Side effects of thiopental. Thiopental Side Effects in Severe Head Injury Treatment: A Comprehensive Analysis
What are the main side effects of thiopental therapy in patients with severe head injuries. How does thiopental affect intracranial pressure in traumatic brain injury cases. What complications can arise during barbiturate coma treatment for increased intracranial pressure.
Understanding Thiopental and Its Use in Severe Head Injuries
Thiopental, a barbiturate drug, plays a crucial role in managing severe traumatic brain injuries. Its primary use involves inducing a barbiturate coma to control dangerously elevated intracranial pressure (ICP). But how exactly does thiopental work in these critical situations?
Thiopental acts by depressing the central nervous system, which in turn reduces cerebral metabolic rate and blood flow. This mechanism helps to lower intracranial pressure, a vital factor in managing severe head injuries. Typically, medical professionals administer thiopental through intravenous infusion, carefully titrating the dose to maintain ICP below 20 mmHg (2.7 kPa).
Key Points on Thiopental Administration
- Initial dose: 5-11 mg/kg intravenously
- Continuous infusion: 4-8 mg/kg/hour
- Treatment duration: Can range from 1 to 15 days
- Goal: Maintain ICP below 20 mmHg (2.7 kPa)
Is thiopental always effective in controlling intracranial pressure? While it’s a powerful tool, its efficacy can vary. In some cases, patients may still experience untreatable increases in ICP despite barbiturate therapy.
Common Side Effects of Thiopental in Head Injury Patients
Thiopental, while effective in managing intracranial pressure, comes with a range of potential side effects. These complications can affect various body systems and require careful monitoring during treatment. What are the most frequently observed side effects in patients undergoing thiopental therapy for severe head injuries?
Cardiovascular Effects
Arterial hypotension is a significant concern, affecting 58% of patients in the study. This drop in blood pressure can potentially compromise cerebral perfusion, necessitating close cardiovascular monitoring and management.
Electrolyte Imbalances
Hypokalemia, or low potassium levels, emerged as the most common side effect, occurring in 82% of patients. This electrolyte disturbance can lead to cardiac arrhythmias and muscle weakness if not properly addressed.
Respiratory Complications
Respiratory issues were observed in 76% of patients. These complications may range from mild respiratory depression to more severe problems requiring mechanical ventilation.
Increased Infection Risk
Infections occurred in 55% of patients undergoing thiopental therapy. The immunosuppressive effects of barbiturates, combined with the critical condition of these patients, likely contribute to this increased susceptibility.
Hepatic and Renal Dysfunction
Liver function abnormalities were notably common, affecting 87% of patients. Renal dysfunction was also observed in 47% of cases. These organ systems play crucial roles in drug metabolism and elimination, making their impairment a significant concern during prolonged barbiturate therapy.
Balancing Efficacy and Risk in Thiopental Therapy
Given the high incidence of side effects, how do medical professionals weigh the benefits of thiopental against its risks? The decision to use thiopental therapy involves careful consideration of the patient’s condition and the potential outcomes.
In the study, 20 out of 38 patients survived, highlighting the life-saving potential of this treatment in managing severe traumatic brain injuries. Importantly, most complications and side effects did not result in permanent symptoms or dysfunctions. This suggests that while the side effects are common and potentially serious, they are often manageable with proper medical care.
However, it’s crucial to note that in one case, complications from barbiturate treatment may have contributed to a fatal outcome. This underscores the need for vigilant monitoring and prompt management of side effects throughout the course of therapy.
Monitoring and Managing Thiopental Side Effects
How can healthcare providers effectively monitor and manage the side effects of thiopental therapy? A comprehensive approach involving multiple specialties is often necessary to ensure patient safety and optimize outcomes.
Cardiovascular Monitoring
- Continuous blood pressure monitoring
- Regular echocardiograms to assess cardiac function
- Careful fluid and vasopressor management to maintain adequate perfusion
Electrolyte Balance
- Frequent electrolyte panels, with particular attention to potassium levels
- Prompt correction of electrolyte imbalances
- Consider magnesium supplementation, as hypomagnesemia often accompanies hypokalemia
Respiratory Care
- Close monitoring of respiratory rate and oxygen saturation
- Mechanical ventilation support as needed
- Regular chest physiotherapy to prevent atelectasis and pneumonia
Infection Prevention and Control
- Strict adherence to aseptic techniques
- Regular screening for infections
- Judicious use of prophylactic antibiotics when indicated
Hepatic and Renal Function
- Regular liver function tests and renal panels
- Adjustment of medication doses based on organ function
- Consider alternative treatments if significant organ dysfunction develops
By implementing these monitoring and management strategies, healthcare teams can optimize the benefits of thiopental therapy while minimizing the risk of severe complications.
