Present Status of Barbiturates in the Acute Stage of Cerebral Damage

  • G. Pfeifer
Conference paper
Part of the Advances in Neurosurgery book series (NEURO, volume 14)


Barbiturates, introduced into clinical practice in 1932 by WEESE and SCHARPFF (30), still have a definite place in the practice of anesthesiology. Barbiturates are the anesthetics of choice for the induction of anesthesia in neurosurgical risk patients. The latter are all patients with decreased intracranial compliance as well as patients with functional narrowing of arterial cerebral afferent vessels.


Status Epilepticus Severe Head Injury Global Cerebral Ischemia Control Hypotension Global Brain Ischemia 
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  1. 1.
    Abramson, N.P., Safar, P., Detre, K., Kelsey, S., Monroe, J., Reinmuth, O., Snyder, J., Mullie, A., Hedstrand, U., Tammisto, H., Lund, I., Breivik, H., Lind, B., Jastremski, M.: Results of a randomized clinical trial of brain resuscitation with thiopental. Anesthesiology 59, A 101 (1983)Google Scholar
  2. 2.
    Astrup, J., Skovsted, P., Gjerris, F., Sørensen, H.R.: Increase in extracellular potassium in the brain during circulatory arrest: Effects of hypothermia, lidocaine and thiopental. Anesthesiology 55, 256–262 (1981)PubMedCrossRefGoogle Scholar
  3. 3.
    Astrup, J.: Energy-requiring cell functions in the ischemic brain. Their critical supply and protective therapy. J. Neurosurg. 56, 483–497 (1982)Google Scholar
  4. 4.
    Astrup, J., Rosenørn, J., Cold, G.E., et al.: Minimum cerebral blood flow and metabolism during craniotomy. Effect of thiopental loading. Acta Anaesth. Scand. 28, 478 (1984)PubMedCrossRefGoogle Scholar
  5. 5.
    Bendtsen, A.O., Cold, G.E., Astrup, J., et al.: Thiopental loading during controlled hypotension for intracranial aneurysm surgery. Acta Anaesth. Scand. 28, 473 (1984)PubMedCrossRefGoogle Scholar
  6. 6.
    Bleyaert, A.L., Nemoto, E.M., Safar, P., Stezoski, S.W., Mickell, J.J., Moossy, I.J., Rao, G.: Thiopental amelioration of brain damage after global ischemia in monkeys. Anesthesiology 49, 390 (1978)PubMedCrossRefGoogle Scholar
  7. 7.
    Bruce, D.A., Alavi, A., Bilaniuk, L., Dolinskas, C, Obrist, W., Uzzell, B.: Diffuse cerebral swelling following head injuries in children: the syndrome of malignant brain edema. J. Neurosurg. 54, 170 (1981)PubMedCrossRefGoogle Scholar
  8. 8.
    Hoppe, E., Christensen, L., Christensen, K.N.: The clinical outcome of patients with severe head injuries, treated with high dose dex-amethasone, hyperventilation and barbiturates. Neurochirurgia 24, 17–20 (1981)PubMedGoogle Scholar
  9. 9.
    Fröscher, W., Ansmann, E.B.: Grand-mal-Status und grand-mal-Serien — Ursachen, Therapie und Verlauf. Anästh. Intensivther. Notfallmed. 20, 12–18 (1985)CrossRefGoogle Scholar
  10. 10.
    Gisvold, S.E., Safar, P., Hendricks, H.H.L., Rao, G., Moossy, J., Alexander, H.: Thiopental treatment after global brain ischemia in pigtailed monkeys. Anesthesiology 60, 88–96 (1984)PubMedCrossRefGoogle Scholar
  11. 11.
    Gross, C.E., Adams, H.P., Sokoll, M.D., Yamada, T.: Use of anticoagulants, electroencephalographic monitoring and barbiturate cerebral protection in carotid endarterectomy. Neurosurgery 9, 1–5 (1981)PubMedCrossRefGoogle Scholar
  12. 12.
    Kass, I.S.: Blocking Ca++-entry protects against anoxic brain damage in vitro. Anesthesiology 61, A 367 (1984)CrossRefGoogle Scholar
  13. 13.
    Kassell, N.F., Hitchon, O.W., Gerk, M.K., Sokoll, M.D., Hill, T.R.: Alterations in cerebral blood flow, oxygen metabolism and electrical activity produced by high dose sodium thiopental. Neurosurgery 7, 598 (1980)PubMedCrossRefGoogle Scholar
  14. 14.
