title: Thiopental dose requirements for induction of anaesthesia and subsequent endotracheal intubation in patients with complete spinal cord injuries.
abstract: BACKGROUND
  Dose requirements of thiopental depend on patient characteristics and infusion rate. We determined thiopental dose requirements for induction of anaesthesia, and the effects of remifentanil on cardiovascular and bispectral index (BIS) responses to tracheal intubation in spinal cord-injured (SCI) patients undergoing general anaesthesia.
  
  
  METHODS
  Twenty patients with traumatic complete SCI undergoing elective surgery were enrolled. Twenty patients without SCI served as control. Anaesthesia was induced with thiopental, followed by remifentanil 1 μg/kg and rocuronium 0.8 mg/kg, and maintained with 2% sevoflurane and 50% nitrous oxide in oxygen after tracheal intubation. Thiopental was administered at a rate of 50 mg/15 s until abolition of the eyelash reflex. Thiopental doses, BIS values, systolic arterial blood pressure (SAP), heart rate (HR) and plasma catecholamine concentrations were measured.
  
  
  RESULTS
  Total thiopental dose required to abolish the eyelash reflex based on total body weight (BW) (5.26 ± 0.87 vs. 3.91 ± 1.07 mg/kg, P < 0.001) or lean BW (6.56 ± 1.37 vs. 5.24 ± 1.36 mg/kg, P < 0.01) were significantly smaller in the SCI group than in the control. SAP was decreased by induction of anaesthesia with thiopental and remifentanil, and increased by tracheal intubation in both groups. However, the peak SAP after intubation was smaller in the SCI patients. HR increased significantly above baseline values following intubation in both groups with no significant intergroup differences. Hypertension was more frequent in the control group. Norepinephrine concentrations remained unaltered following intubation in both groups.
  
  
  CONCLUSIONS
  These results suggest that the dose requirements of thiopental for induction of general anaesthesia and subsequent tracheal intubation are reduced in the SCI patients.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, South Korea. kyyoo@jnu.ac.kr
authors.forename: K Y
authors.initials: KY
authors.lastname: Yoo
authors.forename: C W
authors.initials: CW
authors.lastname: Jeong
authors.forename: H J
authors.initials: HJ
authors.lastname: Jeong
authors.forename: S H
authors.initials: SH
authors.lastname: Lee
authors.forename: J H
authors.initials: JH
authors.lastname: Na
authors.forename: S J
authors.initials: SJ
authors.lastname: Kim
authors.forename: S T
authors.initials: ST
authors.lastname: Jeong
authors.forename: J
authors.initials: J
authors.lastname: Lee
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001143:Arousal / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002395:Catecholamines / Q000097:blood; D056805:Consciousness Monitors; D004305:Dose-Response Relationship, Drug; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008738:Methyl Ethers; D016343:Monitoring, Intraoperative; D009609:Nitrous Oxide; D010100:Oxygen / Q000097:blood; D012372:ROC Curve; D012018:Reflex / Q000187:drug effects; D018401:Sample Size; D000077149:Sevoflurane; D013119:Spinal Cord Injuries / Q000150:complications*; D013874:Thiopental / Q000008:administration & dosage*
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D002395:Catecholamines; D008738:Methyl Ethers; D000077149:Sevoflurane; D013874:Thiopental; D009609:Nitrous Oxide; D010100:Oxygen