Alternative Approaches to Managing Intracranial Hypertension
Are there alternative treatments for managing intracranial hypertension in severe head injury patients? While thiopental remains a valuable tool, other approaches have been explored and may be considered depending on the patient’s condition and response to treatment.
Osmotic Diuretics
Mannitol, an osmotic diuretic, is often used as a first-line treatment for increased intracranial pressure. It works by drawing fluid out of the brain tissue, thereby reducing cerebral edema. Some studies have compared the effects of mannitol to thiopentone on cerebral perfusion pressure and electroencephalogram (EEG) patterns in head-injured patients with intracranial hypertension.
Hypertonic Saline
Hypertonic saline solutions have gained popularity as an alternative to mannitol. They can effectively reduce ICP while maintaining or even improving cerebral perfusion pressure. The choice between hypertonic saline and mannitol often depends on the patient’s serum sodium levels and overall fluid status.
Decompressive Craniectomy
In cases where medical management fails to control intracranial pressure, surgical intervention may be necessary. Decompressive craniectomy involves removing a portion of the skull to allow the brain to expand, relieving pressure. This procedure can be life-saving but carries its own set of risks and potential complications.
Hypothermia
Therapeutic hypothermia has been investigated as a neuroprotective strategy in traumatic brain injury. By lowering brain temperature, it may reduce metabolic demands and inflammation. However, its use remains controversial, with mixed results in clinical trials.
Can these alternatives completely replace thiopental in managing severe head injuries? While each of these approaches has its merits, thiopental’s unique ability to induce a controlled coma and profoundly reduce cerebral metabolic rate makes it an invaluable option in certain cases. The choice of treatment often depends on the specific clinical scenario, patient characteristics, and the expertise available at the treating facility.
Long-Term Outcomes and Follow-Up Care
What are the long-term implications for patients who undergo thiopental therapy for severe head injuries? Understanding the potential long-term effects is crucial for both healthcare providers and patients’ families.
The study highlighted that in most cases, the complications and side effects associated with thiopental treatment did not result in permanent symptoms or dysfunctions. This is encouraging news for patients and their families. However, it’s important to note that the severe head injury itself can have significant long-term consequences, regardless of the treatment used to manage acute intracranial hypertension.
Key Considerations for Long-Term Follow-Up
- Neurological function assessment: Regular evaluations to monitor cognitive, motor, and sensory functions
- Psychological support: Addressing potential emotional and behavioral changes following severe head injury
- Rehabilitation services: Tailored programs to help patients regain lost functions and adapt to any permanent changes
- Monitoring for delayed complications: Some effects of barbiturate therapy or the initial injury may not become apparent immediately
How long should patients be followed after receiving thiopental therapy for severe head injuries? The duration of follow-up care can vary greatly depending on the individual patient’s recovery trajectory. Some patients may require lifelong support and monitoring, while others may achieve a significant degree of recovery within months to years.
It’s also worth noting that advances in neuroimaging and biomarker research may provide new tools for assessing long-term outcomes and guiding personalized follow-up care in the future.
Future Directions in Managing Severe Traumatic Brain Injuries
As medical science advances, what new approaches might emerge for managing severe traumatic brain injuries and intracranial hypertension? Several promising areas of research could potentially revolutionize treatment strategies in the coming years.
Neuroprotective Agents
Researchers are investigating various compounds that could protect neurons from secondary injury following traumatic brain injury. These neuroprotective agents aim to interrupt the complex cascade of cellular events that lead to further damage after the initial insult.
Targeted Temperature Management
While therapeutic hypothermia has shown mixed results, more refined approaches to temperature management are being explored. These may involve selective brain cooling or precisely controlled temperature modulation based on real-time physiological data.
Advanced Monitoring Techniques
The development of sophisticated multimodal monitoring systems could provide a more comprehensive understanding of brain physiology in real-time. This could allow for more precise and personalized management of intracranial pressure and cerebral perfusion.
Gene Therapy and Stem Cell Treatment
Cutting-edge research is exploring the potential of gene therapy and stem cell treatments to promote brain repair and regeneration following severe injuries. While still in early stages, these approaches hold promise for improving long-term outcomes.
Artificial Intelligence in Treatment Planning
Machine learning algorithms could potentially analyze vast amounts of patient data to predict outcomes and guide treatment decisions, including the optimal use of therapies like thiopental.
