, Methadone, Barbiturates and Cocaine have been selected because they have maximum propensity to cause physical harm. These drugs easily cross the placenta and pass into breast milk, affecting the baby and are so addictive that the unborn baby can become dependent on the drug. Women abusing these drugs during pregnancy can experience memory loss, irritability, changes in alertness and can increase the risk of antepartum haemorrhage, preterm birth, low birth weight, neural tube defects, cleft palates, cardiac defects and microcephaly. Cocaine may cause an unborn baby to die or experience stroke, which can result in irreversible brain damage as they have not yet developed the enzyme that inactivates it. Neonatal withdrawal symptoms have also been reported in infants. Drug use in pregnancy is a potentially complex bio-psychosocial problem and is best managed through careful assessment leading to a care plan that is implemented by a multidisciplinary team.

Redistribuição postmortem de barbitúricos em tecidos biológicos humanos / Postmortem redistribution of barbiturates in human biological tissues

Os barbitúricos são fármacos com atividade depressora do sistema nervoso central e estão relacionados com elevados números de casos de intoxicações e uso não-médico em vários países. No Brasil, a droga antiepiléptica mais encontrada em casos de intoxicação é o fenobarbital, pois os pacientes relatam que "essa é uma substância com ação forte no cérebro". De fato, os barbitúricos estão altamente relacionados com tentativa de suicídio e homicídio. Nesses casos existe a necessidade da quantificação dessas substâncias para correlacionar com a causa mortis. No entanto, as análises toxicológicas postmortem são de difícil execução e interpretação, pois a concentração de agentes tóxicos encontrados é bastante complexa e afetada não só pela condição de deterioração do corpo, mas também por um processo conhecido como redistribuição postmortem. Em geral, concentrações mais elevadas são encontradas no sangue situado nos sítios centrais (como o sangue coletado da cavidade cardíaca) em comparação aos níveis verificados nos vasos periféricos (como a veia femoral). Em outros casos, o tempo entre a morte e o exame postmortem é suficiente para que algumas substâncias que normalmente estariam presentes no sangue não estejam mais disponíveis neste fluido biológico. Há ainda um agravante, pois não existem valores de referências para a maioria das amostras biológicas não-convencionais, dificultando assim a interpretação dos resultados. Os exames toxicológicos devem ser realizados em amostras biológicas e tem como objetivo a avaliação da intoxicação como circunstância qualificadora do delito, como causa de periculosidade ou imputabilidade. O objetivo deste trabalho foi o desenvolvimento e aplicação de métodos de identificação de barbitúricos (butalbital, secobarbital, pentobarbital e fenobarbital) em amostras postmortem (sangue cardíaco, sangue femoral e fígado). Os analitos foram extraídos das amostras utilizando a micro extração em fase líquida (LPME), identificados...

Barbiturates are a class of drugs that act as central nervous system depressant and are associated with high numbers of poisoning cases and non-medical use in several countries. In Brazil, phenobarbital is the most related antiepileptic drug involved in intoxication cases. Patients report that "this drug is a substance with strong action in the brain." In fact, barbiturates are highly related to attempted suicide and homicide cases, in which quantification of these substances to correlate with the possible cause of death is necessary. However, postmortem toxicological analyses are difficult to perform and interpret, because the concentration of toxic agents found is quite complex and affected not only by deterioration condition of the body but also by a process known as postmortem redistribution. In general, higher concentrations are found in the blood located in central sites (e.g. heart cavity) compared with the levels found in peripheral vessels (such as the femoral vein). In other cases, the time between death and postmortem examination is enough for some substances that would normally be present in the blood are no longer available in this biological fluid. Besides, there are few reference values for most non-conventional biological samples, making it difficult to interpret the results. The objective of this work was the development and application of methods for identification of barbiturates (butalbital, secobarbital, pentobarbital and phenobarbital) in postmortem samples (heart blood, femoral blood and liver). The analytes were extracted by using liquid-phase micro extraction (LPME) and quantified by gas chromatography-mass spectrometry (GC-MS). After the development and validation, analytical methods were applied in real cases of eleven corpses autopsied by Death Verification Service of São Paulo City (USP-SVO), with suspected of barbiturates involvement. Nine cases were positive for phenobarbital. The mean ratio of blood femoral / cardiac blood was...

Análise da ocorrência de hipertensão intracraniana refratária e da resposta ao tratamento de crianças com traumatismo crânio-encefálico grave / Analysis of the incidence of refractory intracranial hypertension and the response of children with severe head trauma to the treatment

Introdução: o traumatismo crânio-encefálico (TCE) grave é frequente em pediatria, mas as recomendações para seu tratamento têm baixo nível de evidência. Objetivo: analisar a ocorrência de hipertensão intracraniana (HIC) refratária e a resposta ao tratamento em crianças com TCE grave. Métodos: coorte incluindo pacientes com pontuação abaixo de nove na Escala de Coma de Glasgow (ECG) entre setembro de 2005 e agosto de 2008. Aprovado pelo Comitê de Ética em Pesquisa da Fhemig. Resultados: analisados 156 pacientes, 116 masculinos (74,4%), idades entre três meses e 18 anos, média nove, mediana 11. Mediana da pontuação na ECG: 6. Atropelamento: 54 pacientes (34,6%); lesões em ocupantes de veículos: 34 (21,8%); queda: 21 (13,5%); e lesões em ciclistas: 18 (11,5%). Tomografia alterada: 133 pacientes (85,3%); hemorragia intracraniana: 105 (67,3%); swelling: 66 (42,3%); lesão axonal difusa: (28,8%). A monitorização da pressão intracraniana foi realizada em 73 pacientes (46,8%). Foi encontrada HIC com necessidade de tratamento em 56 (76,7%) e refratária em 30 (41%) pacientes. Destes pacientes, 10 receberam barbitúrico e sete morreram. A craniectomia descompressiva foi realizada em nove pacientes, sendo que dois faleceram. O risco relativo de morte com barbitú- rico: 3,9 (IC 95%: 1,1 a 14,1; p=0,02), com significância estatística. O risco relativo de morte com craniectomia descompressiva: 0,3 (IC95%: 0,1 a 1,0, p=0,02). Ocorreram 33 óbitos (21,1%), 59% de redução em relação a estudo anterior da Instituição. Conclusões: HIC refratária foi muito frequente em crianças com TCE grave. O uso de coma barbitúrico para seu tratamento aumentou o risco de morte em quatro vezes.(AU)

