HIGH-DOSE THIOPENTONE FOR OPEN-CHAMBER CARDIAC-SURGERY - A RETROSPECTIVE REVIEW

Purpose: High-dose thiopentone has been reported to reduce the inciden ce of neurological dysfunction after open-chamber cardiac surgery. How ever, this technique delays tracheal extubation and increases requirem ents for inotropic support after cardiopulmonary bypass. As a quality assurance measure to determine the safety of high-dose thiopentone, we reviewed the records of all patients undergoing elective, open-chambe r surgery at our institution between Ist March, 1987 and 31st Dec, 198 9. Methods: The charts of 236 patients were reviewed retrospectively, and 227 met our inclusion criteria. The perioperative characteristics of patients anaesthetized with thiopentone (Group T, n = 80) were comp ared with those of patients anaesthetized with opioids (Group O, n = 1 47). Results: Anaesthetic technique was chosen by the attending anaest hetist. In Group T (n = 80) thiopentone 38.1 +/- 11.8 mg . kg(-1) was infused to produce electroencephalograph ic burst-suppression during b ypass. Moderate hypothermia and arterial line filtration were used dur ing bypass. The groups did not differ with respect to demographics, ty pe of surgery, or conduct of bypass. There were no strokes in Group T and 4 in Group O (P = NS). The time to extubation was prolonged in Gro up T compared with Group O (39 +/- 51 vs 27 +/- 24 h, P = 0.014), as w as the duration of stay in intensive care (66 +/- 56 vs 51 +/- 29 h, P = 0.010). Thiopentone did not increase the need for inotropic or mech anical support after bypass. In-hospital mortality was lower in Group T than in Group O (1.2% vs 9.5%, P=0.034). Conclusions: High-dose thio pentone delays extubation after open-chamber procedures. However, the technique appears safe, and further prospective investigation is justi fiable.