Estudio de los efectos de la asociación Ketamina-tiopental como co-inductores en los distintos periodos de la anestesia general / Study of the effects of ketamine-thiopental partnership as co-inducers in different periods of general anesthesia

La asociación de drogas tiene como finalidad potenciar efectos benéficos y disminuir reacciones adversas, esta investigación pretendió demostrar los efectos de la asociación de Tiopental sódico mas ketamina en dosis subterapeuticas, comparándola con Tiopental sódico en la inducción de la anestesia general para colecistectomías electivas y de urgencia, enfocando el efecto en la analgesia posoperatoria en sala de recuperación posanestesica. Estudio de investigación clínica, estadístico-prospectivo, doble ciego, 150 pacientes, 75 del grupo K, Ketamina 0,8 mg /kg EV mas Tiopental sódico 2 mg/kg EV y 75 del grupo T, Tiopental sódico 5 mg/kg EV, en ambos grupos se administró Anestesia General Balanceada, se valoró calidad de analgesia posoperatoria mediante, el tiempo de analgesia, escala visual numérica para intensidad del dolor y dosis de Morfina suplementaria como dosis rescate en el posoperatorio. Ambos grupos poblacionales fueron similares, con parámetros hemodinámicos y efectos adversos sin diferencia estadísticamente significativa. El tiempo analgésico, definido como el tiempo transcurrido hasta la necesidad de la primera dosis analgésica posoperatoria fue mayor en el grupo K comparado con el grupo T (media 194,64 min. EE 12,00 vs 143,54 EE 7,52 p 0,0001). Escala visual numérica = 3 se presento en el grupo K con diferencia significativa (p 0,0092) y el promedio del consumo total de morfina también fue menor en el grupo K 3.12 mg (EE 0.59) y en el grupo T 6.15mg (E 0.67) obteniéndose p: 0.00001. En este trabajo de investigación la Ketamina demostró marcado efecto en la analgesiaposoperatoria de la población estudiada, no solo por su efecto antagónico de los receptores N.M.D.A, receptores involucrada en la transmisión del dolor sino también por su interacción con receptores opioides, lo cual es concordante con la bibliografía consultada. Su metabolito Norketamina potencia el efecto opioide y potencia el efecto ntinociceptivo de la Morfina

SUMMARY: The association aims to enhance drugs beneficial effects and reduce adverse reactions, this research seeks to demonstrate the effects of the association of sodium thiopental with ketamine subtherapeutic, compared with sodium thiopental for induction of general anesthesia for elective and emergency cholecystectomies , focusing on the effect on postoperative analgesia in recovery room postanesthesic. Clinical research study, statistical-prospective, double blind, 150 patients, 75 of Group K, ketamine 0.8 mg / kg sodium thiopental EV 2 mg / kg group and 75 EV T thiopental sodium 5 mg / kg IV, in both groups were given general anesthesia, was assessed by postoperative quality of analgesia, analgesia duration, visual numeric scale for pain intensity and supplemental morphine as rescue doses postoperatively. Both populations were similar, with adverse hemodynamic and no statistically significant difference. The analgesic time, defined as time to first need for postoperative analgesic dose was higher in group K than in group T (mean 194.64 min. 12.00 vs 143.54 EE EE 7.52 p 0, 0001). Visual numeric scale = 3 is presented in the K group with significant difference (p 0.0092) and mean total morphine consumption was also lower in group K 3.12 mg (SD 0.59) and in group T 6.15mg (E 0.67) to obtain p: 0.00001. In this research work, ketamine showed marked effect in postoperative analgesia of the population studied, not only by its antagonistic effect of NMDA receptors, receptors involved in pain transmission but also by their interaction with opioid receptors, which is consistent with the literature. Norketamine metabolite enhances the effect and power opioip antinociceptive effect of morphine

Propofol vs. thiopental NA; pregnancy outcome and postoperative nausea and vomiting [PONV] in art cycle

