Clinical Use of Thiopental in Perioperative Seizure in Subdural Hemorrhage and Space Occupying Lesion (SOL) Patient : A Case Report
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Abstract
Subdural hematoma (SDH) is a blood clot between the dura mater and the arachnoid membrane surrounding the brain. Trauma is the leading cause of subdural hematoma. The perioperative management provided by the anesthetist for trauma brain injury is to prevent secondary injuries that occur and things that can be avoided, such as hypotension, hypoxemia, hyperglycemia, or hypercarbia. A 30-year-old man came with complaints of headaches after hitting a drainage canal. When the patient had a post-seizure, the patient was fully conscious. A CT-scan examination revealed subdural bleeding; the patient was diagnosed with subdural hematoma with epilepsy and a history of space-occupying lesions. The patient was planned to undergo a craniotomy. Management of TBI in the presence of a history of SOL is very complex and requires good perioperative management to prevent mortality and morbidity. This case report will explain the principles of neuroanesthesia used to prevent secondary brain injury with the facilities and infrastructure available at the hospital.
[1] Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3 Suppl):S16-24.
[2] Safari S, Zali A, Pezeshgi P, Bastanhagh E, Jahangirifard A, et al. Neuroprotective Strategies in the Perioperative Period: A Systematic Review. J Cell Mol Anesth. 2020; 6(1):e149666.
[3] Perks A, Cheema S, Mohanraj R. Anaesthesia and epilepsy. Br J Anaesth. 2012; 108(4):562-71.
[4] Bilotta F, Gelb AW, Stazi E, Titi L, Paoloni FP, Rosa G. Pharmacological perioperative brain neuroprotection: a qualitative review of randomized clinical trials. Br J Anaesth. 2013; 110 Suppl 1:i113-20.
[5] Tarimah K, Bramawangsa LB, Suhardi CJ, Wiyarta E, Bisri DY. Hypertonic saline achieves superior brain relaxation in tumor craniotomy: An updated systematic-network meta-analysis. J Taibah Univ Med Sci. 2024; 19(5):961-973.
[6] Safaee M, Oh MC, Bloch O, Sun MZ, Kaur G, Auguste KI, et al. Choroid plexus papillomas: advances in molecular biology and understanding of tumorigenesis. Neuro Oncol. 2013; 15(3):255-67.
[7] Ünal N, Engin MMN, Kılıçaslan Ö. A Case of Choroid Plexus Papilloma with Rare Location Presenting with Impaired Consciousness. Istanbul Med J. 2019; 20(2):156-158.
[8] Aronica E, Ciusani E, Coppola A, Costa C, Russo E, Salmaggi A, et al. Epilepsy and brain tumors: Two sides of the same coin. J Neurol Sci. 2023; 446:120584.
[9] Englot DJ, Chang EF, Vecht CJ. Epilepsy and brain tumors. Handb Clin Neurol. 2016; 134:267-85.
[10] Seidel S, Wehner T, Miller D, Wellmer J, Schlegel U, Grönheit W. Brain tumor related epilepsy: pathophysiological approaches and rational management of antiseizure medication. Neurol Res Pract. 2022; 4(1):45.
[11] Maschio M, Aguglia U, Avanzini G, Banfi P, Buttinelli C, Capovilla G, et al. Management of epilepsy in brain tumors. Neurol Sci. 2019; 40(10):2217-2234.
[12] Jeon YJ, Kim MH. Effect of levetiracetam on rocuronium duration in patients undergoing cerebrovascular surgery. Anesth Pain Med. 2018; 13(4):409-14.
[13] Micov A, Tomić M, Popović B, Stepanović-Petrović R. The antihyperalgesic effect of levetiracetam in an inflammatory model of pain in rats: mechanism of action. Br J Pharmacol. 2010; 161(2):384-92.
[14] Prabhakar H, Rajan S, Kapoor I, Mahajan C. Problem Based Learning Discussions in Neuroanesthesia and Neurocritical Care. Springer; 2020.
[15] Flexman AM, Wong H, Riggs KW, Shih T, Garcia PA, Vacas S, et al. Enzyme-inducing anticonvulsants increase plasma clearance of dexmedetomidine: a pharmacokinetic and pharmacodynamic study. Anesthesiology. 2014; 120(5):1118-25.
[16] Prabhakar H, Kalaivani M. Propofol versus thiopental sodium for the treatment of refractory status epilepticus. Cochrane Database Syst Rev. 2017; 2(2):CD009202.