How might these advancements impact the use of thiopental in managing severe head injuries? While thiopental is likely to remain an important tool, these new approaches could potentially reduce the need for barbiturate coma in some cases or enhance its effectiveness when used. The future of traumatic brain injury management may involve a more nuanced, personalized approach that combines traditional therapies like thiopental with cutting-edge treatments tailored to each patient’s unique physiological profile.
Ethical Considerations in Thiopental Use for Severe Head Injuries
The use of thiopental to induce barbiturate coma in severe head injury cases raises several ethical considerations that healthcare providers, patients’ families, and society at large must grapple with. What are the key ethical issues surrounding this treatment approach?
Informed Consent and Decision-Making
In many cases, patients with severe head injuries are unable to provide informed consent for treatment. This responsibility often falls to family members or designated healthcare proxies. How can medical teams ensure that these decision-makers fully understand the potential benefits and risks of thiopental therapy?
Quality of Life Considerations
While thiopental therapy can be life-saving, the long-term quality of life for survivors of severe head injuries can vary greatly. How should the potential for poor long-term outcomes be weighed against the immediate life-saving benefits of the treatment?
Resource Allocation
Barbiturate coma treatment requires intensive care resources and prolonged hospital stays. In a healthcare system with limited resources, how should decisions be made about allocating these resources to patients with severe head injuries versus other critical care needs?
Research Ethics
As new treatments for traumatic brain injury are developed, how can researchers ethically conduct trials involving severely injured patients who cannot consent? Balancing the need for scientific advancement with patient protection remains a crucial ethical challenge.
Addressing these ethical considerations requires ongoing dialogue between medical professionals, ethicists, patient advocates, and policymakers. As our understanding of traumatic brain injury and its treatment evolves, so too must our approach to these complex ethical issues.
Complications and side effects during thiopentone therapy in patients with severe head injuries
. 1992 May;36(4):369-77.
doi: 10.1111/j.1399-6576.1992.tb03483.x.
W Schalén
1
, K Messeter, C H Nordström
Affiliations
Affiliation
- 1 Department of Neurosurgery, University Hospital, Lund, Sweden.
PMID:
1595344
DOI:
10.1111/j.1399-6576.1992.tb03483.x
W Schalén et al.
Acta Anaesthesiol Scand.
1992 May.
. 1992 May;36(4):369-77.
doi: 10.
1111/j.1399-6576.1992.tb03483.x.
Authors
W Schalén
1
, K Messeter, C H Nordström
Affiliation
- 1 Department of Neurosurgery, University Hospital, Lund, Sweden.
PMID:
1595344
DOI:
10.1111/j.1399-6576.1992.tb03483.x
Abstract
This study reports all complications and side effects occurring in 38 patients with severe traumatic brain lesions treated with barbiturate coma because of a dangerous increase in intracranial pressure. The treatment was induced by intravenous infusion of thiopentone (5-11 mg.
kg-1) followed by a continuous infusion of 4-8 mg.kg-1.h-1. The subsequent rate of thiopentone infusion was governed by the level of the intracranial pressure with the intention of keeping ICP below 20 mmHg (2.7 kPa). The duration of treatment was 1-15 days. Arterial hypotension occurred in 58%, hypokalemia in 82%, respiratory complications in 76%, infections in 55%, hepatic dysfunction in 87% and renal dysfunction in 47% of the patients. Twenty patients survived. Mortality in 17 patients was caused by an untreatable increase in intracranial pressure. In one patient complications due to barbiturate treatment may have contributed to the fatal outcome. In none of the other cases were the noted complications and side effects associated with any permanent symptoms or dysfunctions.
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Signs, Symptoms, & Side Effects
Thiopental, also sold under the brand name Pentothal, is a rapid-onset, short-acting anesthetic that’s used to prepare patients for surgery.
Patients are given Pentathol intravenously before administering general anesthesia. Pentothal reduces anxiety.
Recreational use of Pentothal is rare due to limited access to the drug.
Pentothal’s side effects are like those of nearly all anesthetic medications. Pentothal depresses respiratory and cardiovascular function. Hypotension (low blood pressure) and airway obstruction may also occur.
Pentothal should only be administered by a trained medical professional in a sterile hospital environment.
Pentothal is a barbiturate that enhances the inhibitory action of the GABA receptor. GABA is a neurotransmitter in the brain that’s critical for reducing anxiety. GABA is the inhibitory neurotransmitter to the excitatory neurotransmitter glutamate. GABA reduces anxiety by decreasing glutamate activity.
Pentothal used to be the go-to medication for reducing anxiety before administering general anesthesia. A newer barbiturate, propofol, has since replaced Pentothal.