Background: Severe head trauma is common in children, but there is a lack of evidence for the intracranial hypertension treatment in the literature. Objectives: To analyze the occurrence of refractory intracranial hypertension and the response of children and adolescents with severe head trauma to the treatment. Method: Cohort study between September 2005 and August 2008 involving pediatric patients with Glasgow coma scale (GCS) from 3 to 8 points. This study was approved by the ethical committee of FHEMIG. Results: From the 156 patients, 116 were male (74,4%). The range of age varied from tree months to 18 years, mean age 9, and median 11. Median of GCS score: 6. Running over crash: 54 patients (34,6%), car occupants injuries: 34 (21,8%), falls: 21 (13,5%) e cyclist´s injuries: 18 (11,5%). Abnormalities in computed tomography: 133 patients (85,3%), intracranial hemorrhage: 105 (67,3%), swelling: 66 (42,3%), diffuse axonal injury: (28,8%). Seventy three patients received intracranial pressure monitoring (46,3%); 56 had had intracranial hypertension that needed treatment (76,7%), and 30 had had refractory intracranial hypertension (41%). From the patients with refractory hypertension, 10 received barbiturates as treatment, seven died. Nine underwent decompressive craniectomy, two died. Relative risk of death with barbiturates: 3,9 (CI 95%: 1,1 a 14,1; p=0,02). Relative risk of death with decompressive craniectomy: 0,3 (IC95%: 0,1 a 1,0, p=0,02). Total mortality rate was 21,1% (33 patients). This showed a decrease of 59% in mortality comparing to previous study done in the same hospital. Conclusion: refractory intracranial hypertension were very common in pediatric patients with severe head injury. The use of barbiturates for its treatment increased the risk of death four times.(AU)

Validation of an analytical methodology by gas chromatography for the assay of barbiturates in blood samples / Validación de una metodología analítica para la determinación de barbitúricos en muestras de sangre por cromatografía gaseosa con detector de ionización de llama

An analytical methodology was developed for the quantitative assay of phenobarbital, pentobarbital and butobarbital in blood samples, using aprobarbital as an internal standard. After sample cleaning by liquid-liquid extraction, the separation was achieved by liquid gas chromatography using a capillary column in pulsed splitless mode, temperature ramp, and helium as carrier gas and flame ionization detector. The methodology was selective, linear, precise and accurate. The linearity was adequate, between 20 and 100 mcg/mL, for all of three barbiturates studied. The developed methodology was applied in two forensic cases presented in the Toxicology lab of the National Institute of Legal Medicine and Forensic Sciences in Bogotá.

Una metodología analítica fue desarrollada y validada para la determinación de butabarbital, pentobarbital y fenobarbital en muestras de sangre, utilizando aprobarbital como estándar interno. Para la identificación de los diferentes fármacos se llevó a cabo una extracción líquido-líquido con posterior separación cromatográfica empleando una columna capilar en modo de inyección pulsado sin división conrampa de temperatura, helio como gas de arrastre y detector de ionización de llama. La metodología validada fue selectiva, lineal, precisa y exacta. La linealidad fue evaluada para concentraciones entre 20 y 100 mcg/mL para cada uno de los tres barbitúricos. La metodología desarrollada se aplicó en dos casos forenses presentados en el Laboratorio de Toxicología del Instituto Nacional de Medicina Legal y Ciencias Forenses en Bogotá.

Pink teeth in toxicology.

Pink teeth may be seen after trauma, a fight or car accident, and barbiturate poisoning. Pink dentine is visible by external inspection, although a case could be made for any pigmentation present originally in the layers of the tooth root having been leached out over the course of time. In the cases reported in the forensic literature two strong factors seem to contribute to the appearance of the pink colouration. This paper reviews the causes, detection and factors responsible for pink teeth.

Profound hypothermia and circulatory arrest for aneurysm surgery / 대한마취과학회지

Direct surgical repair of complex intracranial vascular lesions is difficult. Sometimes the neurosurgery is performed under circulatory arrest, profound hypothermia and barbiturates cerebral protection. Total ischemia is tolerated for 30~60 minutes because oxygen requirements of the brain decrease exponentially as body temperature is lowered. We experienced that this technique was successfully used for inoperable basilar artery aneurysm. We reviewed the surgical and anesthetic considerations of basilar artery aneurysm.

Experimental Study of Barbiturates on Cerebral Protective Action with a Rat Forebrain Ischemic Model / 대한마취과학회지

The pathologic effects of barbiturates on cerebral ischemia were investigated in 40 male rats. Twenty animals given intravenous thiopental (4 mg/kg) before 10-minute occlusion of both common carotid arteries with mean arterial pressure of 50 mmHg were compared to 20 control animals which were not treated with thiopental. 1) There were no significant statistical differences in body weight, body temperature and mean arterial pressure between the two groups. 2) The experimental group treated with barbiturates showed a significant decrease in neuronal damage at the hippocampus CA 1 area (p<0.0001). From the above results, barbiturates are effective in preventing damage of the nervous tissue during brain ischemia.