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Barbiturate therapy in the management of cerebral ischaemia
Author(s) -
BELOPAVLOVIC M.,
BUCHTHAL A.
Publication year - 1980
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.1980.tb05095.x
Subject(s) - medicine , cerebral ischaemia , barbiturate , anesthesia , cerebral vasospasm , ischemia , surgery , occlusion , aneurysm , cerebral circulation , vasospasm , subarachnoid hemorrhage , cardiology
Summary Two patients who underwent surgery for cerebral aneurysms are presented. In the first case 31 g thiopentone were given postoperatively over 20 h after the patient had already been comatose for many hours. Such high doses raise considerable problems in patient management. In the second case a loading dose of 50 mg/kg thiopentone was given prophylactically to a patient undergoing cerebral aneurysm surgery beginning at the induction of anaesthesia and before surface cooling was begun. Cerebral activity was monitored continuously with a cerebral function monitor (CFM). There was no significant cardiovascular depression, little delay in postoperative recovery and no permanent neurological sequelae. In cerebral aneurysm surgery, cerebral oedema following cerebral ischaemia, either associated with vasospasm or resulting from surgical occlusion of vessels, remains a major problem postoperatively and may be an indication for preventive treatment with barbiturates. The authors contend that this technique merits further evaluation in cerebro‐vascular surgery, especially in high risk cases.