The aim of this study was to compare the side effects, fertilization rate and pregnancy rate [PR] and duration of recovery between Propofol and Thiopental Na after ICSI-vaginal retrieval of oocyte in ART cycle. This study was a prospective, randomized clinical trial. Ninety eight ASA [American Society of Anesthesiologist] physical status I and II women participating in an intracytoplasmic sperm injection [ICSI] program were assessed. All of the patients underwent general anesthesia induction with Propofol and Thiopental Na. The first group [49 cycles] received 2-2.5mg/kg of Propofol, and the second group [49 cycles] received 5mg/kg Thiopental during transvaginal oocyte retrieval. An informed consent form was obtained for each patient's treatment. Variables under study included: female age, cause and duration of infertility postoperative nausea and vomiting [PONV], heamodynamic changes, mean number of oocyte retrieved, oocyte metaphase II, embryo cleaved, embryo transferred, embryo quality and pregnancy rate [PR] and duration recovery. Statistical analysis was carried out by using SPSS. 10 software and statistical test of T-test and chi-square. The PR in Propofol group was 18 [36.7%] and in Thiopental Na group was 19 [38.8%] with no significant differences the mean duration of infertility and weight weren't statistically significant. The mean number of oocyte retrieved [metaphase II], embryo cleaved, embryo transferred and embryo quality weren't significant between the two groups. The incidence of nausea in Propofol group in comparison with Thiopental Na group was lower with significant differences. The incidence of vomiting between two groups was statistically significant [46.9% vs. 28.6% respectively] [p<0.05] between two groups Duration of recovery in Propofol group was 15 +/- 3 min and in Thiopental Na group was 25 +/- 5 min that was statistically significant [P<0.05]. Propofol offered lowerincidence of post operative nausea and vomiting and a quick recovery from anesthesia without any adverse effect on pregnancy outcome. These findings showed that Propofol was a good alternative for Thiopental Na in short time operation, like ICSI -vaginal retrieval of oocytes

Cardiovascular collapse during induction of general anesthesia.

Anaphylactic reactions to anesthetic drugs, though rare, may be encountered by anyone involved. The clinical manifestation of the anaphylactic reactions, which may be different from patient to patient, is caused by the histamine released either from the mast cells or basophils or both. Laboratory investigations can determine the source of histamine release. Here, I present a case of anaphylactic reaction to sodium thiopental. The main stay of the treatment is oxygenation, fluids and epinephrine, which was applied in this case also, with successful outcome of the patient.

Comparison between propofol and thiopentone sodium for laryngeal mask airway insertion in day case surgery

To assess the effectiveness of laryngeal mask airway insertion after induction with propofol or thiopentone in one hundred urological patients. This study was carried out in the Department of Anaesthesiology Khyber Teaching Hospital Peshawar from January 2007 to June 2007. Hundred urological patients coming for day case surgery were included in the study. Patients were divided into two groups [A and B] of fifty each. Group A [Propofol Group] received propofol [2.5mg/kg] and Group B [Thiopentone group] received thiopentone sodium [4-6 mg/kg] IV. Management of anaesthesia was identical in both groups. Midazolam 0.03 mg/kg body weight was used for co-induction. Laryngeal mask airway was inserted after adequate level of anaesthesia. The presence of gagging, coughing, laryngospasm and movement was noted and graded. Thiopentone was associated with an adverse response in 76% of patients, compared with propofol in 26% [p<0.01]. Head movement, laryngospasm, inadequate jaw relaxation were more common using thiopentone [p<0.05]. The quality of anaesthesia according to patients was significantly higher in the propofol group [Group A, 80%] than in thiopentone group [Group B, 30%]. Adverse responses in propofol Group were less than thiopentone Group. Propofol, therefore is superior to thiopentone as an induction agent for laryngeal mask airway

