Dose Of Thiopental Research Articles

Perioperative Craniotomy Excision of Dextra Subtemporal Tumor with Thiopental, Sufentanyl and Invasive Monitor

Intracranial masses can arise from a variety of aetiologies, including congenital, neoplastic, infectious, or vascular processes, each requiring distinct diagnostic and management considerations. Establishing the presence or absence of intracranial hypertension is a critical component of the preoperative evaluation for patients undergoing craniotomy for mass lesions. Hemodynamic is an examination of the physical aspects of blood circulation, cardiac function and physiological characteristics of peripheral vasculature. A 74 year old man was admitted to the hospital because of cephalgia, and left limb weakness. Previously, the patient often felt headaches that came and went since six months ago. Three days before being admitted, the patient felt weak in his left limb and experienced decreasing in consciousness. The patient was given thiopental because the onset of action of thiopental was very short. Administration of intravenous doses of thiopental can cause cerebral vasoconstriction. Sufentanil was administered as an analgesic, because sufentanil is an opioid that has a rapid onset and analgesic potential, compared to fentanyl, intravenous and sufentanil is 5–10 times stronger. This efficacy to maintain adequate cerebral perfusion pressure (CPP), reduce cerebral blood flow (CBF), maintain normal autoregulation, reduce cerebral metabolic rate for oxygen (CMRO2). Arterial cannulation with continuous transduction is considered the gold standard for blood pressure monitoring during anaesthetic procedures. Rapid fluctuations in blood pressure can occur due to patient positioning, surgical manipulation, and the effects of anaesthetics drugs, and close monitoring of these changes is crucial for maintaining hemodynamic stability. The impact of anaesthetic management on CBF is also an integral component of neuroanesthesia, as increases in CBF are associated with increases in cerebral blood volume (CBV). An effective neuro-anesthesia management program that incorporates both invasive blood pressure monitoring and optimization of cerebral perfusion that can help preserving hemodynamic stability and improving outcomes for patients undergoing craniotomy surgery

The effect of propofol versus thiopentone on APGAR score of babies delivered and recovery of pregnant mothers undergoing elective cesarean section

Background and objectives: The Apgar score is a vital indicator of the baby's well-being. This study aims to compare the effects of propofol and thiopental anesthetics on babies' Apgar scores and mothers' recovery times, this study was carried out. Methods: This single-arm interventional study was conducted in Zhyan and Soma Hospital in Sulaimani, Kurdistan Region of Iraq from February 2022 to July 2022. Separate doses of propofol and thiopental were given to 140 pregnant women who were candidates for elective cesarean section in two separate groups. Apgar scores at 1 and 5 minutes after birth, recovery time, and hemodynamic changes before and after the intervention were evaluated and compared. Results: The results of the diastolic pressure variable after the intervention and the hemodynamic variables were significantly different in each group before and after the intervention (P<0.001). The mean recovery time in propofol and thiopental groups was 21.4 ± 2.4 and 26.0 ± 1.8 minutes, respectively, and they were statistically significantly different (p<0.001). There was a statistically significant difference in the Apgar score at the 5th minute between the two groups (p=0.03). In terms of the need for resuscitation after the first minute, the results were in favor of the propofol group (p<0.001). Conclusion: Propofol can be used more safely since patients who had anesthesia with it had better hemodynamics, quicker recovery times, neonates with higher Apgar scores, and less need for postpartum resuscitation.

Propofol and thiopental for intravenous induction in neonates: study protocol for a dose-finding trial.

