| Name: |
THIOPENTAL SODIUM (PentothalR) |
| Classification: |
barbiturate; general anaesthetic
- induction of anaesthesia
- intubation in the head injured patient
- treatment of intracranial hypertension
- status epilepticus
|
| Dose: |
- Intubation:
- barbiturate-induced coma (for seizures or ICP): loading dose 5mg/kg
- Maintenance:
- infusion 3-5 mg/kg/hr (doses may be as high as 15mg/kg/hr.)
|
| Administration: |
- 1g vials:
- reconstitute vial with 40mL D5W, NS, sterile water to make a 2.5% solution
- may be given by slow intravenous administration
- 5g bottles available for continuous infusion
|
| Adverse Effects: |
- respiratory depression
- hypotension
- decreased cardiac index
- hypothermia
- extravasation of solution may cause tissue necrosis and neuritis
- shivering
- dysrhythmias
- bronchospasm; laryngospasm
- toxic effects:
- severe cardiovascular depression
- interburst interval (EEG) > 40 sec
- fixed dilated pupils
- loss of deep tendon reflexes
|
| Cautions: |
- in anaemia
- in hepatic failure
|
| Contraindications: |
- status asthmaticus, porphyria
|
| Monitoring Therapy: |
- HR, ECG
- BP
- ICP, CPP (when indicated)
- interburst interval (EEG)
- urine output
- cardiac index
- electrolytes
- ventilatory parameters
- arterial blood gases
- pupils
- arterial lactate
- serum levels: TOXIC: thiopental >618 uM/L, pentobarbital 31 uM/L
|
| CCTC Protocol: |
- May be administered by IV infusion by an approved nurse in CCTC.
- May be titrated by an approved nurse in CCTC.
- Must be administered via a central line.
- Continuous infusion must be administered via an infusion pump.
- Patient requires placement of an arterial line to monitor BP.
- Patient requires mechanical ventilation.
- Patient must have continual EEG monitoring for continuous infusion (see CCTC procedure for barbiturate coma).
|
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