Comparative effects of different anesthetic regimens on the oculocardiac reflex

The oculocardiac reflex [OCR], which is most often encountered during strabismus surgery in children, may cause bradycardia, arrhythmias, and cardiac arrest following a variety of stimuli arising in or near the eyeball. The main purpose of this study was to evaluate the effects of various anesthetic regimens on modulation of the cardiovascular response of the OCR during strabismus surgery. Three hundred American Society of Anesthesia [ASA] physical status I-II patients, scheduled for elective strabismus surgery under general anesthesia, randomly allocated in a double blind fashion to one of three anesthetic regimens of group P [propofol 2 mg/kg, alfentanil 0.02 mg/kg, and atracurium 0.5 mg/kg at induction], group K [ketamine racemate 2mg/kg, alfentanil 0.02 mg/kg, and atracurium 0.5 mg/kg at induction] and group T [thiopental 5mg/kg, alfentanil 0.02 mg/kg, and atracurium 0.5 mg/kg at induction. Mean arterial pressure [MAP] and heart rate [HR] were recorded just before and at 1, 15, 30, 45, and 60 min after induction. OCR was defined as a 20 beats/min change in HR induced by traction compared with basal value. Mean heart rate [ +/- SD] during the course of surgery in group P was significantly slower than in the K group [111.90 +/- 1.10 vs. 116.7 +/- 0.70 respectively, P < 0.05] .Mean HR changes [ +/- SD] in group K was significantly higher than in P group [11.2 +/- 1.44 vs. 8.7 +/- 1.50 respectively, P < 0.05]. Mean arterial pressure changes [ +/- SD] were significantly lower in group P than in group K or T patients [12.5 +/- 1.13 vs. 19.3 +/- 0.80 or 18.9 +/- 0.91 respectively, P < 0.05]. Frequency of OCR was significantly lower in group K than group T or P patients [9% vs. 16% or 13% respectively, P < 0.05]. Induction of anesthesia with ketamine is associated with least cardiovascular changes induced by OCR during strabismus surgery

[ comparison of propofol with thiopental on neonatal apgar during cesarean section]

Neonatal apgar, at the beginning of childbirth, is one of the most important causes of postnatal death. The aim of this study was to compare the effect of thiopental with that of propofol on neonate apgar and on their mothers. In this clinical double blind trial, seventy women undergoing elective cesarean section were randomly divided into two equal groups. In the first group, general anesthesia was induced by interavenous [IV] injection of 5mg/kg thiopental and 2mg/kg of succinyl choline per kg of mother weight. After intubations, 0.4g of atracurium per kg was used. In the second group, general anesthesia was initially induced using 2 mg of each propofol and succinyl choline and followed by injection of propofol, 0.1mg/min per kg of mother weight. Neonates apgar in the first and fifth minutes and post operation complications in the mothers were recorded in both the groups. Data were analyzed using independent t, X[2], and Fisher tests. Neonate's apgar in the fifth minute after birth was 10 in 97.2% of group one and 100% of group two [P>0.05]. There was a significant decrease in mothers systolic blood pressure in propofol group 4 minutes after anesthetic induction. In the group two, who received propofol, the post operative opioid usage and mean recovery time were significantly less than group one [P<0.01]. The results of this study showed that induction of anesthesia using propofol would decrease the time of maternal recovery and also reduce the amount of drug required for mother at the first two hours post-operation with no effect on decreasing neonate apgar

Hemodynamic variation following induction and tracheal intubation-thiopental vs propofol