Propofol and thiopental are commonly used induction agents in neonatal anesthesia. Even though both hypnotics have been used off-label for many years, pharmacological knowledge regarding these agents is scarce in neonates. The significant variability in neonates' body composition, organ function, and maturation makes pharmacological studies highly relevant albeit challenging. As a result, there is currently limited data about the anesthetic induction dose of thiopental and propofol in neonates. In addition, a knowledge gap exists concerning the pharmacodynamics of induction doses. To determine the median effective anesthetic induction dose of propofol and thiopental in neonatal patients of different gestational and postnatal ages and evaluate the pharmacodynamics of the anesthesia induction doses on the neonatal systemic and cerebral hemodynamics. This is a single-center, prospective, open-label, interventional, dose-finding study, including neonatal patients from birth up to 28 postnatal days undergoing general anesthesia for surgical or diagnostic procedures. The patients will be stratified according to their gestational and postnatal age and allocated to one of the two trial arms: anesthesia induction with propofol or anesthesia induction with thiopental. We will use Dixon's up-and-down method to estimate the median effective anesthesia induction dose of both agents in neonates of different gestational and postnatal ages. In addition, we will study the relationship between anesthesia induction doses and changes in systemic and cerebral hemodynamics. Alterations in the systemic and cerebral regional hemodynamics secondary to anesthesia induction may be harmful in neonates, especially premature and critically ill newborns, due to their immature organ systems, reduced physiological reserves, and impaired cerebral autoregulation. Perfusion homeostasis is considered one of the significant and modifiable determinants of anesthesia-related neurocognitive outcomes. Therefore, dose-finding and safety pharmacological studies of the anesthetic induction agents in neonates are urgently needed and acknowledged as a high priority by the European Medicine Agency. Estimating adequate induction doses to ensure optimal depth of anesthesia while avoiding systemic and cerebral hemodynamic disturbances will help ensure safe anesthesia and potentially improve anesthesia-related outcomes in this group of patients. This article is protected by copyright. All rights reserved.

Comparison of Low and High Doses of Pentobarbital or Thiopental for Euthanasia of Isoflurane-anesthetized Pigs.

Barbiturate overdose is a common method for euthanizing pigs. However, barbiturates can cause tissue damage and may affect experimental results, so the minimal dose should be used. The minimal dose of barbiturate for euthanasia in pigs under isoflurane anesthesia has not yet been determined. In this study, we compared the effect of low and high doses of 2 barbiturates (pentobarbital, 30 or 60 mg/kg; thiopental, 20 and 40 mg/kg) on hemodynamic parameters and time to cardiac arrest in female pigs maintained on isoflurane. Acute decreases in blood pressure and end-tidal CO₂ occurred in all pigs shortly after administration of the barbiturate. However, these changes were not different between either of the high- and low dose groups. Cardiac arrest occurred significantly faster for high dose as compared with low dose thiopental groups, but this parameter was different between the 2 pentobarbital groups. The bispectral index fell immediately after dosing, in all pigs, but no significant differences were observed in the time needed to achieve 0 for the high or low-doses of either drug. In pigs maintained on isoflurane, a low dose of barbiturates is adequate for euthanasia and may result in less tissue damage.

The effects of thiopental on cold ischemic injury in renal transplantation

One of the most important factors influencing post-transplant success in kidney transplantation is preserving the viability of the organ from removal to transfer into the recipient. This study aimed to reduce the energy requirement with thiopental doses administered before organ transplantation, and to increase the organ viability by minimizing the tissue damage during the cold ischemia process. Twenty female Wistar albino rats were divided into two groups: control group (group C), and thiopental group (group T). In group C, a midline incision was performed, and the renal artery was isolated under ketamine and xylazine anesthesia. A standard organ storage solution (cooled to +4°C) was used for kidney perfusion. Nephrectomy was applied, and the removed kidneys were placed into +4°C standard organ storage solution and stored at +4°C for 12 hours. Animals in group T were subjected to the procedures explained above under 85mg/kg thiopental sodium anesthesia. After 12-hour storage, samples from the kidney tissues were fixed in 10% neutral buffered formalin. Histopathological evaluation and apoptosis detection via TUNEL method were performed. Tubular necrosis was more extensive in group C compared with that in group T and this difference was statistically significant. Similarly, vacuolization was widely observed in group C, and this increase was also statistically significant. For the 'dilatation of Bowman's space' parameter, a significant decrease was observed in group T compared with group C. When the apoptotic index values of both groups were examined, it was seen that they were lower in group T than those in group C. This result was statistically significant. These data suggest that thiopental provides protection to the kidney tissue during the cold storage process. Thiopental has been shown to decrease the number of apoptotic cells in the kidney tissue when administered to the donor before organ transplantation, increasing the organ viability.

Incidence of adverse events for procedural sedation and analgesia for cardioversion using thiopental in elderly patients: a multicenter prospective observational study.