[17] Stier GR, Vandse R, Cole DJ. Neurosurgical Diseases and Trauma of the Spine and Spinal Cord: Anesthetic Considerations. In: Cottrell and Patel's Neuroanesthesia. Elsevier; 2024. p. 390-449.
[18] Dabricot E, Seqat I, Dailler F, Rheims S, Boulogne S, Balança B. How to monitor thiopental administration in the intensive care unit for refectory status epilepticus or intracranial hypertension? Crit Care. 2021; 25(1):439.
[19] Pérez-Bárcena J, Barceló B, Homar J, Abadal JM, Molina FJ, de la Peña A, et al. Comparación de la eficacia del pentobarbital y el tiopental en el control de la hipertensión intracraneal refractaria. Resultados preliminares en una serie de 20 pacientes [Comparison of the effectiveness of pentobarbital and thiopental in patients with refractory intracranial hypertension]. Neurocirugia (Astur). 2005; 16(1):5-12.
[20] Pérez-Bárcena J, Llompart-Pou JA, Homar J, Abadal JM, Raurich JM, Frontera G, et al. Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial. Crit Care. 2008; 12(4):R112.
[21] Parviainen I, Uusaro A, Kalviainen R, Kaukanen E, Mervaala E, Ruokonen E. High-dose thiopental in the treatment of refractory status epilepticus in intensive care unit. Neurology. 2002; 59(8):1249-51.
[22] D'Hollander S, Laenen MV, Gillet JB, De Deyne C, Heylen R, Boer W, et al. Retrospective analysis of the hemodynamic effects of induction of barbiturate coma in patients with refractory elevated intracranial pressure. Crit Care. 2013; 17(Suppl 2):P330.
[23] Gökten M, Oecal O, Sezer C, Zırh S, Muftuoglu S, Oecal E, et al. In vivo study of the utility of selective intra-arterial injection of thiopental for neuroprotection in reversible cerebral ischemia. Acta Radiol. 2024; 65(1):115-22.
[24] Schwer CI, Lehane C, Guelzow T, Zenker S, Strosing KM, Spassov S, et al. Thiopental inhibits global protein synthesis by repression of eukaryotic elongation factor 2 and protects from hypoxic neuronal cell death. PLoS One. 2013; 8(10):e77258.
[25] Wang T, Raley-Susman KM, Wang J, Chambers G, Cottrell JE, Kass IS. Thiopental attenuates hypoxic changes of electrophysiology, biochemistry, and morphology in rat hippocampal slice CA1 pyramidal cells. Stroke. 1999; 30(11):2400-7.
[26] Murphy PG, Davies MJ, Columb MO, Stratford N. Effect of propofol and thiopentone on free radical mediated oxidative stress of the erythrocyte. Br J Anaesth. 1996; 76(4):536-43.
[27] Inoue G, Ohtaki Y, Satoh K, Odanaka Y, Katoh A, Suzuki K, et al. Sedation Therapy in Intensive Care Units: Harnessing the Power of Antioxidants to Combat Oxidative Stress. Biomedicines. 2023; 11(8):2129.
[28] Ellens NR, Figueroa BE, Clark JC. The use of barbiturate-induced coma during cerebrovascular neurosurgery procedures: A review of the literature. Brain Circ. 2015; 1(2):140-5.
[29] Kim BG, Jeon YT, Han J, Bae YK, Lee SU, Ryu JH, et al. The Neuroprotective Effect of Thiopental on the Postoperative Neurological Complications in Patients Undergoing Surgical Clipping of Unruptured Intracranial Aneurysm: A Retrospective Analysis. J Clin Med. 2021; 10(6):1197.
[30] Vespa P. Seizures after acute subdural hemorrhage: call for more monitoring. Crit Care Med. 2023; 51(12):1839-40.
[31] Won SY, Konczalla J, Dubinski D, Cattani A, Cuca C, Seifert V, et al. A systematic review of epileptic seizures in adults with subdural haematomas. Seizure. 2017; 45:28-35.
[32] Wu L, Guo X, Ou Y, Yu X, Zhu B, Li Y, et al. Seizure after chronic subdural hematoma evacuation: associated factors and effect on clinical outcome. Front Neurol. 2023; 14:1190878.
[33] Howe J, Lu X, Thompson Z, Peterson GW, Losey TE. Intraoperative seizures during craniotomy under general anesthesia. Seizure. 2016; 38:23-5.