Hemodynamic variations are inevitable during induction of anesthetic drugs. The present study, investigates the hemodynamic variations of two different drugs used for induction; Thiopental vs. Propofol. In a prospective randomized double-blind study, from June 2003 to November 2004, 120 [ASA I and II] patients scheduled for elective surgery, were randomly divided into two equal groups. Patients were premedicated with midazolam [0.05 mg/kg] and fentanyl [1 micro g/kg]. Anesthesia was induced with either thiopental 5 mg/kg [group T] or propofol 2 mg/kg [group P]. Neuromuscular blockade was achieved with atracurium [0.5 mg/kg] and anesthesia was maintained with halothane 1%, nitrous oxide [67%] in O[2]. Hemodynamic variable [systolic and diastolic blood pressure, mean arterial pressure and heart rate] were measured non-invasively in three periods: before drug administration, immediately after injection, prior to intubation, and finally immediately after intubation. The incidence of hemodynamic changes in systolic, diastolic, mean arterial blood pressures and heart rate were significantly higher in group T compared to group P. We conclude that Propofol causes less hemodynamic changes compared to Thiopental. Therefore, we recommend Propofol especially when dealing with hemodynamically compromised patients

Effect of intravenous anesthetics on endothelium-dependent vasodilatation in intact rats

In-vitro studies had shown that ketamine, thiopental and propofol attenuated endothelium-dependent vasodilatation in different species. In this study, the effect of intravenous anesthetics on endothelium-dependent and - independent vasodilatation was examined in intact rats. The effect of acetylcholine and sodium nitroprusside on mean arterial pressure [MAP] was examined in conscious and ketamine, thiopental, propofol and urethane anesthetized rats. MAP was significantly higher in ketamine-anesthetized rats than in conscious rats. There was no significant change in MAP in other anesthetized groups. Also, acetylcholine and sodium nitroprusside induced dose-dependent decrease in MAP in all groups. Ketamine and thiopental potentiated the vasodepressor effect of both acetylcholine and sodium nitroprusside in comparison to the conscious group. Propofol did not have any significant effect on the vasodepressor response to both acetylcholine and sodium nitroprusside. Urethane potentiated the effect of acetylcholine but not that of sodium nitroprusside induced vasodilatation. Ketamine and thiopental, but not propofol, potentiated both endothelium-dependent and independent vasodilatation in intact rats

Estudo comparativo da anestesia com propofol ou thionembutal em cães / Comparative study of the anesthesia with propofol or thionembutal in dogs

Os autores compararam o uso de propofol e thionembutal observando as freqüências cardíaca e respiratória e a presença das seguintes intercorrências: apnéia, tremor, bradicardia, taquicardia, taquipnéia e parada cardíaca. Foram randomizados 100 cães para serem anestesiados com propofol ou thionembutal, sendo monitorizados os parâmetros de interesse ao estudo. Foi constatado que existe importância significantemente maior em relação a ocorrência de apnéia e tremor em ambos os grupos, sendo menores com o uso de propofol. O propofol mostrou-se uma droga mais segura para a anestesia em cães do que o thionembutal.

Xilazina como pré-medicação para anestesia com tiopental sódico em cães / Xylazine as a premedication for thiopental sodium anaesthesia in the dogs

A xilazina produz um bom efeito sedativo-analgésico quando associado à drogas anestésicas. O tiopental sódico é um barbitúrico de curta duração que produz sonolência, sedação e hipnose. O objetivo deste trabalho é verificar a eficiência da associação da xilazina como pré-medicação e do tiopental sódico na manutenção da anestesia, em cães. Foram usados 32 cães sem raça definida, adultos, machos e com peso entre 8 e 10 kg, que foram submetidos à procedimento operatório no esôfago cervical. A dose média de xilazina administrada foi de 3,8 mg/kg e de tiopental sódico foi de 7,7 mg/kg. Não houve necessidade de intubação endotraqueal e não ocorreu óbito relacionado com as medicações anestésicas. Concluindo, o procedimento anestésico descrito é de fácil execução, é seguro e diminui o estresse do animal.