The incidence and characteristics of thiopental-related adverse events (AEs) in elderly patients during procedural sedation and analgesia (PSA) have not been well studied. We aimed to characterize thiopental-related AE in elderly patients during PSA and compare the incidence of AE in elderly patients with non-elderly adults. This is a secondary analysis of the Japanese Procedural Sedation and Analgesia Registry (JPSTAR). We included all adult patients who received thiopental for PSA in the emergency departments and excluded patients who received concomitant sedative(s) in addition to thiopental or patients with missing body weight data. We compared the incidence of AE between the non-elderly (18-64 years) and elderly groups (≥65 years). The JPSTAR had data on 379 patients who received thiopental for PSA and included 311 patients for analysis. Most (222/311, 71.3%) were elderly. Cardioversion was the most common reason for PSA (96.1%). The AE incidence between groups overall was similar, however, hypoxia was significantly more frequent in the elderly compared with the non-elderly group (10.3% versus 2.2%; adjusted odds 5.63, 95% confidence interval 1.27-25.0). The initial and total doses of thiopental were significantly lower in the elderly group than in the non-elderly group (1.95 mg/kg versus 2.21 mg/kg and 2.33 mg/kg versus 2.93 mg/kg, respectively). Although elderly patients received lower doses of thiopental, hypoxic events were significantly more frequent in this group compared with the non-elderly patients. However, the AE incidence was similar.

Adequacy of maternal anesthesia depth with two sodium thiopental doses in elective caesarean section: a randomized clinical trial

BackgroundAdministration of an optimal dose of anesthetic agent to ensure adequate depth of hypnosis with the lowest risk of adverse effects to the fetus is highly important in cesarean section. Sodium thiopental (STP) is still the first choice for induction of anesthesia in some countries for this obstetric surgery. We aimed to compare two doses of STP with regarding the depth of anesthesia and the condition of newborn infants.MethodsIn this clinical trial, parturient undergoing elective Caesarian section were randomized into two groups receiving either low-dose (5 mg/kg) or high-dose (7 mg/kg) STP. Muscle relaxation was provided with succinylcholine 2 mg/kg and anesthesia was maintained with O2/N2O and sevoflurane. The depth of anesthesia was evaluated using isolated forearm technique (IFT) and bispectral index (BIS) in various phases. Additionally, infants were assessed using Apgar score and neurobehavioral test.ResultsForty parturient were evaluated in each group. BIS was significantly lower in high-dose group at skin incision to delivery and subcutaneous and skin closure. Also, significant differences were noticed in IFT over induction to incision and incision to delivery. Apgar score was significantly lower in high-dose group at 1 min after delivery. Newborn infants in low-dose group had significantly better outcomes in all three domains of the neurobehavioral test.Conclusion7 mg/kg STP is superior to 5 mg/kg in creating deeper hypnosis for mothers. However, it negatively impacts Apgar score and neurobehavioral test of neonates. STP seems to has dropped behind as an acceptable anesthetic in Cesarean section.Trial registrationIRCT No: 2016082819470 N45, 13/03/2019.

Pretreatment with dexmedetomidine and magnesium sulphate in prevention of etomidate induced myoclonus - A double blinded randomised controlled trial.

Pretreatment with dexmedetomidine and magnesium sulphate in prevention of etomidate induced myoclonus - A double blinded randomised controlled trial.

Factors Associated With Seizure Adequacy Along the Course of Electroconvulsive Therapy.

Eliciting a generalized seizure is essential to electroconvulsive therapy (ECT), but there is still a need to understand how patient and session variables interact to generate a seizure of adequate quality. Here, we investigate factors associated with motor seizure length as a measure of quality in a large database of patients who underwent ECT. This is a retrospective cohort including data from all adult inpatients who underwent ECT at a university hospital in Brazil from 2009 to 2015. We used linear mixed models to investigate the effects of patient, session, and medication on seizure length. Session information was available for 387 patients, a total of 3544 sessions and 4167 individual stimulations. Multiple stimulations were necessary in 12.4% of sessions. Median seizure length was 30 seconds. Seizure length was directly correlated with stimulus dosage and inversely correlated with the session number, patient age, prescription of anticonvulsants in the day before and β-blockers during the session, and the thiopental dose. Use of benzodiazepines was not associated with a shorter seizure duration, irrespective of dose. We demonstrate here how motor seizure length evolves during a course of ECT. With a large number of sessions, we are able to integrate a host of factors in a prediction model. Seizure quality was influenced by a number of the studied factors, many of which are potentially modifiable and could be assessed before initiating and handled during treatment.