Doctors may still choose to use Pentothal depending on local availability of certain drugs. Pentothal remains popular as an induction agent during intubation and in uses in obstetrics.
Following intravenous injection, Pentothal reaches the brain and can cause unconsciousness within 30-45 seconds. Peak concentrations of 60% are achieved in this time. After five to ten minutes, concentrations in the brain are low enough for consciousness to return.
Pentothal is not used for general anesthesia because it induces unconsciousness for too long when given at higher doses. This is due to the slow elimination rate of Pentothal. Inhaled anesthetics are eliminated more quickly and are preferred. It can take between 11.5 and 26 hours for Pentothal to be eliminated by the body.
Cases of Pentothal addiction have been reported but they are uncommon due to the restricted access to the drug.
Potential contraindications to Pentothal use include liver disease, myxedema, hypotension, severe breathing disorders, heart disease, Addison’s disease, or a family history of porphyria.
Physicians who choose to administer pentoxifylline with Pentothal increase the patient’s risk of suffering acute pulmonary edema. In rodent studies, the combination of these medications has resulted in increased pulmonary vascular permeability.
When patients wake up following the use of Pentothal, they may have hangover-like symptoms that last for up to 36 hours. These side effects can include nausea, headache, extreme sleepiness and fatigue, and agitated emergence. Agitated emergence is a type of poor coordination that can linger after surgery.
Pentothal has some chemical similarities to sulfa drugs but does not trigger reactions in people who are allergic to sulfa. For some patients, the injection of Pentothal can trigger an immediate smell of rotting onions or garlic.
Some individuals experience other, less common side effects. Some patients have a hypersensitivity to Pentothal or have other pre-existing risk factors that can make symptoms worse. These additional side effects can include urticaria, bronchospasm, vasodilation, edema, coughing, respiratory depression, cardiac arrhythmias and myocardial depression.
For patients with pre-existing conditions, Pentothal has, on rare occasions, induced immune hemolytic anemia with renal failure.
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Sodium thiopental – description of the substance, pharmacology, use, contraindications, formula
Properties:
Contents
Structural formula
Russian name
English title
Latin name
chemical name
Gross formula
Pharmacological group of the substance Sodium thiopental
Nosological classification
CAS code
pharmachologic effect
Characteristic
Pharmacology
Application of sodium thiopental
Contraindications
Use during pregnancy and lactation
Side effects of sodium thiopental
Interaction
Overdose
Dosage and administration
Precautionary measures
Trade names with the active substance Sodium thiopental
Structural formula
Russian name
Sodium thiopental
English name
Thiopental sodium
Latin name
Thiopentalum Natrium ( 9006 3 genus Thiopentali Natrii)
Chemical name
5-Ethyldihydro-5-(1-methylbutyl)-2-thioxo-4,6-(1H,5H)-pyrimidinedione monosodium salt
General formula
C 11 H 900 73 17 N 2 O 2 SNa
Pharmacological group of the substance Sodium thiopental
Anesthetics
Nosological classification
ICD-10 code list
CAS code
71-73-8
Pharmacological action
Pharmacological action –
anesthetic , anticonvulsant , hypnotic .
Characteristics
Dry porous mass or powder of yellowish (yellowish-greenish) color with a peculiar smell. Easily soluble in water. Aqueous solutions are alkaline (pH about 10.0), not stable (prepare immediately before use).
Pharmacology
Prolongs the period of opening of GABA-dependent channels on the postsynaptic membrane of brain neurons, prolongs the entry of chloride ions into the nerve cell and causes hyperpolarization of the membrane. In large doses, it has a GABA mimetic effect (directly activates GABA A receptors), suppresses the effects of excitatory amino acids (aspartate and glutamate).
Increases the excitability threshold of neurons and blocks the conduction and propagation of a convulsive impulse in the brain (anticonvulsant activity). Suppresses polysynaptic reflexes and slows down conduction through the intercalary neurons of the spinal cord, contributing to muscle relaxation. Reduces metabolic processes in the brain, the utilization of glucose and oxygen by the brain.
The hypnotic effect is manifested by accelerating the process of falling asleep and changing the structure of sleep. It depresses the respiratory center and reduces its sensitivity to carbon dioxide. Causes cardiodepression. Reduces stroke volume, cardiac output and blood pressure, increases the capacity of the venous bed; reduces hepatic blood flow and glomerular filtration rate.
After intravenous administration, it quickly penetrates into the brain and well-perfused (skeletal muscles, kidneys, liver) and adipose (concentration in fat depots 6–12 times higher than plasma) tissues. Plasma protein binding – 80-86%; passes through the placental barrier, is secreted into breast milk. T 1/2 in the distribution phase – 5-9 min. Undergoes biotransformation in the liver with the formation of inactive metabolites (a small part is inactivated in the kidneys and brain). Elimination T 1/2 is 10-12 hours Excreted mainly by the kidneys.