[34] Kutteruf R, Yang JT, Hecker JG, Kinney GA, Furman MA, Sharma D. Incidence and Risk Factors for Intraoperative Seizures During Elective Craniotomy. J Neurosurg Anesthesiol. 2019; 31(2):234-240.
[35] Sagher O, Hervey-Jumper SL. Epilepsy surgery: intraoperative seizure. In: Case Studies in Neuroanesthesia and Neurocritical Care. Cambridge University Press; 2011. p. 110.
[36] Kumar S, Rodriguez AJ, Burbridge MA. Intraoperative Seizure Under General Anesthesia Not Detected by EEG: A Case Report. Cureus. 2023; 15(7):e42765.
[37] Kumar A, Kumar A, Kumar N, Kumar A. Intraoperative refractory status epilepticus caused by propofol -a case report. Korean J Anesthesiol. 2021; 74(1):70-72.
[38] Russell K, Kornberg ST. Ventriculoperitoneal Shunting for Brain Tumors. Vet Clin North Am Small Anim Pract. 2025; 55(1):135-47.
[39] Zanon N, da Costa Benalia VH, Hoesker T, Hayashi CY, Frigieri G, Coelho G. Noninvasive intracranial pressure monitoring throughout brain compliance guiding a ventriculoperitoneal shunt replacement in hydrocephalus-case report. Childs Nerv Syst. 2023; 39(8):2215-2219.
[40] Sari IP, Perdani RRW, Mayasari D, Kurniati I, Ramayani F, Hanriko R, et al. Literature Review: The Role of Ventriculoperitoneal Shunts in Treatment Strategies for Hydrocephalus in Children. Med Prof J Lampung. 2025; 14(10):1868-1874.
[41] Huang KT, Bi WL, Abd-El-Barr M, Yan SC, Tafel IJ, Dunn IF, et al. The neurocritical and neurosurgical care of subdural hematomas. Neurocrit Care. 2016; 24(2):294-307.
[42] Cottrell JE, Patel P. Cottrell and Patel’s Neuroanesthesia. Elsevier Health Sciences; 2023.
[43] Bisri D, Bisri T. Dasar-Dasar Neuroanestesi. Fakultas Kedokteran Universitas Padjajaran; 2019.
[44] Karunarathna I, Kusumarathna K, Jayathilaka P, Rathnayake B, Bandara S, Abeykoon M, et al. Optimizing Traumatic Brain Injury Management: A Multidisciplinary Approach and Lessons Learned from a Complex Case. Uva Clinical Lab; 2024.
[45] Algarra NN, Sharma D. Perioperative management of traumatic brain injury. Curr Anesthesiol Rep. 2016; 6(3):193-201.
[2] Safari S, Zali A, Pezeshgi P, Bastanhagh E, Jahangirifard A, et al. Neuroprotective Strategies in the Perioperative Period: A Systematic Review. J Cell Mol Anesth. 2020; 6(1):e149666.
[3] Perks A, Cheema S, Mohanraj R. Anaesthesia and epilepsy. Br J Anaesth. 2012; 108(4):562-71.
[4] Bilotta F, Gelb AW, Stazi E, Titi L, Paoloni FP, Rosa G. Pharmacological perioperative brain neuroprotection: a qualitative review of randomized clinical trials. Br J Anaesth. 2013; 110 Suppl 1:i113-20.
[5] Tarimah K, Bramawangsa LB, Suhardi CJ, Wiyarta E, Bisri DY. Hypertonic saline achieves superior brain relaxation in tumor craniotomy: An updated systematic-network meta-analysis. J Taibah Univ Med Sci. 2024; 19(5):961-973.
[6] Safaee M, Oh MC, Bloch O, Sun MZ, Kaur G, Auguste KI, et al. Choroid plexus papillomas: advances in molecular biology and understanding of tumorigenesis. Neuro Oncol. 2013; 15(3):255-67.
[7] Ünal N, Engin MMN, Kılıçaslan Ö. A Case of Choroid Plexus Papilloma with Rare Location Presenting with Impaired Consciousness. Istanbul Med J. 2019; 20(2):156-158.
[8] Aronica E, Ciusani E, Coppola A, Costa C, Russo E, Salmaggi A, et al. Epilepsy and brain tumors: Two sides of the same coin. J Neurol Sci. 2023; 446:120584.
[9] Englot DJ, Chang EF, Vecht CJ. Epilepsy and brain tumors. Handb Clin Neurol. 2016; 134:267-85.