Thiopental Elevates Steady-State Levels of Intracellular Ca2+ and Zn2+ in Rat Thymic Lymphocytes

Thiopental is an ultra-short-acting barbiturate and has been used commonly in the induction phase of general anesthesia. However, the toxic effect of thiopental is not completely clear. The effect of thiopental on intracellular Ca2+ ([Ca2+]i) levels was investigated in non-excitable cells. Experiments were carried out using a flow-cytometric technique, rat thymic lymphocytes (as non-excitable cells), and appropriate fluorescent probes. Treatment of cells with 300 µM thiopental increased Fluo-3 fluorescence intensity, indicating elevation of [Ca2+]i. This increase was partially attenuated by a chelator of intracellular Zn2+. Thus, thiopental elevated both [Ca2+]i and intracellular Zn2+ ([Zn2+]i) levels. Under intracellular Zn2+-free conditions, 100–300 µM thiopental was still able to induce a statistically significant increase in [Ca2+]i, whereas removal of extracellular Ca2+ greatly reduced the increase in [Ca2+]i induced by this dose of thiopental. Therefore, the thiopental-induced increase in [Ca2+]i was mainly due to an increased influx of Ca2+. Treatment of cells with 300 µM thiopental increased FluoZin-3 fluorescence intensity, indicating the presence of [Zn2+]i, both in the presence and absence of extracellular Zn2+. The thiopental-induced elevation of [Zn2+]i was due to an increase in both influx of Zn2+ and intracellular Zn2+ release. Concanavalin A (10 µg/mL) augmented Fluo-3 fluorescence in the presence of an intracellular Zn2+ chelator. The combination of concanavalin A and 100–300 µM thiopental synergistically increased [Ca2+]i. Results suggest that thiopental increases [Ca2+]i in both quiescent and activated lymphocytes, possibly resulting in modulation of immune system function.

Initial Seizure Threshold in Brief-Pulse Bilateral Electroconvulsive Therapy in Patients with Schizophrenia or Schizoaffective Disorder.

ObjectiveThe present study aimed to report the initial seizure threshold (IST) of a brief-pulse bilateral electroconvulsive therapy (BP-BL ECT) in Korean patients with schizophrenia/schizoaffective disorder and to identify IST predictors. MethodsAmong 67 patients who received ECT and diagnosed with schizophrenia/schizoaffective disorder based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, we included 56 patients who received 1-millisecond BP-BL ECT after anesthesia with sodium thiopental between March 2012 and June 2018. Demographic and clinical information was gathered from electronic medical records, and a multiple regression analysis was conducted to identify predictors of the IST. ResultsThe mean age of the patients was 36.9±12.0 years and 30 (53.6%) patients were male. The mean and median IST were 105.9±54.5 and 96 millicoulombs (mC), respectively. The IST was predicted by age, gender, and dose (mg/kg) of sodium thiopental. Other physical and clinical variables were not associated with the IST. ConclusionThe present study demonstrated that the IST of 1-ms BP-BL ECT following sodium thiopental anesthesia in Korean patients was comparable to those reported in previous literature. The IST was associated with age, gender, and dose of sodium thiopental.

A preliminary study on effects of subanesthetic doses of preemptive ketamine given prior to premedication on total intravenous anesthesia for short- to medium-term surgical procedures in horses

This study was conducted to determine the effects of subanesthetic doses of ketamine given prior to premedication on the quality of anesthesia, recovery, and postoperative pain in horses. Eighteen horses were randomly recruited into three equal groups, S, LK, and HK, wherein saline, ketamine at 0.2 mg/kg body weight (bwt), and ketamine at 0.4 mg/kg bwt were given, respectively, i.v. for 30 min as a continuous rate infusion (CRI). Horses were premedicated with xylazine at 1 mg/kg bwt i.v. and butorphanol at 0.05 mg/kg bwt i.v. after 30 min. Anesthesia was induced using ketamine and midazolam and was maintained with ketamine at 2 mg/kg/h as CRI, and bolus doses of thiopental 5% solution was given i.v. whenever necessary. Preemptive ketamine infusion clinically enhanced the quality of sedation and enabled smooth induction with significantly (P < 0.05) higher sedation and postinfusion ataxia and shorter down-time (P < 0.05) in group HK. Physiological, hematological, serological, and vital parameters remained within normal limits. All the horses recovered well without any adverse effects and stood in less than 2 h after surgery. Fluctuation in pain scores at 1 h and 2 h after the end of surgery was minimum in group HK.