After intravenous administration, the effect develops after 40 seconds, and after rectal administration – after 8-10 minutes; duration of anesthesia – up to 15 minutes.
With repeated administration, the action is prolonged (cumulates).
Use of the substance Sodium thiopental
Intravenous anesthesia for short-term surgical interventions, induction and basic anesthesia with balanced anesthesia using analgesics and muscle relaxants, grand mal seizures, status epilepticus, increased intracranial pressure, prevention of cerebral hypoxia in traumatic brain injuries.
Contraindications
Hypersensitivity, bronchial asthma, status asthmaticus, liver and kidney dysfunction, impaired myocardial contractility, severe anemia, shock and collaptoid conditions, myasthenia gravis, myxedema, Addison’s disease, fever, inflammatory diseases of the nasopharynx, porphyria, pregnancy.
Use in pregnancy and lactation
FDA fetal category – C.
Side effects of the substance Sodium thiopental
Arrhythmia, hypotension, respiratory depression or cessation, laryngospasm, bronchospasm, nausea, vomiting; drowsiness, headache, chills, heart failure, rectal irritation and bleeding (with the rectal route of administration), allergic reactions: urticaria, skin rashes and itching, anaphylactic shock.
Interaction
Enhances the effect of antihypertensive and hypothermic agents, depresses the central nervous system under the influence of alcohol, sedatives, hypnotics, ketamine, antipsychotics, magnesium sulfate. Activity is increased by probenecid and H 1 – adrenoblockers; weakened by aminophylline, analeptics and some antidepressants.
Pharmaceutically incompatible (cannot be mixed in the same syringe) with antibiotics (amikacin, benzylpenicillin, cefapirin), tranquilizers, muscle relaxants (suxamethonium, tubocurarine), analgesics (codeine), ephedrine, ascorbic acid, dipyridamole, chlorpromazine and ketamine.
Overdose
Symptoms: respiratory depression up to apnea, laryngospasm, hypotension, tachycardia, cardiac arrest, pulmonary edema; postanesthesia delirium.
Treatment: bemegrid (specific antagonist). When breathing stops – mechanical ventilation, 100% oxygen; laryngospasm – muscle relaxants and 100% oxygen under pressure; hypotension – plasma-substituting solutions, hypertensive drugs.
Route of administration and doses
Adults for anesthesia: trial dose – 25-75 mg, followed by the introduction of 50-100 mg with an interval of 30-40 seconds until the desired effect is achieved or once at the rate of 3-5 mg / kg. To maintain anesthesia – 50-100 mg; relief of seizures – 75-125 mg IV, development of seizures during local anesthesia 125-250 mg for 10 minutes. In case of cerebral hypoxia, 1.5–3.5 mg/kg is administered in 1 min before temporary circulatory arrest; drug analysis – 100 mg for 1 min. In patients with impaired renal function (Cl creatinine less than 10 ml / min, 75% of the average dose is prescribed). The highest single dose for adults is 1 g.
Children – in / in a stream, slowly (within 3-5 minutes) once administered at the rate of 3-5 mg / kg. Before inhalation anesthesia without previous premedication in newborns – 3-4 mg / kg, from 1 to 12 months – 5-8 mg / kg, from 1 year to 12 years – 5-6 mg / kg; for anesthesia in children weighing from 30 to 50 kg – 4-5 mg / kg.
The maintenance dose is 25-50 mg. In children with impaired renal function (Cl creatinine less than 10 ml / min, 75% of the average dose is administered).
Precautions
Enter slowly (to avoid a sharp drop in blood pressure and the development of collapse). It is not recommended to use solutions with a concentration of less than 2% due to the risk of hemolysis.
Trade names with active substance Sodium thiopental
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Thiopental: instruction, price, analogues | lyophilisate for solution for injection Kievmedpreparat
schema.org/SiteNavigationElement”> pharmacodynamics. Sodium thiopental is a non-inhalation anesthetic. Under the action of the drug, the period of opening of GABA-dependent channels on the postsynaptic membranes of brain neurons, the time of entry of chloride ions into neurons, and membrane hyperpolarization occur. Reduces the severity of the exciting action of amino acids (aspartate and glutamate). In high doses, directly activating GABA receptors, it has a GABAergic effect. It has anticonvulsant activity, increasing the excitability threshold of neurons and blocking the conduction and propagation of convulsive impulses in the brain.