[10] Seidel S, Wehner T, Miller D, Wellmer J, Schlegel U, Grönheit W. Brain tumor related epilepsy: pathophysiological approaches and rational management of antiseizure medication. Neurol Res Pract. 2022; 4(1):45.
[11] Maschio M, Aguglia U, Avanzini G, Banfi P, Buttinelli C, Capovilla G, et al. Management of epilepsy in brain tumors. Neurol Sci. 2019; 40(10):2217-2234.
[12] Jeon YJ, Kim MH. Effect of levetiracetam on rocuronium duration in patients undergoing cerebrovascular surgery. Anesth Pain Med. 2018; 13(4):409-14.
[13] Micov A, Tomić M, Popović B, Stepanović-Petrović R. The antihyperalgesic effect of levetiracetam in an inflammatory model of pain in rats: mechanism of action. Br J Pharmacol. 2010; 161(2):384-92.
[14] Prabhakar H, Rajan S, Kapoor I, Mahajan C. Problem Based Learning Discussions in Neuroanesthesia and Neurocritical Care. Springer; 2020.
[15] Flexman AM, Wong H, Riggs KW, Shih T, Garcia PA, Vacas S, et al. Enzyme-inducing anticonvulsants increase plasma clearance of dexmedetomidine: a pharmacokinetic and pharmacodynamic study. Anesthesiology. 2014; 120(5):1118-25.
[16] Prabhakar H, Kalaivani M. Propofol versus thiopental sodium for the treatment of refractory status epilepticus. Cochrane Database Syst Rev. 2017; 2(2):CD009202.
[17] Stier GR, Vandse R, Cole DJ. Neurosurgical Diseases and Trauma of the Spine and Spinal Cord: Anesthetic Considerations. In: Cottrell and Patel's Neuroanesthesia. Elsevier; 2024. p. 390-449.
[18] Dabricot E, Seqat I, Dailler F, Rheims S, Boulogne S, Balança B. How to monitor thiopental administration in the intensive care unit for refectory status epilepticus or intracranial hypertension? Crit Care. 2021; 25(1):439.
[19] Pérez-Bárcena J, Barceló B, Homar J, Abadal JM, Molina FJ, de la Peña A, et al. Comparación de la eficacia del pentobarbital y el tiopental en el control de la hipertensión intracraneal refractaria. Resultados preliminares en una serie de 20 pacientes [Comparison of the effectiveness of pentobarbital and thiopental in patients with refractory intracranial hypertension]. Neurocirugia (Astur). 2005; 16(1):5-12.
[20] Pérez-Bárcena J, Llompart-Pou JA, Homar J, Abadal JM, Raurich JM, Frontera G, et al. Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial. Crit Care. 2008; 12(4):R112.
[21] Parviainen I, Uusaro A, Kalviainen R, Kaukanen E, Mervaala E, Ruokonen E. High-dose thiopental in the treatment of refractory status epilepticus in intensive care unit. Neurology. 2002; 59(8):1249-51.
[22] D'Hollander S, Laenen MV, Gillet JB, De Deyne C, Heylen R, Boer W, et al. Retrospective analysis of the hemodynamic effects of induction of barbiturate coma in patients with refractory elevated intracranial pressure. Crit Care. 2013; 17(Suppl 2):P330.
[23] Gökten M, Oecal O, Sezer C, Zırh S, Muftuoglu S, Oecal E, et al. In vivo study of the utility of selective intra-arterial injection of thiopental for neuroprotection in reversible cerebral ischemia. Acta Radiol. 2024; 65(1):115-22.
[24] Schwer CI, Lehane C, Guelzow T, Zenker S, Strosing KM, Spassov S, et al. Thiopental inhibits global protein synthesis by repression of eukaryotic elongation factor 2 and protects from hypoxic neuronal cell death. PLoS One. 2013; 8(10):e77258.
[25] Wang T, Raley-Susman KM, Wang J, Chambers G, Cottrell JE, Kass IS. Thiopental attenuates hypoxic changes of electrophysiology, biochemistry, and morphology in rat hippocampal slice CA1 pyramidal cells. Stroke. 1999; 30(11):2400-7.
[26] Murphy PG, Davies MJ, Columb MO, Stratford N. Effect of propofol and thiopentone on free radical mediated oxidative stress of the erythrocyte. Br J Anaesth. 1996; 76(4):536-43.
