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Canadian Journal of Anesthesia, Vol 30, 615-622, Copyright © 1983 by Canadian Anesthesiologists' Society

Thiopental Bolus During Carotid Endarterectomy-rational Drug Therapy?

J. A. MOFFAT PHD1, M. J. McDOUGALL BSC1, D. BRUNET MD1, F. SAUNDERS MD1, E. S. SHELLEY MD1, F. W. CERVENKO MD1, and B. MILNE MD1

1 Departments of Anaesthesia, Medicine and Surgery, Queen's University, Kingston, Ontario

Address correspondence to: Dr. Brian Milne, Department of Anaesthesia, Queen's University, Kingston, Ontario, K7L 3N6

Ten studies were performed to examine the time course of arterial and venous thiopental concentrations following the administration of thiopental (4 mg·kg-1 over 3 min) for cerebral protection during carotid occlusion in nine patients undergoing elective carotid endarterectomy; in five patients the time course of EEG change was also studied. The arterial and venous thiopental concentrations were similar with no evidence of a sustained arterial-venous gradient. The average arterial concentration was 20.1 µg·ml-1 ± 10 (SD) at 2 min after thiopental, and fell rapidly to 13.0 µg·ml-1 ± 3.2 at 5 min, 10.7 µg·ml-1 ± 4 A at 10 min and 6.2 µg·ml-1 at 30min. After thiopental the EEG record showed an increase in delta activity and in four patients a burst suppression pattern was seen. The duration of burst suppression activity was variable (130 to 367 seconds) but in all instances cortical activity had returned to the pre-thiopental level by five to ten minutes. Thus concentrations of thiopental of 10-30 µg·ml-1 were associated with EEG burst suppression and both were seen only within the first five minutes after drug administration. In contrast the carotid artery was occluded for considerably longer (26 ± 4) minutes. We conclude that, since there was no sustained arterial-venous gradient, either arterial or venous concentrations are adequate for the study of thiopental pharmacokinetics. However, using burst suppression as an index of cerebral protection with thiopental it appears that the administration of thiopental (4 mg·kg-1 over three minutes) before carotid occlusion is not adequate to protect for the duration of the carotid endarterectomy procedure.

Key Words: SURGERY: carotid endarterectomy • ANAESTHETICS, INTRAVENOUS: thiopental; barbiturate protection






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Copyright © 1983 by the Canadian Anesthesiologists' Society.