Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Comparative Study of Brain Protection Effect between Thiopental and Etomidate Using Bispectral Index during Temporary Arterial Occlusion

  • Kim, Tae-Kwan (Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital) ;
  • Park, Ik-Seong (Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital)
  • Received : 2011.08.01
  • Accepted : 2011.12.19
  • Published : 2011.12.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : This study was conducted to compare the effect of etomidate with that of thiopental on brain protection during temporary vessel occlusion, which was measured by burst suppression rate (BSR) with the Bispectral Index (BIS) monitor. Methods : Temporary parent artery occlusion was performed in forty one patients during cerebral aneurysm surgery. They were randomly assigned to one of two groups. General anesthesia was induced and maintained with 1.5-2.5 vol% sevoflurane and 50% $N_2O$. The pharmacological burst suppression (BS) was induced by a bolus injection of thiopental (5 mg/kg, group T) or etomidate (0.3 mg/kg, group E) according to randomization prior to surgery. After administration of drugs, the hemodynamic variables, the onset time of BS, the numerical values of BIS and BSR were recorded at every minutes. Results : There were no significant differences of the demographics, the BIS numbers and the hemodynamic variables prior to injection of drugs. The durations of burst suppression in group E ($11.1{\pm}6.8$ min) were not statistically different from that of group T ($11.1{\pm}5.6$ min) and nearly same pattern of burst suppression were shown in both groups. More phenylephrine was required to maintain normal blood pressure in the group T. Conclusion : Thiopental and etomidate have same duration and a similar magnitude of burst suppression with conventional doses during temporary arterial occlusion. These findings suggest that additional administration of either drug is needed to ensure the BS when the temporary occlusion time exceed more than 11 minutes. Etomidate can be a safer substitute for thiopental in aneurysm surgery.