An Autopsy Case of Death After Deep Sedation of Thiopental

The victim was a morbidly obese and bull-necked woman in her twenties. She had the disorders, due to Down's syndrome, including severe mental retardation, advanced hearing loss, congenital cataract surgery, and amblyopia at postoperative glaucoma. She was deeply sedated for rest with an intravenous drip infusion of 350 mg of thiopental (TP) for 5 minutes during an intraocular pressure examination with secondary glaucoma at a hospital. The examination was finished within 10 minutes after the TP injection, but her respiratory condition deteriorated rapidly when the doctor left the patient. Although immediate artificial respiration was carried out, she was declared dead about 20 hours after the examination. Medical malpractice was suspected for her death. At autopsy, no fatal disease or injury was observed in the victim. The serum TP level was 0.80 µg /ml. TP is an ultra-short-acting intravenous anesthetic, and usually only the smallest amount should be administered by frequent additions after pre-anesthesia administration while maintaining contact with patients. Although contact with patients with a disability can be difficult, it was diagnosed that the death was caused by both respiratory arrest due to a single dose of TP and delay in resuscitation due to the absence of a doctor.

New evidence for refinement of anesthetic choice in procedures preceding the forced swimming test and the elevated plus-maze

Previous studies indicated that some general anesthetics induce long-term antidepressant and/or anxiolytic-like effects. This raises the concern about the use of anesthesia in surgeries that precede psychopharmacological tests, since it may be a potential bias on results depending on the experimental design used. Thus, we evaluated whether general anesthetics used in surgeries preceding psychopharmacological tests would affect rats behavior in tests predictive of antidepressant or anxiolytic-like effects. We tested if a single exposure to sub-anesthetic or anesthetic doses of tribromoethanol, chloral hydrate, thiopental or isoflurane would change rats behavior in the forced swimming test (FST) or in the elevated plus-maze (EPM) test, at 2 h or 7 days after their administration. We also evaluated whether prior anesthesia would interfere in the detection of the antidepressant-like effect of imipramine or the anxiolytic-like effect of diazepam. Previous anesthesia with the aforementioned anesthetics did not change rats behaviors in FST per se nor it changed the antidepressant-like effect induced by imipramine treatment. Rats previously anesthetized with tribromoethanol or chloral hydrate exhibited, respectively, anxiogenic-like and anxiolytic-like behaviors in the EPM. Prior anesthesia with thiopental or isoflurane did not produce any per se effect in rats behaviors in the EPM nor disturbed the anxiolytic-like effect of diazepam. Our results suggest that, in our experimental conditions, tribromoethanol and chloral hydrate are improper anesthetics for surgeries that precede behavioral analysis in the EPM. Isoflurane or thiopental may be suitable for anesthesia before evaluation in the EPM or in the FST.

Ankara keçilerinde ovariektomi operasyonlarında tiopental-sevofluran ile tiopental-isofluran’ın kardiyovasküler sistem üzerine etkilerinin karşılaştırılması

Aim: The purpose of this study was to evaluate the effects of inhalation anaesthetics on cardiovascular functions in 16 healthy female Angora goats undergoing ovariectomy. Material and Methods: Anaesthesia was induced with thiopental sodium then maintained with isoflurane or sevoflurane in oxygen. Cardiovascular parameters were measured before and at 0, 15th, 30th, 60th and 90th minutes after induction of anaesthesia. Recovery variables including time to extubation, first lift of the head, thoracic recumbency and standing up were also recorded. Results: The mean induction dose of thiopental was 18.23 ± 3.87 mg / kg. There were no significant differences between groups for heart rate (HR), respiration rate (RR), noninvasive blood pressure and body temperature measured prior to and under anaesthesia. All animals recovered uneventfully in both groups. Conclusion: There were no statistical differences between groups for their cardiovascular parameters and recovery times although the results of this study showed a rapid recovery time in each parameter for sevoflurane anaesthesia. On the basis of the results, sevoflurane and isoflurane are suitable inhalation anaesthetics in goats.

