Classification: barbiturate; general anaesthetic
  • induction of anaesthesia
  • intubation in the head injured patient
  • treatment of intracranial hypertension
  • status epilepticus
  • 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.)
  • 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
  • in anaemia
  • in hepatic failure
  • 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).

Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: August 7, 2006

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Last Updated March 24, 2009 | © 2007, LHSC, London Ontario Canada