Thiopental Loading During Controlled Hypotension for Intracranial Aneurysm Surgery

Abstract

Clinical experience with supplementary thiopental loading is reported based on 30 patients undergoing surgery for intracranial aneurysm after a recent episode of subarachnoid hemorrhage. As standard procedure, pentobarbitone induction, pancuronium relaxation, endotracheal intubation, maintenance with halothane 0.5%, N2O 66% in oxygen, fentanyl, and moderate hypocapnia were used. A thiopental load of up to 20 mg/kg was supplied while the aneurysm was approached. Satisfactory and well-controlled hypotension was obtained in 5 cases after thiopental alone, and after thiopental and sodium nitroprusside (SNP) (.hivin.X .+-. S.D.) 1.3 .+-. 0.9 .mu.g/kg .cntdot. min-1 in the remaining 25 patients. No ECG sign of myocardial ischemia was observed. One disadvantage was a prolonged recovery period, which in some cases necessitated controlled ventilation for some hours. Thiopental loading can be used safely as a supplement to neuroanesthesia for aneurysm surgery.