Calosfrío postoperatorio relacionado con el uso de propofol comparado con tiopental / Relationship of postoperative shivering with the use of Propofol or Thiopental

El objetivo del estudio fue comparar la frecuencia de aparición de calosfrío postoperatorio con la administración de propofol o tiopental para la inducción de la anestesia. Se estudiaron 40 pacientes de ambos sexos; grupo 1 (n = 20) estudio, propofol 2.5 mg/kg y grupo 2 (n=20) control, tiopental 5 mg/kg. Se registró el tiempo anestésico quirúrgico y grado de calosfrío 10 minutos después del ingreso de los pacientes a recuperación. La temperatura de la sala de operaciones y axilar se monitorizó durante los periodos pre, trans y postanestésico inmediato. La duración de los procedimientos fue de 115 ñ 33 y 95.5 ñ 40 minutos en los grupos 1 y 2 respectivamente. La temperatura de la sala de operaciones en el grupo 1 fue de 22.6 ñ 2.1 y 23.7 ñ 1.5 ºC en el grupo 2 con diferencia de p < 0.003. El calosfrío postoperatorio se presento en el 30 por ciento de los pacientes manejados con propofol y 60 por ciento en los de tiopental (p < 0.03). El promedio del registro de la temperatura axilar durante los procedimientos fue de 35.9 ñ 0.6 para el grupo 1 y 36 ñ 0.6 ºC para el grupo 2. La administración de propofol como agente inductor de la anestesia se asocia con una baja incidencia de calosfrío postoperatorio comparado con el uso de tiopental

Utilización de métodos experimentales para constatar procesos degenerativos en trayectos nerviosos: una ayuda para comprobar la evolución de la degeneración nerviosa en animales vagotomizados vagotomizados / Utilization of experimentals methods to verify degenerations lapses in nervous distance: a help to confirm the evolution of degeneration lapse in vagotomized animals

Se presentan los hallazgos en relación al patrón de degeneración nerviosa observando en los estómagos de 25 ratas albinas y 8 perros. Ambos tipos de animales fueron divididos en dos grupos, un primer grupo fue sometido a vagotomía por las técnicas convencionales y un segundo grupo fue intervenido con microcirugía. Los tiempos de superviviencia permitidos fueron desde 24 horas hasta 5 meses. Las muestras de estómago fueron procesadas por parafina y luego sometidos a diversas técnicas de coloración y de impregnación. Se correlacionaron los patrones de degeneración con el tipo de intervención quirúrgica practicada

Tiopental sódico, etomidato y propofol: efectos sobre tensión arterial y frecuencia cardíaca durante la inducción anestésica / Thiopental sodium etamidat and propofol: effects on arterial pressure and heart rate during the anesthetic induction

Con el fin de comparar las variaciones de tensión arterial y frecuencia cardíaca durante la inducción anestésica con Tiopental Sódico, Etomidato y Propofol, se estudiaron 30 pacientes de edades comprendidas entre 25 y 50 años, ASA I, sin premedicación que iban a ser sometidos a anestesia general para cirugía electiva. Fueron distribuidos aleatoriamente en 3 grupos. En un grupo, la anestesia fue inducida con Tiopental Sódico (4 mg/kg), otro grupo con Etomidato (0,3 mg/Kg), y el otro con Propofol (2,5 mg/kg). Todos los pacientes recibieron Fentanil (5 mg/kg) 10 minutos antes de la inducción anestésica. La tensión arterial sistólica y diastólica disminuyó en los 3 grupos sin diferencias significativas. La frecuencia cardíaca descendió en los grupos inducidos con Propofol y con Etomidato. Las variaciones de la frecuencia cardíaca en los 3 grupos fueron significativas. Se concluyó que con la administración de Etomidato se produce más estabilidad hemodámica que con Tiopental Sódico o Propofol

Respostas circulatórias à induçåo e intubaçåo traqueal com associaçåo de vecurônio ao tiopental ou etomidato / Circulatory responses to induction and tracheal intubation under vecuronium associated with thiopental or etomidate