Amazing Supremacy of Thiopental Compared to Propofol in Rat Bronchi with Supramaximal Tonus

Introduction: Bronchospasm is an undesirable phenomenon in all phases of operation and anesthesia.Tracheal intubation after induction of anesthesia causes a measurable increase in the resistance of the respiratory system, which often results in bronchoconstriction.Propofol and thiopental have been used as an intravenous anesthetic agent in induction of anesthesia for many years.Barbiturates are recommended not be used in patients with risks due to bronchospasm-causing effects. Propofol is generally recommended for patients with asthma and bronchospasm due to bronchodilatation and muscle relaxant effects. In our study, we aimed to demonstrate this superiority of propofol to thiopental in rat bronchi with supramaximal tonus in a bronchospasm model.Materials and methods:A total of 30 adult male rats were divided into four groups. Double-blinded group T1 received 1x10-5 M thiopental at supramaximal contraction. In Group T2, 1x10-6M thiopental was applied at supramaximal contraction while in Group P1 1x10-1M propofol was applied at supramaximal contraction and in Group P2, 1x10-2M propofol was applied. Tissue voltages were measured with MAY GTA0303 GENIUS TRANSDUCER AMPLITUDE® and recorded in the Acknowledge MP100® program.Results:In Group T1, the reduction in tonus was statistically significant (estimated mean difference, -0.41; 95% confidence interval [CI], -0.36 to 1.18; p=0.000. In Group T2, the tonus difference was statistically significant (estimated mean difference, -0.20; 95% confidence interval [CI], -0.62 to 1.03; p=0.001).There was no statistically significance between tonus levels in neither group P1 nor group P2 before and after the implementationConclusion: In our study, relaxation effect in two different doses of thiopental was shown in rat bronchus tissue in in vitro bronchospasm model. Propofol did not show any relaxation or contraction responses in two separate doses. Surprisingly, Our results suggest that propofol has no direct bronchodilatation effect and thiopental provides bronchodilation. Consequently, we noticed that the effect of thiopental dose-dependent bronchodilatation is not well debate in the literature. For this reason, bronchodilatation doses of thiopental should be determined in further clinical and experimental studies.

Early postmortem biochemical and histopathological changes in the kidney, liver, and muscles of dogs

The goal of the present study was to investigate the biochemical and histological changes in dog’s kidney, liver, heart, and skeletal muscles within 72 h after death. Ten male mongrel dogs aged from 1 to 2 years old were subjected to this study. Dogs were euthanized by the rapid intravenous injection of a lethal dose of sodium thiopental, and then the liver, kidney, heart, and skeletal muscle samples were collected from the whole carcasses at different time intervals 4, 12, 24, 48, and 72 h postmortem. Samples were divided into two parts; one part was used for measuring tissue levels of lactate dehydrogenase (LDH), lactate, creatine phosphokinase (CPK), and aspartate aminotransferase (AST). The other part was subjected to histopathological examinations. On the biochemical level, LDH in the liver, kidney, and cardiac and skeletal muscles showed a significant increase at 4 h followed by significant decrease at 48 and 72 h in all the studied tissues. Lactate level showed variable degrees of increase and decrease in kidney and liver tissues while muscles showed increased lactate concentration during the first 48 h then decreased at 72 h. CPK in cardiac and skeletal muscles showed similar changes; it increased from 4 to 48 h then decreased at 72 h. AST level decreased in liver tissue at 4 until 72 h, while in muscular tissue it showed a delayed reduction in concentration which started at 12 and 24 h in the cardiac and skeletal muscles respectively. Similar changes of AST levels in both skeletal and cardiac muscles were observed; it increased at 4 h and then decreased at 24, 48, and 72 h. Histopathological changes in the kidneys were the earliest changes seen in tissue. The changes in the hepatic tissue were earlier than those of heart and skeletal muscle. We concluded that LDH enzyme showed regular changes in all examined tissues; the biochemical changes in cardiac and skeletal muscles were regular and can be useful in estimation of the time of death. The histopathological changes in the kidney, liver, and cardiac and skeletal muscles were very clear and can be used for estimating the postmortem intervals in dogs.