[27] Inoue G, Ohtaki Y, Satoh K, Odanaka Y, Katoh A, Suzuki K, et al. Sedation Therapy in Intensive Care Units: Harnessing the Power of Antioxidants to Combat Oxidative Stress. Biomedicines. 2023; 11(8):2129.
[28] Ellens NR, Figueroa BE, Clark JC. The use of barbiturate-induced coma during cerebrovascular neurosurgery procedures: A review of the literature. Brain Circ. 2015; 1(2):140-5.
[29] Kim BG, Jeon YT, Han J, Bae YK, Lee SU, Ryu JH, et al. The Neuroprotective Effect of Thiopental on the Postoperative Neurological Complications in Patients Undergoing Surgical Clipping of Unruptured Intracranial Aneurysm: A Retrospective Analysis. J Clin Med. 2021; 10(6):1197.
[30] Vespa P. Seizures after acute subdural hemorrhage: call for more monitoring. Crit Care Med. 2023; 51(12):1839-40.
[31] Won SY, Konczalla J, Dubinski D, Cattani A, Cuca C, Seifert V, et al. A systematic review of epileptic seizures in adults with subdural haematomas. Seizure. 2017; 45:28-35.
[32] Wu L, Guo X, Ou Y, Yu X, Zhu B, Li Y, et al. Seizure after chronic subdural hematoma evacuation: associated factors and effect on clinical outcome. Front Neurol. 2023; 14:1190878.
[33] Howe J, Lu X, Thompson Z, Peterson GW, Losey TE. Intraoperative seizures during craniotomy under general anesthesia. Seizure. 2016; 38:23-5.
[34] Kutteruf R, Yang JT, Hecker JG, Kinney GA, Furman MA, Sharma D. Incidence and Risk Factors for Intraoperative Seizures During Elective Craniotomy. J Neurosurg Anesthesiol. 2019; 31(2):234-240.
[35] Sagher O, Hervey-Jumper SL. Epilepsy surgery: intraoperative seizure. In: Case Studies in Neuroanesthesia and Neurocritical Care. Cambridge University Press; 2011. p. 110.
[36] Kumar S, Rodriguez AJ, Burbridge MA. Intraoperative Seizure Under General Anesthesia Not Detected by EEG: A Case Report. Cureus. 2023; 15(7):e42765.
[37] Kumar A, Kumar A, Kumar N, Kumar A. Intraoperative refractory status epilepticus caused by propofol -a case report. Korean J Anesthesiol. 2021; 74(1):70-72.
[38] Russell K, Kornberg ST. Ventriculoperitoneal Shunting for Brain Tumors. Vet Clin North Am Small Anim Pract. 2025; 55(1):135-47.
[39] Zanon N, da Costa Benalia VH, Hoesker T, Hayashi CY, Frigieri G, Coelho G. Noninvasive intracranial pressure monitoring throughout brain compliance guiding a ventriculoperitoneal shunt replacement in hydrocephalus-case report. Childs Nerv Syst. 2023; 39(8):2215-2219.
[40] Sari IP, Perdani RRW, Mayasari D, Kurniati I, Ramayani F, Hanriko R, et al. Literature Review: The Role of Ventriculoperitoneal Shunts in Treatment Strategies for Hydrocephalus in Children. Med Prof J Lampung. 2025; 14(10):1868-1874.
[41] Huang KT, Bi WL, Abd-El-Barr M, Yan SC, Tafel IJ, Dunn IF, et al. The neurocritical and neurosurgical care of subdural hematomas. Neurocrit Care. 2016; 24(2):294-307.
[42] Cottrell JE, Patel P. Cottrell and Patel’s Neuroanesthesia. Elsevier Health Sciences; 2023.
[43] Bisri D, Bisri T. Dasar-Dasar Neuroanestesi. Fakultas Kedokteran Universitas Padjajaran; 2019.
[44] Karunarathna I, Kusumarathna K, Jayathilaka P, Rathnayake B, Bandara S, Abeykoon M, et al. Optimizing Traumatic Brain Injury Management: A Multidisciplinary Approach and Lessons Learned from a Complex Case. Uva Clinical Lab; 2024.
[45] Algarra NN, Sharma D. Perioperative management of traumatic brain injury. Curr Anesthesiol Rep. 2016; 6(3):193-201.
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How to Cite
1.
Sepriwan T, Bisri D, Halimi R. Clinical Use of Thiopental in Perioperative Seizure in Subdural Hemorrhage and Space Occupying Lesion (SOL) Patient : A Case Report. Arch Anesth & Crit Care. 2026;.