Promotes muscle relaxation, inhibiting polysynaptic reflexes, and slows down conduction through the intercalary neurons of the spinal cord. Slows down metabolic processes in the brain, reduces the utilization of glucose and oxygen by the brain. It has a hypnotic effect, which manifests itself in accelerating the process of falling asleep and changing the structure of sleep. It depresses the respiratory center and reduces its sensitivity to carbon dioxide. It has a cardiodepressive effect: it reduces stroke volume, cardiac output and lowers blood pressure. Increases the capacity of the venous system, reduces hepatic blood flow and glomerular filtration rate.
Pharmacokinetics. When administered intravenously, it rapidly penetrates into the brain, skeletal muscle, kidneys, liver and adipose tissue. In fat depots, the concentration of the drug is 6–12 times higher than in blood plasma. 80-86% of the drug binds to plasma proteins. Penetrates through the placental barrier and excreted in breast milk.
It is biotransformed mainly in the liver with the formation of inactive metabolites, a small part is inactivated in the kidneys and brain. T ½ is 10-12 hours. It is excreted mainly in the urine. With the correct dosage of the drug, the period of induction into anesthesia is easy and fast – within 40 seconds. The surgical depth of anesthesia is characterized by deterioration or disappearance of tendon and corneal reflexes, slight miosis (or normal pupil size), immobility or floating movements of the eyeballs, relaxation of the pharyngeal muscles with tongue retraction, a decrease in the depth of breathing and a decrease in blood pressure. The duration of anesthesia after intravenous administration of the drug is an average of 20 minutes. Upon recovery from anesthesia, the analgesic effect of sodium thiopental ceases with the awakening of the patient. It has the ability to cumulate with repeated injections.
induction anesthesia.
As an additional agent for basic anesthesia (followed by the use of analgesics and muscle relaxants).
As an additional remedy for the relief of convulsive conditions of various etiologies, including those caused by the use of local anesthesia agents.
To reduce intracranial pressure in patients with increased intracranial pressure during mechanical ventilation.
Thiopental can only be used in a hospital setting.
Exclusively for IV administration, slow!
Before administration, it is necessary to carry out skin tests for individual sensitivity to the drug in the absence of contraindications to their conduct.
IV injection
Prepare solution only immediately before use with sterile water for injection. Solutions must be absolutely transparent.
Do not inject cloudy solution or solution with incompletely dissolved content of the vial. Thiopental is used in the form of a solution of 25 mg / ml. In some cases, Thiopental can be used in the form of a solution of 50 mg / ml.
Anesthesia use
The dose of the drug is always determined by the effect, therefore the data below is used only as a general guide.
In general, the required dose is proportional to the body weight of the patient.
For induction of anesthesia, as a rule, a dose of 100-150 mg of Thiopental is used, which is injected slowly over 10-15 seconds. If necessary, it is possible to re-administer a dose of 100-150 mg after 1 minute.
The dose of the drug should be carefully adjusted depending on the response of the patient to minimize the risk of respiratory depression or the possibility of overdose, while taking into account factors such as the age, sex and body weight of the patient. Sodium thiopental reaches an effective concentration in brain tissue within 30 seconds, and anesthesia usually occurs within 1 minute after IV administration.
Adults . The average dose for an adult weighing 70 kg is 200–300 mg (8–12 ml of 25 mg/ml solution), the maximum dose is 500 mg.
Children. The average dose of Thiopental 25 mg/mL is 2–7 mg/kg body weight, administered intravenously slowly over 10–15 seconds.
If necessary, it is possible to re-administer a dose of 2-7 mg / kg of body weight after 1 min. The dose of the drug should be carefully adjusted depending on the response of the patient. The maximum dose of Thiopental should not exceed 7 mg/kg.
Elderly patients . Low doses for adults are recommended.
Use for relief of convulsive conditions . The average dose is 75–125 mg (3–5 ml of 25 mg/ml solution). The drug should be administered as soon as possible after the onset of seizures. Re-introduction of the drug may be required in order to relieve convulsive conditions caused by the use of local anesthetics.
Other regimens such as intravenous or rectal diazepam may also be used to control seizures.
Use in neurological patients to reduce intracranial pressure . Intermittent bolus injections of the drug at a dose of 1.5–3 mg/kg of body weight are used to reduce elevated intracranial pressure during mechanical ventilation.
hypersensitivity to sodium thiopental and / or other barbiturates, attacks of acute intermittent porphyria (in the patient’s history or in his close relatives), exacerbation of BA, acute circulatory disorders, Addison’s disease, collapse, terminal stage of shock, feverish conditions.