Determination of Death in Execution by Lethal Injection in China

Since 1997, execution in China has been increasingly performed by lethal injection. The current criteria for determination of death for execution by lethal injection (cessation of heartbeat, cessation of respiration, and dilated pupils) neither conform to current medical science nor to any standard of medical ethics. In practice, death is pronounced in China within tens of seconds after starting the lethal injection. At this stage, however, neither the common criteria for cardiopulmonary death (irreversible cessation of heartbeat and breathing) nor that of brain death (irreversible cessation of brain functions) have been met. To declare a still-living person dead is incompatible with human dignity, regardless of the processes following death pronouncement. This ethical concern is further aggravated if organs are procured from the prisoners. Analysis of postmortem blood thiopental level data from the United States indicates that thiopental, as used, may not provide sufficient surgical anesthesia. The dose of thiopental used in China is kept secret. It cannot be excluded that some of the organ explantation surgeries on prisoners subjected to lethal injection are performed under insufficient anesthesia in China. In such cases, the inmate may potentially experience asphyxiation and pain. Yet this can be easily overlooked by the medical professionals performing the explantation surgery because pancuronium prevents muscle responses to pain, resulting in an extremely inhumane situation. We call for an immediate revision of the death determination criteria in execution by lethal injection in China. Biological death must be ensured before death pronouncement, regardless of whether organ procurement is involved or not.

Short term general anesthesia for retro-bulbar block in ophthalmic surgery generates no significant hypercapnia.

To assess the impact of short time hypnosis for retro-bulbar anesthesia on ventilation in patients undergoing ophthalmic surgery of the anterior eye chamber. In all patients, a combined continuous transcutaneous carbon dioxide tension (PtcCO2) and partial oxygen saturation (SpO2) measurement was applied in addition to routine monitoring. To enable unconscious application of retro-bulbar anesthesia, intravenous thiopental was given in one to multiple bolus doses. Transient breathing support included chin lift, Esmarch maneuver and manual hand-bag ventilation via face mask. Main endpoints were apnea time, recovery time according to the Richmond Agitation Sedation Scale, as well as SpO2 and PtcCO2 readings at predefined time points. Fifty-two patients with a mean age of 68 ± 13years were included. Average thiopental dose was 2.7 ± 0.6mg/kg. In seven (13.5%) patients repeated doses of thiopental were necessary to a total of 3.3 ± 1.1mg/kg. Except one patient, no severe, significant or clinical relevant hypercapnia or desaturation periods were observed, and the occurring elevation of PtcCO2 values did not correlate with the application of repeated doses of thiopental or the need for the Esmarch maneuver. Higher PtcCO2 values were associated with the presence of hypertension and smoking. Apnea (p < 0.001) and recovery (p = 0.003) time were significantly prolonged in the patients needing the Esmarch maneuver. Short term anesthesia with thiopental in ophthalmic surgery is associated with a mild but not clinically relevant hypercapnia.

Efficacy and safety of intravenous thiopental for sedation during magnetic resonance imaging in pediatric patients: A retrospective analysis.

Introduction:Although the administration of rectal thiopental for sedation during magnetic resonance imaging (MRI) has been well described, there are limited data regarding its intravenous (IV) use in this clinical scenario. The aim of this study was to investigate the efficiency of IV thiopental for sedation during MRI in the pediatric population.Methods:A retrospective review was conducted over a 12-month period of pediatric patients who received IV thiopental for sedation during MRI. Data collected included the procedure length, the induction dose, the time to sedation, recovery time, total sedation time, and adverse events. The parents were telephoned and questioned regarding any adverse effect after discharge and their satisfaction (yes = satisfied; no = not satisfied) regarding the sedation process.Results:A total of 300 (American Society of Anesthesiology I–II status) pediatric patients received IV thiopental for sedation during MRI. The average age of the patients was 4.7 ± 3 years. Thiopental was administered as an initial IV bolus dose of 3 mg/kg, followed by additional bolus doses of thiopental (1 mg/kg) as needed to achieve a Ramsay sedation score of 4. The average procedure length was 20.7 ± 11.9 min. The average total dose of thiopental during the procedure was 5.6 ± 0.9 mg/kg. Patients recovered in an average time of 11 ± 5.6 min after a total sedation time of 31.7 ± 14.2 min. None of the patients had oxygen desaturation, adverse effects before or after discharge, and no patient required unplanned hospital admission. All parents were satisfied with the sedation process.Conclusion:IV thiopental is an effective, safe, and inexpensive medication for the sedation of children undergoing MRI.