Keywords

References

  1. An HS, Cho BM, Kang JH, Kim MK, Oh SM, Park SH : Efficacy of low dose barbiturate coma therapy for the patients with intractable intracranial hypertension using the bispectral index monitoring. J Korean Neurosurg Soc 47 : 252-257, 2010 https://doi.org/10.3340/jkns.2010.47.4.252
  2. Bader MK, Arbour R, Palmer S : Refractory increased intracranial pressure in severe traumatic brain injury : barbiturate coma and bispectral index monitoring. AACN Clin Issues 16 : 526-541, 2005 https://doi.org/10.1097/00044067-200510000-00009
  3. Batjer HH, Frankfurt AI, Purdy PD, Smith SS, Samson DS : Use of etomidate, temporary arterial occlusion, and intraoperative angiography in surgical treatment of large and giant cerebral aneurysms. J Neurosurg 68 : 234-240, 1988 https://doi.org/10.3171/jns.1988.68.2.0234
  4. Bruhn J, Bouillon TW, Shafer SL : Bispectral index (BIS) and burst suppression : revealing a part of the BIS algorithm. J Clin Monit Comput 16 : 593-596, 2000 https://doi.org/10.1023/A:1012216600170
  5. Doyle PW, Matta BF : Burst suppression or isoelectric encephalogram for cerebral protection : evidence from metabolic suppression studies. Br J Anaesth 83 : 580-584, 1999 https://doi.org/10.1093/bja/83.4.580
  6. Drummond JC, Cole DJ, Patel PM, Reynolds LW : Focal cerebral ischemia during anesthesia with etomidate, isoflurane, or thiopental : a comparison of the extent of cerebral injury. Neurosurgery 37 : 742-748; discussion 748-749, 1995 https://doi.org/10.1227/00006123-199510000-00019
  7. Drummond JC, Patel PM. Neurosurgical Anesthesia in Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL(eds) : Miller's Anesthesia. Philadelphia : Elsevier, 2009, pp2045-2087
  8. Edelman GJ, Hoffman WE, Charbel FT : Cerebral hypoxia after etomidate administration and temporary cerebral artery occlusion. Anesth Analg 85 : 821-825, 1997
  9. Gelb AW, Floyd P, Lok P, Peerless SJ, Farrell M : A prophylactic bolus of thiopentone does not protect against prolonged focal cerebral ischaemia. Can Anaesth Soc J 33 : 173-177, 1986 https://doi.org/10.1007/BF03010828
  10. Hoff JT, Pitts LH, Spetzler R, Wilson CB : Barbiturates for protection from cerebral ischemia in aneurysm surgery. Acta Neurol Scand Suppl 64 : 158-159, 1977
  11. Hoffman WE, Charbel FT, Edelman G, Misra M, Ausman JI : Comparilowerson of the effect of etomidate and desflurane on brain tissue gases and pH during prolonged middle cerebral artery occlusion. Anesthesiology 88 : 1188-1194, 1998 https://doi.org/10.1097/00000542-199805000-00008
  12. Jaggi P, Schwabe MJ, Gill K, Horowitz IN : Use of an anesthesia cerebral monitor bispectral index to assess burst-suppression in pentobarbital coma. Pediatr Neurol 28 : 219-222, 2003 https://doi.org/10.1016/S0887-8994(02)00633-1
  13. Lavine SD, Masri LS, Levy ML, Giannotta SL : Temporary occlusion of the middle cerebral artery in intracranial aneurysm surgery : time limitation and advantage of brain protection. J Neurosurg 87 : 817-824, 1997 https://doi.org/10.3171/jns.1997.87.6.0817
  14. Milde LN, Milde JH, Michenfelder JD : Cerebral functional, metabolic, and hemodynamic effects of etomidate in dogs. Anesthesiology 63 : 371-377, 1985 https://doi.org/10.1097/00000542-198510000-00005
  15. Moffat JA, McDougall MJ, Brunet D, Saunders F, Shelley ES, Cervenko FW, et al. : Thiopental bolus during carotid endarterectomy-rational drug therapy? Can Anaesth Soc J 30 : 615-622, 1983 https://doi.org/10.1007/BF03015232
  16. Nussmeier NA, Arlund C, Slogoff S : Neuropsychiatric complications after cardiopulmonary bypass : cerebral protection by a barbiturate. Anesthesiology 64 : 165-170, 1986 https://doi.org/10.1097/00000542-198602000-00006
  17. Patel PM, Drummond JC : Cerebral physiology and the effects of anesthetic change In; Miller RD. Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL(eds) : Miller's Anesthesia. Philadelphia; Elsevier, 2009, 305-339
  18. Ramesh VJ, Umamaheswara Rao GS : Quantification of burst suppression and bispectral index with 2 different bolus doses of thiopentone sodium. J Neurosurg Anesthesiol 19 : 179-182, 2007 https://doi.org/10.1097/ANA.0b013e318038d323
  19. Renou AM, Vernhiet J, Macrez P, Constant P, Billerey J, Khadaroo MY, et al. : Cerebral blood flow and metabolism during etomidate anaesthesia in man. Br J Anaesth 50 : 1047-1051, 1978 https://doi.org/10.1093/bja/50.10.1047
  20. Rhoney DH, Parker D Jr : Use of sedative and analgesic agents in neurotrauma patients : effects on cerebral physiology. Neurol Res 23 : 237-259, 2001 https://doi.org/10.1179/016164101101198398
  21. Samson D, Batjer HH, Bowman G, Mootz L, Krippner WJ Jr, Meyer YJ, et al. : A clinical study of the parameters and effects of temporary arterial occlusion in the management of intracranial aneurysms. Neurosurgery 34 : 22-28; discussion 28-29, 1994 https://doi.org/10.1227/00006123-199401000-00005
  22. Sano T, Patel PM, Drummond JC, Cole DJ : A comparison of the cerebral protective effects of etomidate, thiopental, and isoflurane in a model of forebrain ischemia in the rat. Anesth Analg 76 : 990-997, 1993
  23. Shapiro BM, Wendling WW, Ammaturo FJ, Chen D, Pham PS, Furukawa S, et al. : Vascular effects of etomidate administered for electroencephalographic burst suppression in humans. J Neurosurg Anesthesiol 10 : 231-236, 1998
  24. Taylor CL, Selman WR, Kiefer SP, Ratcheson RA : Temporary vessel occlusion during intracranial aneurysm repair. Neurosurgery 39 : 893-905; discussion 905-906, 1996
  25. Tobias JD : Bispectral index monitoring documents burst suppression during pentobarbital coma. J Intensive Care Med 23 : 258-262, 2008 https://doi.org/10.1177/0885066608318459
  26. Wagner RL, White PF : Etomidate inhibits adrenocortical function in surgical patients. Anesthesiology 61 : 647-651, 1984 https://doi.org/10.1097/00000542-198412000-00003

Cited by

  1. Concerns and challenges during anesthetic management of aneurysmal subarachnoid hemorrhage vol.9, pp.3, 2011, https://doi.org/10.4103/1658-354x.154733
  2. Comparative study evaluating efficacy of sufentanil versus midazolam in preventing myoclonic movements following etomidate vol.32, pp.1, 2011, https://doi.org/10.4103/0970-9185.173382
  3. Effects of transcutaneous acupoint electrical stimulation combined with low-dose sufentanil pretreatment on the incidence and severity of etomidate-induced myoclonus: A randomized controlled trial vol.97, pp.23, 2018, https://doi.org/10.1097/md.0000000000010969
  4. Zero bispectral index through sensor on the mandible during aneurysm clipping surgery: a case report vol.32, pp.1, 2019, https://doi.org/10.23736/s0394-9508.18.04849-0
  5. TO EVALUATE THE HAEMODYNAMIC EFFECTS OF ETOMIDATE AND A COMBINATION OF ETOMIDATE AND PROPOFOL AS INDUCTION AGENTS IN ELECTIVE SURGERIES vol.8, pp.9, 2011, https://doi.org/10.14260/jemds/2019/123
  6. COMPARATIVE STUDY OF HAEMODYNAMIC CHANGES DURING INDUCTION OF GENERAL ANAESTHESIA: PROPOFOL VERSUS ETOMIDATE vol.6, pp.27, 2011, https://doi.org/10.18410/jebmh/2019/373
  7. The Neuroprotective Effect of Thiopental on the Postoperative Neurological Complications in Patients Undergoing Surgical Clipping of Unruptured Intracranial Aneurysm: A Retrospective Analysis vol.10, pp.6, 2011, https://doi.org/10.3390/jcm10061197