Background and Objectives - Vecuronium has been shown to cause minimum cardiovascular effects. However, some authors have demonstrated bradycardia associated with its use. The purpose of this study was evaluate the changes in arterial blood pressure and heart rate following the use of vecuronium, in patients induced with etomidate or thiopental. Methods - Forty adult patients submitted to elective surgical procedures were studied and were allocated into 4 groups as folows: Group NT = 10 normotensive patients induced with thiopental; Group NE = 10 normotensive patients induced with etomidate; Group HT = 10 hypertensive patients induced with thiopental; Group HE = 10 hypertensive patients induced with etomidate. All patients were sedated with diazepan and fentanyl, and received fentanyl and vecuronium during induction, besides the specific induction agent for each group. Systolic and diastolic blood pressure and heart rate were evaluated at six consecutive moments: M1 = control, beforeinduction; M2 = two minutes following sedation; M3 = immediately following induction; M4 = one minute following orotracheal intubation; M5 = three minutes following orotracheal intubation. M6 = six minutes following orotracheal intubation. Results - Anthropometric data were similar in all groups (p<0.05). Systolic and diastolic blood pressures were evaluated separetely and a statistically significant decrease was observed at moment 3, as compared to moments 1 and 2, although the values were not clinically relevant in any of the groups. Regarding heart rate, statistically significant decreases were observed in the groups induced with etomidate (NE and HE). Conclusions - It is concluded that vecuronium is associated with stable blood pressure. Heart rate is decreased following the vecuronium-etomidate association, both in normotensive and hypertensive patients

Comparación del propofol y tiopental sódico en la inducción anestésica pediátrica / Comparison of propofol and tiopental sodium in the induction paediatrics anesthetics

El presente trabajo se realizó con la finalidad de comparar las características de inducción del Propofol 2,5 mg/kg y Tiopental 6 mg/kg en dos grupos cada uno de 25 niños, Asa I-II, sometidos a cirugía electiva. Tanto el Propofol como el TPS, produjeron una inducción rápida y uniforme, con una baja incidencia de efectos secundarios, pero el Propofol produjo con mayor frecuencia dolor durante la inyección. La pérdida de la conciencia y el reflejo parpebral fue más rápida en el grupo de pacientes que recibieron TPS. los dos grupos presentaron aumento de las cifras tensionales y frecuencia cardíaca. A los dos minutos post-intubación el grupo de Propofol sufrió una caída significativa de la TAS,TAD Y TAM. El efecto hipotensor del Propofol parece ser beneficioso en la amortiguación de los efectos hemodinámicos de la intubación, concluyéndose que es una alternativa útil para la inducción anestésica pediátrica

Estudio comparativo entre propofol y tiopental para intervenciones quirúrigicas de corta duración

En 20 pacientes ASA 1 Y 2 se comparan las condiciones de recuperación utilizando propofol (2.0 mg/kg) o tiopental (3 mg/kg) , como agentes anestésicos principales para cirugías de corta duración. El tiempo de ápnea fue más prolongado para el grupo propofol con una media de 132 segundos, mientras que con el tiopental fue de 50.6 segundos. En el grupo propofol se comprobó un descenso de la presión arterial diatólica de un 10 por ciento a los dos minutos de la inducción anestésica, retornando a los valores normales a los 10 minutos. El tiempo de recuperación para sentarse fue significativamente menor para el grupo propofol (13,8 minutos) que para el grupo tiopental (13.8 minutos ). Esta diferencia se acentúa cuando se considera el intervalo entre la finalización de la operación y la cpacidad de pararse sin ayuda (21.9 minutos) vs 59.1 minutos) La calidad de la anestesia fue superior para el grupo propofol en una significancia estadística de 99 por ciento. La anestesia postoperatoria fue excelente en los dos grupos. En el grupo propofol una paciente presentó náusea, a diferencia del grupo tiopental; en que tres pacientes presentaron vómito y/o náusea, cefálea una paciente, mareo cuatro pacients y somnolencia 8 pacientes...