Caution should be exercised in patients with severe cardiovascular disease, severe bronchopulmonary disease and hypertension of various etiologies.
Barbiturates are contraindicated in cases of shortness of breath or airway obstruction, such as acute severe asthma, or when airway management cannot be guaranteed.
Coughing and sneezing may occur during thiopental induction, as with any barbiturate.
From the immune system : allergic reactions, including skin rashes, urticaria, itching, Quincke’s edema, skin flushing, chills, anaphylactic shock. There is information regarding the development of hemolytic anemia and renal failure associated with an increase in the amount of antibodies to thiopental.
From the digestive system: hypersalivation, nausea, vomiting.
From the side of metabolism and nutrition : possible anorexia, hypo- and / or hyperkalemia.
From the side of the central and peripheral nervous system : muscle hypertonicity, drowsiness, headache, confusion, amnesia, dizziness.
Psychiatric disorders : Possible delirium in elderly patients.
From the respiratory system : respiratory depression or cessation, laryngospasm, bronchospasm.
From the side of the cardiovascular system : arterial hypotension, tachycardia, arrhythmia, heart failure, decreased myocardial contractility.
Other : malaise, fatigue.
Local reactions : in case of extravasation with barbiturates (penetration of the drug into the surrounding soft tissues when administered intravenously), there is a risk of necrosis and severe pain. With the introduction of 5% solution, the development of thrombophlebitis is possible. In case of accidental intravenous administration of sodium thiopental, severe arterial spasm and intense burning pain around the injection site develop (see SPECIAL INSTRUCTIONS).
it should be taken into account that the achievement and maintenance of anesthesia of the required depth and duration depend both on the amount of the drug and on the patient’s individual sensitivity to it.
It should be borne in mind that the drug causes cardiodepression: it reduces stroke volume, cardiac output and blood pressure. In order to prevent a reaction associated with an increase in the tone of the vagus nerve, the patient should be premedicated with atropine or metacin before anesthesia.
It is recommended to use sodium thiopental with caution in violation of the contractile function of the myocardium.
Sodium thiopental is not recommended as the sole anesthetic for intubation anesthesia because of the risk of laryngeal spasm and cough. Sodium thiopental causes respiratory depression in patients with cardiovascular diseases, the use of sodium thiopental can lead to acute circulatory failure.
Sodium thiopental should be used with extreme caution in patients with: hypovolemia, severe bleeding, burns, cardiovascular disease, myasthenia gravis, adrenal insufficiency (even with cortisone control), cachexia, increased intracranial pressure, elevated urea levels.
Reduce dose in shock, dehydration, severe anemia, hyperkalemia, toxemia, thyrotoxicosis, myxedema and diabetes.
Use in hepatic and renal insufficiency. Sodium thiopental is metabolized primarily in the liver, so dose reduction should be considered in patients with hepatic impairment.
Barbiturates should be used with caution in severe renal impairment. Dose reduction is also necessary when using the drug in the elderly and in patients in whom narcotic analgesics were used for premedication.
For patients on long-term use of drugs such as acetylsalicylic acid, oral anticoagulants, MAO inhibitors and lithium preparations, dose adjustment or discontinuation of therapy with the above drugs before elective surgery is necessary.
Patients with diabetes mellitus or hypertension need to adjust the doses of basic therapy before anesthesia.
Dose escalation. Dose escalation is necessary for patients with a history of addiction or dependence on alcohol or drugs.
In such cases, additional use of analgesics is recommended.
Extravasation. The manifestation of extravasation is recommended to stop cold or local injection of hydrocortisone.
Random IV injection . In case of accidental intravenous administration of sodium thiopental, the needle must be left in place for the administration of antispasmodic drugs such as papaverine or prilocaine hydrochloride. In such cases, it is also recommended to use anticoagulant therapy in order to reduce the risk of thrombosis.
Use in neurological patients with increased intracranial pressure. There are risks of refractory hypokalemia during and after discontinuation of sodium thiopental infusion, these risks should be taken into account after completion of sodium thiopental infusion.
Sodium thiopental contains sodium (up to 59 mg in 0.5 g vials and up to 118 mg in 1.0 g vials). This fact must be taken into account in patients who are on a hyponatric diet.
Use during pregnancy and lactation. Sodium thiopental easily crosses the placental barrier and is also detected in breast milk. Therefore, breastfeeding should be temporarily suspended or breast milk should be expressed before induction of anesthesia. It has been proven that sodium thiopental can be used without adverse reactions during pregnancy, but the total dose should not exceed 250 mg. Thiopental during pregnancy can be prescribed only if the expected benefit outweighs the potential risk.
