Belopavlovic M, Buchthal A
Anaesthesia. 1980 Mar;35(3):271-8. doi: 10.1111/j.1365-2044.1980.tb05095.x.
Two patients who underwent surgery for cerebral aneurysms are presented. In the first case 31 g thiopentone were given postoperatively over 20 h after the patient had already been comatose for many hours. Such high doses raise considerable problems in patient management. In the second case a loading dose of 50 mg/kg thiopentone was given prophylactically to a patient undergoing cerebral aneurysm surgery beginning at the induction of anaesthesia and before surface cooling was begun. Cerebral activity was monitored continuously with a cerebral function monitor (CFM). There was no significant cardiovascular depression, little delay in postoperative recovery and no permanent neurological sequelae. In cerebral aneurysm surgery, cerebral oedema following cerebral ischaemia, either associated with vasospasm or resulting from surgical occlusion of vessels, remains a major problem postoperatively and may be an indication for preventive treatment with barbiturates. The author contend that this technique merits further evaluation in cerebro-vascular surgery, especially in high risk cases.
本文介绍了两名接受脑动脉瘤手术的患者。在第一个病例中，患者已经昏迷数小时后，在术后20小时内给予了31克硫喷妥钠。如此高的剂量给患者管理带来了相当大的问题。在第二个病例中，对一名接受脑动脉瘤手术的患者，从麻醉诱导开始且在体表降温开始之前，预防性给予了50毫克/千克硫喷妥钠的负荷剂量。使用脑功能监测仪（CFM）持续监测脑活动。没有明显的心血管抑制，术后恢复几乎没有延迟，也没有永久性神经后遗症。在脑动脉瘤手术中，脑缺血后的脑水肿，无论是与血管痉挛相关还是由血管手术闭塞引起，仍然是术后的一个主要问题，可能是使用巴比妥类药物进行预防性治疗的指征。作者认为，这种技术值得在脑血管手术中进一步评估，尤其是在高危病例中。
