What are the main side effects of thiopental in severe head injury patients. How does thiopental affect intracranial pressure in traumatic brain injury. What complications can occur during barbiturate coma therapy for brain injuries. How effective is thiopental for managing increased intracranial pressure. What monitoring is required for patients receiving thiopental infusions.

Thiopental Use in Traumatic Brain Injury Management

Thiopental, a barbiturate drug, plays a crucial role in managing severe traumatic brain injuries, particularly when intracranial pressure (ICP) becomes dangerously elevated. This article delves into the complexities of using thiopental for barbiturate coma therapy, exploring its efficacy, side effects, and the careful monitoring required during treatment.

Mechanism of Action

Thiopental works by depressing the central nervous system, reducing cerebral metabolism and blood flow. This action helps lower intracranial pressure, which is critical in preventing secondary brain damage in severe head injury cases.

Administration Protocol

The study outlines a specific protocol for thiopental administration:

• Initial intravenous infusion: 5-11 mg/kg
• Continuous infusion: 4-8 mg/kg/hour
• Duration: 1-15 days, adjusted based on ICP levels
• Target: Maintain ICP below 20 mmHg (2.7 kPa)

Common Side Effects and Complications of Thiopental Therapy

The use of thiopental in barbiturate coma therapy is associated with various side effects and complications. Understanding these is crucial for effective patient management and risk mitigation.

Cardiovascular Effects

Arterial hypotension is a significant concern, occurring in 58% of patients. This side effect requires careful monitoring and management to ensure adequate cerebral perfusion pressure is maintained.

Electrolyte Imbalances

Hypokalemia was observed in 82% of patients, making it one of the most common side effects. Regular electrolyte monitoring and correction are essential during thiopental therapy.

Respiratory Complications

Respiratory issues were reported in 76% of patients. These may include respiratory depression, necessitating mechanical ventilation support in many cases.

Infections

Infections occurred in 55% of patients. The immunosuppressive effects of barbiturates and prolonged ICU stays likely contribute to this increased infection risk.

Hepatic and Renal Dysfunction

Hepatic dysfunction was observed in 87% of patients, while renal dysfunction occurred in 47%. These high rates underscore the importance of regular liver and kidney function monitoring during treatment.

Efficacy and Mortality Rates in Thiopental-Treated Patients

The study provides insights into the outcomes of patients treated with thiopental for severe traumatic brain injuries:

• Survival rate: 20 out of 38 patients (52.6%)
• Mortality rate: 18 out of 38 patients (47.4%)
• Primary cause of death: Untreatable increase in intracranial pressure (17 patients)
• Potential treatment-related mortality: 1 patient

These figures highlight both the potential benefits and risks associated with barbiturate coma therapy in severe head injury cases.

Long-Term Outcomes and Safety Considerations

An important finding from the study is that in the majority of cases, the complications and side effects observed during thiopental therapy were not associated with permanent symptoms or dysfunctions. This suggests that while the treatment carries risks, many of these risks may be manageable and reversible with proper care.

Risk-Benefit Analysis

When considering thiopental therapy for severe traumatic brain injuries, clinicians must carefully weigh the potential benefits of reducing intracranial pressure against the risks of side effects and complications. The high survival rate (52.6%) in this high-risk patient group suggests that the treatment can be life-saving in many cases, despite the associated risks.

Monitoring and Management Strategies During Thiopental Therapy

Given the range of potential complications, comprehensive monitoring is crucial for patients receiving thiopental infusions. Key areas of focus include:

1. Continuous intracranial pressure monitoring
2. Regular blood pressure checks and management
3. Frequent electrolyte level assessments, particularly potassium
4. Respiratory function monitoring and ventilation support as needed
5. Infection surveillance and prophylaxis
6. Liver and kidney function tests
7. Continuous EEG monitoring to assess barbiturate effect and detect seizures

Implementing these monitoring strategies can help healthcare providers identify and address complications early, potentially improving patient outcomes.

Alternatives and Adjuncts to Thiopental Therapy

While thiopental remains a valuable tool in managing severe traumatic brain injuries, other treatments and strategies are often used in conjunction with or as alternatives to barbiturate coma therapy:

• Mannitol for osmotic diuresis
• Hypertonic saline solutions
• Decompressive craniectomy
• Hypothermia therapy
• Cerebrospinal fluid drainage

The choice of treatment depends on various factors, including the specific nature of the injury, patient characteristics, and the expertise available at the treating facility.

Future Directions in Traumatic Brain Injury Management

As research in traumatic brain injury management continues to evolve, several areas of focus may shape future treatment approaches:

Personalized Medicine Approaches

Developing more targeted therapies based on individual patient characteristics and injury patterns could help optimize treatment outcomes while minimizing side effects.

Novel Neuroprotective Agents

Research into new drugs that can provide neuroprotection without the systemic side effects associated with barbiturates may offer alternative treatment options in the future.

Advanced Monitoring Techniques

Innovations in neuroimaging and real-time brain monitoring could allow for more precise management of intracranial pressure and cerebral perfusion, potentially reducing the need for prolonged barbiturate coma therapy.

Combination Therapies

Exploring synergistic effects of different treatment modalities may lead to more effective management strategies that can address the complex pathophysiology of severe traumatic brain injuries.

As our understanding of traumatic brain injury pathophysiology deepens and new treatment modalities emerge, the role of thiopental in managing these critical cases may evolve. However, its current importance in controlling intracranial pressure in severe cases remains significant, warranting continued research into optimizing its use and mitigating associated risks.

Practical Considerations for Healthcare Providers

For healthcare providers managing patients with severe traumatic brain injuries, several practical considerations should be kept in mind when using thiopental therapy:

Patient Selection

Careful patient selection is crucial. Thiopental therapy is typically reserved for cases where other interventions have failed to control intracranial pressure. Factors such as the patient’s overall condition, the nature of the brain injury, and the potential for recovery should all be considered.

Dosage Titration

Individualized dosing is essential. The thiopental infusion rate should be carefully titrated based on ICP readings, with the goal of using the minimum effective dose to reduce the risk of side effects.

Multidisciplinary Approach

Managing patients on thiopental therapy requires a multidisciplinary team approach, involving neurosurgeons, intensivists, neurologists, and specialized nursing staff. This collaborative effort ensures comprehensive care and rapid response to any complications that may arise.

Family Education

Given the intensive nature of barbiturate coma therapy and its potential risks, it’s crucial to educate patients’ families about the treatment process, expected outcomes, and potential complications. This helps in managing expectations and facilitating informed decision-making.

By carefully considering these practical aspects, healthcare providers can optimize the use of thiopental in managing severe traumatic brain injuries, potentially improving patient outcomes while minimizing risks.

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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Publication types

MeSH terms

Substances

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

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• Pharmacological properties
• Indications Thiopental
• Application Thiopental
• Contraindications
• Side effects
• Special instructions
• Interactions
• Overdose
• Storage conditions
• Diagnosis
• Recommended alternatives
• Trade names

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.

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