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Thiopentone in the Treatment of Severe Head Injury: Is Raised Intracranial Pressure the Sole Indication for Its Use?

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Brain Protection

Abstract

Prompted by the extensive experience of Bruce et al. W and Marshall et al. (14), we induced barbiturate coma in 27 brain trauma patients with intracranial pressure (ICP) raised to more than 25 torr for more than 15 minutes, and unresponsive to dexamethasone, mannitol, furosemide and moderate hyperventilation, as in a boy exhibiting Lundberg waves and pronounced ICP reactions to nursing (Fig. 1).

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References

  1. Altenburg BM, Michenfelder JD, Theye RA (1969) Acute tolerance to thiopental in canine cerebral oxygen consumption studies. Anesthesiology 31:443–448

    Article  PubMed  CAS  Google Scholar 

  2. Astrup J, Skovsted P, Gjerris F, Sørensen HR (1981) Increase in extracellular potassium in the brain during circulatory arrest: effects of hypothermia, lidocaine and thiopental. Anesthesiology 55:256–262

    Article  PubMed  CAS  Google Scholar 

  3. Becker KE (1978) Plasma levels of thiopental necessary for anesthesia. Anesthesiology 49:192–196

    Article  PubMed  Google Scholar 

  4. Bruce DA, Raphaely RA, Swerdlow D, Schut L (1980) The effectiveness of iatrogenic barbiturate coma in controlling increased ICP in 61 children. In: Shulman K, Marmarou A, Miller JD, Becker DP, Hochwald GM, Brock M. Eds. Intracranial pressure. Springer, Berlin Heidelberg New York, pp 630–632

    Chapter  Google Scholar 

  5. De los Reyes RA, Babcock RA, Malik GM, Diaz FG, Ausman JI (1981) Silent duodenal perforation: A difficult diagnosis in iatrogenic barbiturate coma. Crit Care Med 9:104–105

    Article  PubMed  Google Scholar 

  6. Frost E AM, Tabaddor K, Kim BY (1981) Induced barbiturate coma: results in 20 cases (Abstr.). Anesth Analg 60:247

    Article  Google Scholar 

  7. Gennarelli TA, Spielman GM, Langfitt TW, Gildenberg PL, Harrington T, Jane JA, Marshall LF, Miller JD, Pitts LH (1982) Influence of the type of intracranial lesion on outcome from severe head injury. A multicenter study using a new classification system. J Neurosurg 56:26–32

    Article  PubMed  CAS  Google Scholar 

  8. Gisvold SE, Safar P, Hendricks H, Alexander H (1981) Thiopental treatment after global brain ischemia in monkeys. Anesthesiology 55:A97

    Google Scholar 

  9. Gobiet W (1977) Intensivtherapie nach Schädel-Hirn-Trauma. Springer, Berlin Heidelberg, New York, p 48

    Google Scholar 

  10. Hasselström L, Kristoffersen MB (1979) Hepatitis following thiopentone. A case report. Br J Anaesth 51:801–804

    Google Scholar 

  11. Jennett B, Bond MR (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484

    Article  PubMed  CAS  Google Scholar 

  12. Jennett B, Teasdale G, Braakman R, Minderhoud H, Heiden J, Kurze T (1979) Prognosis of patients with severe head injury. Neurosurgery 4:283–289

    Article  PubMed  CAS  Google Scholar 

  13. Lauven PM Personal communication. Department of Anesthesiology, University of Bonn, FRG

    Google Scholar 

  14. Marshall LF, Smith RW, Shapiro HM (1979) The outcome with aggressive treatment in severe head injuries. Part II Acute and chronic barbiturate administration in the management of head injury. J Neurosurg 50:26–30

    Article  PubMed  CAS  Google Scholar 

  15. Michenf Elder JD (1974) The interdependency of cerebral functional and metabolic effects following massive doses of thiopental in the dog. Anesthesiology 41:231–236

    Article  CAS  Google Scholar 

  16. Nilsson B, Nordström CH (1977) Rate of cerebral energy consumption in concussive head injury in the rat. J Neurosurg 47:274–281

    Article  PubMed  CAS  Google Scholar 

  17. Overgaard J, Mosdal C, Tweed WA (1981) Cerebral circulation after head injury. Part 3: Does reduced regional cerebral blood flow determine recovery of brain function after blunt head injury? J Neurosurg 55:63–74

    Article  PubMed  CAS  Google Scholar 

  18. Pagliaro L, Campesi G, Aguglia F (1969) Barbiturate jaundice. Report of a case due to a barbital-containing drug with positive rechallenge to phénobarbital. Gastroenterology 56:938–943

    PubMed  CAS  Google Scholar 

  19. Steen PA, Michenf Elder JD (1980) Mechanisms of barbiturate protection. Anesthesiology 53:183–185

    Article  PubMed  CAS  Google Scholar 

  20. Todd MM, Chadwick HS, Shapiro HM, Dunlop BJ, Marshall LF, Dueck R (1982) The neurologic effects of thiopental therapy following experimental cardiac arrest in cats. Anesthesiology 57:76–86

    Article  PubMed  CAS  Google Scholar 

  21. Toner W, Howard PJ, McGowan WAW, Dundee JW (1980) Another look at acute tolerance to thiopentone. Br J Anaesth 52:1005–1008

    Article  PubMed  CAS  Google Scholar 

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© 1983 Springer-Verlag Berlin Heidelberg

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Wiedemann, K. (1983). Thiopentone in the Treatment of Severe Head Injury: Is Raised Intracranial Pressure the Sole Indication for Its Use?. In: Wiedemann, K., Hoyer, S. (eds) Brain Protection. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-69175-1_18

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  • DOI: https://doi.org/10.1007/978-3-642-69175-1_18

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-69177-5

  • Online ISBN: 978-3-642-69175-1

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