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پنتوباربیتال
Tolerance to the CBF and CMR effects of barbiturates may quickly develop.80 In patients with severe head injury in whom barbiturate coma was maintained for 72 hours, the blood concentration of thiamylal required to maintain EEG burst suppression was observed to be increased by the end of the first 24 hours and continued to increase over the next 48 hours.81 During deep pentobarbital anesthesia, autoreg-
CBV is considerably greater during isoflurane anesthesia than dur- ing propofol or pentobarbital anesthesia.63 In human vol- unteers, 1 MAC sevoflurane reduced regional CBF but not regional CBV; by contrast, propofol reduced both regional CBF and regional CBV (Fig. 11.16).84 In addition, CBV responds to changes in Paco2 by a reduction in CBV with hypocapnia and an increase in CBV with hypercapnia.
, thiopental, thiamylal, methohexital, pentobarbital) have similar effects on the CMR and have generally been assumed to have equal pro- tective efficacy.
In a direct com- parison of three clinically used barbiturates, methohexital and thiopental, but not pentobarbital, reduced injury in an animal model of focal ischemia.273 These data suggest that mechanisms other than or at least in addition to meta- bolic suppression may contribute to the protective effect of
Cerebral infarction was significantly reduced in propofol-anesthetized animals in comparison with awake animals.287 Direct comparison of propofol to pentobarbital has also demonstrated that cere- bral injury after focal ischemia is similar in animals anes- thetized with the two drugs.288 Similar to the situation with volatile anesthetics, initial investigations revealed that pro- pofol protection is not sustained.289
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