Comparison of sedative effectiveness of thiopental versus midazolam in reduction of shoulder dislocation

BACKGROUND: Various sedative drugs have been proposed to control anxiety and agitation in shoulder dislocation, but none of them has been diagnosed as the best sedative and relaxant agent. The study aimed to compare the sedative effectiveness of thiopental versus midazolam in reduction of shoulder dislocation.METHODS: A randomized double-blind controlled trail was performed in 80 patients with shoulder dislocation recruited from the emergency department. Ten patients were excluded and 70 patients were enrolled in the study. Case group received intravenous thiopental 2 mg/kg+2 μg/kg fentanyl while control group received intravenous midazolam 0.1 mg/kg+2 μg/kg fentanyl. Number of times, patients and physician's satisfaction, difficulty of procedure, degree of muscle relaxation, time of sedation and complete recovery, number of patients with apnea episode, O2 saturation, patient's pain score and adverse events were all recorded.RESULTS: Muscular tone had significant difference between the two groups(P-value=0.014) and thiopental was more muscle relaxant than midazolam. Replacement of shoulder dislocation in thiopental group was easier than midazolam group(P-value=0.043). There was no need to use multiple methods of reduction in either group. Before drug infusion the mean±SD VAS scores were 8.37±2.21 in the midazolam group(A) and 8.94±1.78 in the thiopental group(B); mean difference 0.57, 95% CI= –0.38 to 1.52. After completion of the procedure, the mean±SD VAS scores in group(A) and(B) were 3.20±1.30 vs. 3.65±1.30; mean difference –0.45, 95% CI= –1.07 to 0.16.CONCLUSION: Thiopental might be more effective and relaxant than midazolam for reduction of shoulder dislocation.

Energy Aspects of Sodium Thiopental Action on Nervous Activity

Sodium thiopental, used in a narcotic dose, makes it possible to identify the nervous processes that underlie consciousness and establish the causes of its disorder. When studying the cortical EEG activity, the impulses of individual nerve cells and the electromyographic activity of the muscles of the forelimb, it was found that thiopental blocks a number of neuronal reactions requiring energy support: tonic activating reactions to acetylcholine, applied to neurons, cease;the rate of spontaneous neuronal activity drops;the stage of non-specific activation in response to electrocutaneous stimulation disappears. So, thiopental blocks consciousness by significant limitation of the brain energy metabolism. This results in a loss of the adaptive function of the central nervous system. At the same time, glutamatergic excitation, the formation of which does not depend on energy support, is resistant to the action of thiopental. The blocking of the brain’s energy supply caused by thiopental, in accordance with its depth, develops in two stages—hypoxic and narcotic. The hypoxic stage is accompanied by hyperactivity in the nervous system, which is manifested by epileptiform discharges on the EEG and powerful unmotivated movement;the narcotic stage is associated with blockade of motor activity and flattening of EEG oscillations. The post-narcotic state associated with the consequence of the hypoxic effect of thiopental leads to the loss of ionic homeostasis and is accompanied by a steady drop in the amplitude of cortical neuron spikes.

Effects of propofol, midazolam and thiopental sodium on outcome and a mino acids accumulation in focal cerebral ischemia-reperfusion in rats

To investigate the effects of propofol, midazolam and thiopental sodium on outco mes and amino acid accumulation in focal cerebral ischemia reperfusion in rats Methods Male Sprague Dawley (SD) rats were scheduled to undergo 3 hour middle cerebral artery occlusion by intraluminal suture and 24 hour reperfusion Neurologic outcomes were score d on a 0-5 grading scale Infarct volume was shown with triphenyltetrazolium c hloride staining and measured by an image analysis system Concentrations of va rious amino acids (aspartate, glutamate, glycine, taurine, and gama aminobutyri c acid) were measured after 3 hours of reperfusion using high performance liquid chromatography Propofol, midazolam and thiopental sodium were given intraperi toneally at the beginning of reperfusion Results Both propofol and midazolam attenuated neurological deficits and reduced infarct and edema volumes Propofol showed better neurological protection than midazol am while thiopental sodium did not exhibit any protective effect Both propofol and midazolam decreased excitatory amino acids accumulation, while propofol inc reased gama aminobutyric acid accumulation in ischemic areas in reperfusion Conclusion Propofol and midazolam, but not thiopental sodium, may provide protective effect s against reperfusion induced injury in rats subjected to focal cerebral ischemi a This neurological protection may be due to the acceleration of excitatory am ino acids elimination in reperfusion

胶束电动毛细管色谱法测定血中的硫喷妥钠

建立了一种测定血中硫喷妥钠含量的胶束电动毛细管色谱法。在优化的分析条件下，硫喷妥钠的线性范围为1．0～80ug／mL，最低检出质量浓度为1．0ug／mL，方法的回收率为98．7％，日间相对标准偏差为4．6％。实验结果表明，胶束电动毛细管色谱为临床监测血中巴比妥类药物的浓度提供了一种高效、快速的测定新手段。