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Canadian Journal of Anesthesia, Vol 26, 269-276, Copyright © 1979 by Canadian Anesthesiologists' Society

Repercussion sur le Debit Sanguin Cerebral D'Une Perfusion de Thiopental

J. COTÉ M.D.1, D. SIMARD M.D.1, and M. ROUILLARD M.D.1

1 Département d'Anesthesie-réanimation, Hôpital de l'Enfant-Jésus, 1401-18e Rue, Québec, P.Q., G1J 1Z4

The protection of the brain is still one of the major concerns for those involved in the treatment of the severely injured and neurosurgical patients.

Although it is well known that barbiturates can afford some protection in experimental animals and in man by decreasing the cerebral metabolic rate of oxygen (CMRo2) and the cerebral blood flow (CBF), there are no precise data available in the medical literature as to how much thiopentone at a dose usually employed in clinical practice might decrease the CMRo2 and the CBF in man.

The cerebral blood flow, regional cerebral blood flow and the CMRo2 were measured in eight patients after an intra-arterial injection of Xenon133, according to a method described by Hoedt-Rasmussen and Paulson. Following this they were given a bolus of thiopentone 6 mg·kg-1 followed by an 0.4 per cent infusion of thiopentone adjusted to deliver 14 mg·kg-1 hourly.

The measures were then repeated at 20, 40 and 60 minutes after induction time. Using this technique, a 28 per cent reduction in CBF was noted 20 minutes after the beginning of the experiment and a 35 per cent reduction in CMRo2 was also recorded, followed by a 30 per cent reduction in CBF and a 46 per cent reduction in CMRo2 one hour later.

This tends to confirm the hypothesis that the protection offered by the barbiturates is related to the loss of consciousness (loss of function) since the decrease in CBF and CMRo2 after one hour of infusion had somewhat plateaued. If the cerebral protection attributed to the barbiturates is proportional to the decrease in the CBF, then the relatively small doses employed in the present study would be sufficient to assure brain protection during an insult. Following the termination of the infusion, the arousal time was fairly rapid. It was also found that the decrease in the CBF and the CMRo2 was comparable to what has been found by other workers, using much higher dosage.

Respiratory depression has been minimal as the Pacoco2 increased by only 0.8 kpa (6 mm Hg). This technique has also offered excellent stability from the cardiovascular standpoint. Consequently it is suggested that thiopentone infusion might be the technique of choice for neuro-radiological procedures such as pneumo-encephalography and cerebral angiography.

Finally, assuming that the protection of the brain is related and proportional to the reduction in the CBF and the CMRo2 and, accordingly, to a relatively small dose of thiopentone as it is indicated in the present work, it is suggested that this mode of anaesthesia be revisited in neurosurgery and carotid surgery.






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Copyright © 1979 by the Canadian Anesthesiologists' Society.