    Klöti, J., Dangel, P., Boltshauser, E.: Die Behandlung des Schädel-Hirn-Traumas im Kindesalter. Notfallmedizin 8, 194–211 (1982)Google Scholar
  15. 15.
    Marshall, L.F., Smith, R.W., Shapiro, H.M.: The outcome with aggressive treatment in severe head injuries. II. Acute and chronic barbiturate administration in the management of head injury. J. Neurosurg. 50, 26–30 (1979)PubMedCrossRefGoogle Scholar
  16. 16.
    Miller, J.D.: Head injury and brain ischaemia — implications for therapy. Br. J. Anaesth. 57, 120–129 (1985)PubMedCrossRefGoogle Scholar
  17. 17.
    Newberg, L.A., Steen, P.A., Gisvold, S.E., Milde, J.H., Scheithauer, B.W., Lanier, W.L., Michenfelder, J.D.: Effects of nimodipine on neurologic function following complete global ischemia in primates. Anesthesiology 61, A 127 (1984)CrossRefGoogle Scholar
  18. 18.
    Nordby, H.K., Nesbakken, R.: The effect of high dose barbiturate decompression after severe head injury. A controlled clinical trial. Acta Neurochirurgia 72, 157–166 (1984)CrossRefGoogle Scholar
  19. 19.
    Rea, G.L., Rockswold, G.L.: Barbiturate therapy in uncontrolled intracranial hypertension. Neurosurgery 12, 401–404 (1983)PubMedCrossRefGoogle Scholar
  20. 20.
    Safar, P., Bleyaert, A., Nemoto, E.M., Moossy, J., Snyder, J.: Resuscitation after global brain ischemia - anoxia. Crit. Care Medicine 6, 215–227 (1978)CrossRefGoogle Scholar
  21. 21.
    Selman, W.R., Spetzler, R.F., Roski, R.A., Roessmann, U., Crumrine, E., Macko, R.: Barbiturate coma in focal cerebral ischemia. J. Neurosurg. 56, 685–690 (1982)PubMedCrossRefGoogle Scholar
  22. 22.
    Shapiro, H.M.: Barbiturates in brain ischaemia. Br. J. Anaesth. 57, 82–95 (1985)PubMedCrossRefGoogle Scholar
  23. 23.
    Spetzler, R.F., Selman, W.R., Roski, R.A., Bonstelle, C.: Cerebral revascularization during barbiturate coma in primates and humans. Surg. Neurol. 17, 111 (1982)PubMedCrossRefGoogle Scholar
  24. 24.
    Spring, A., Dietz, H., Höllerhage, H.G., Kirchner, E.: Barbiturat-therapie in der Neurochirurgie. Neurochirurgia 26, 104–111 (1983)PubMedGoogle Scholar
  25. 25.
    Steen, P.A., Milde, J.H., Michenfelder, J.D.: No barbiturate protection in a dog model of complete cerebral ischaemia. Ann. Neurol. 5, 343 (1979)PubMedCrossRefGoogle Scholar
  26. 26.
    Steen, P.A., Newberg, L.A., Milde, J.H., Michenfelder, J.D.: Nimodipine improves cerebral blood flow and neurologic recovery after complete cerebral ischemia in the dog. J. Cereb. Blood Flow Meta-bol. 3 38–43 (1983)CrossRefGoogle Scholar
  27. 27.
    Steen, P.A., Newberg, L.A., Milde, J.H., Michenfelder, J.D.: Hypothermia and barbiturates: individual and combined effects on canine cerebral oxygen consumption. Anesthesiology 58, 527 (1983)PubMedCrossRefGoogle Scholar
  28. 28.
    Todd, M.M., Chadwick, H.S., Shapiro, H.M., Dunlop, B.J., Marshall, L.F., Dueck, R.: The neurologic effects of thiopental therapy following experimental cardiac arrest in cats. Anesthesiology 57, 76–86 (1982)PubMedCrossRefGoogle Scholar
  29. 29.
    Vaagenes, P., Cantadore, R, Safar, P., Alexander, H.: Effects of 2 calcium entry blockers on neurological outcome after 10 minutes ventricular fibrillation cardiac arrest in dogs. Anesthesiology 61, A 126 (1984)Google Scholar
  30. 30.
    Weese, H., Scharpff, W.: Evipan, ein neuartiges Einschlafmittel. Dtsch. Med. Wschr. 58, 1205–1207 (1932)CrossRefGoogle Scholar
  31. 31.
    Wiedemann, K., Hamer, J., Weinhardt, F., Just, O.H.: Barbiturat-infusion bei schwerem Schädel-Hirn-Trauma. Anaesth. Intensivther. Notfallmed. 15, 303 (1980)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1986

Authors and Affiliations

  • G. Pfeifer
    • 1
  1. 1.Kliniken der Stadt DüsseldorfKrankenhaus GerresheimDüsseldorf 12Germany

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