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تیوپنتال
Cortical somatosensory evoked responses to median nerve stimulation can be readily recorded at doses of thiopental far in excess of those required to cause complete suppression of the EEG but are difficult to elicit at concentrations of isoflurane associated with a burst-sup- pression pattern (~1.5 minimum alveolar concentration [MAC]).
When large doses of thiopental cause complete EEG suppression, CBF and CMR are reduced by approximately 50% to 60%.78,79 Further increases in the barbiturate dose have no addi- tional effect on the CMR.78 These observations suggest that the major effect of nontoxic doses of depressant anesthetics is a reduction in the component of cerebral metabolism that is linked to electrical brain function (e.g.
Induction of anesthesia with either thiopental or etomidate resulted in a similar reduction in MCAfv by approximately 27%.91 The changes in CBF and CMR are substantial.
In patients in whom anes- thesia was induced with thiopental, administration of 25 to 50 痢/kg of alfentanil transiently decreased MCAfv, indicat- ing a slight reduction in CBF.99 By contrast,100 no change in MCAfv was observed in response to 25 to 50 痢/kg of alfent- anil given to patients during the maintenance of anesthesia with isoflurane-N2O.
The effectiveness of bolus doses of thiopental, 3 mg/kg, and lidocaine, 1.5 mg/kg, in controlling the acute increase in ICP that occurred after the application of a pin head holder or skin incision in patients undergoing craniotomies has been assessed.128 The two regimens were equally effec- tive in causing a reduction in ICP.
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