Children. The drug is used from the first days of life (see APPLICATION).
The ability to influence the reaction rate when driving vehicles or working with other mechanisms . Postoperative dizziness, disorientation and sedation may occur for a long time after the use of Thiopental, so you should refrain from driving vehicles or doing work that requires increased attention and speed of psychomotor reactions, especially in the first 24-36 hours after using the drug.
Thiopental increases the effect of antihypertensive and hypothermic agents. The drug potentiates the inhibitory effect on the central nervous system of sedatives and hypnotics, ketamine, neuroleptics, magnesium sulfate, ethanol. The activity of the drug is increased by blockers H 1 -adrenergic receptors and probenecid; decreases – analeptics and some antidepressants, aminophylline. So, Thiopental should be used with caution with the above-mentioned drugs.
With the simultaneous use of sodium thiopental with sulfafurazole, a reduction in the initial dose and, if necessary, maintenance of anesthesia with repeated doses is indicated.
Concomitant use of general anesthetics with drugs such as β-adrenergic and calcium channel blockers, ACE inhibitors, α-adrenergic receptor blockers, angiotensin II antagonists, phenothiazine, diazoxide, diuretics, methyldopa, moxonidine, nitrates, peripheral vasodilators (hydralazine, minoxidil, nor troprusside) may potentiate their hypotensive action.
Analgesics . There is evidence of an increase in the activity of sodium thiopental with previous use of acetylsalicylic acid. Due to the possibility of respiratory depression, sodium thiopental should be used with caution in combination with narcotic analgesics. Sodium thiopental may reduce the analgesic effect of pethidine.
Antibacterial preparations. There is evidence that general anesthetics may increase the hepatotoxicity of isoniazid, sensitization and adverse reactions may also occur with the simultaneous use of sodium thiopental and the administration of vancomycin.
Antidepressants . With simultaneous use with tricyclic antidepressants, the risk of arrhythmia and arterial hypotension increases. With the simultaneous use of sodium thiopental with MAO inhibitors, there is a risk of developing arterial hypotension and hypertension.
Antipsychotics . Sodium thiopental may enhance the sedative properties of some phenothiazines, especially promethazine.
Benzodiazepines . Midazolam potentiates the anesthetic effect of sodium thiopental.
When co-administering sodium thiopental with metoclopramide and droperidol, the dose of sodium thiopental should be reduced.
With the simultaneous use of other drugs that depress the central nervous system, synergism of their action is possible for premedication, therefore, in some cases, it is necessary to use drugs for general anesthesia in lower doses.
Bradycardia has been reported with induction of anesthesia with sodium thiopental in combination with fentanyl.
Incompatible . Solution of Thiopental should not be mixed in the same syringe with antibiotics (amikacin, benzylpenicillin, cefapirin), tranquilizers, muscle relaxants (suxamethonium, tubocurarine), analgesics, ephedrine, ascorbic acid, dipyridamole, chlorpromazine, ketamine, pethidine, morphine, promethazine, as well as acids and acid salts .
in case of overdose, respiratory depression up to apnea, laryngospasm, arterial hypotension, tachycardia, cardiac arrest, pulmonary edema are noted; postanesthetic delirium.
Treatment : Bemegride, which is a specific antagonist, is administered. When breathing stops, mechanical ventilation is used, inhalation of 100% oxygen; with laryngospasm – muscle relaxants and inhalation of 100% oxygen under pressure; with arterial hypotension – infusion of plasma-substituting solutions, hypertensive drugs.
in original packaging at a temperature not exceeding 25 °C.
| Varicose veins of the lower extremities with ulcer | ICD I83.0 |
| Hip dislocation | ICD S73.0 |
| Dislocation of the shoulder joint | ICD S43.0 |
| Dislocation of the foot | ICD S93.3 |
| Glaucoma secondary to inflammatory disease of the eye | ICD h50.4 |
| Mixed delirium | ICD F05.8 |
| Other convulsions | ICD R56. 8 |
| Other specified malformations of the nervous system | ICD Q07.8 |
| Other specified status epilepticus | ICD G41.8 |
| Intramural uterine leiomyoma | ICD D25.1 |
Gallbladder stones with acute cholecystitis | ICD K80.0 |
| Complicated cataract | ICD h36.2 |
| Acute appendicitis | ICD K35.8 |
| Wrist and hand fracture | ICD S62.8 |
| Umbilical hernia | ICD K42.9 |
| Combined fracture of the diaphysis of the ulna and radius | ICD S52.4 |
| Senile Morganian cataract | ICD h35.2 |
| Senile nuclear cataract | ICD h35. |