Critical Care Trauma Centre


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

This is a Tier 3 drug and only approved physicians may order


Loading Dose

    • 2-3 mg/kg for barbiturate-induced coma (for seizures or ICP)

Maintenance Dose:

    • infusion 3-5 mg/kg/hour (doses may be as high as 15mg/kg/hour)

Reduce dosage in renal failure

Creatinine Clearance Dose Reduction

10-50 mL/minute

(0.17-0.84 mL/second)

Administer 100% of dose

Less than 10 mL/minute

(0.17 mL/second)

Administer 75% of dose

Use with caution in hepatic failure

  • 500 mg vial:
    • reconstitute vial with 20 mL of sterile water for injection to produce a 25 mg/mL solution
    • 1000 mg in 250 mL sodium chloride 0.9% (4 mg/mL) polyelofin bag
Adverse Effects:
  • hypotension
  • decreased cardiac output
  • hypothermia
  • extravasation of solution may cause tissue necrosis and neuritis
  • shivering
  • dysrhythmias
  • severe hypokalemia with rebound hyperkalemia after stopping infusion
  • bronchospasm; laryngospasmrespiratory depression
  • Anphylaxis
  • 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:
  • continuous heart rate and rhythm
  • continuous blood pressure monitoring via arterial line
  • full mechanical ventilation with continuous End Tidal CO2 monitoring
  • ICP, CPP (when indicated)
  • interburst interval (period of suppression) on Continuous EEG
  • urine output
  • electrolytes, lactate
  • liver function tests
  • ventilatory parameters 
  • arterial blood gases
  • pupils
  • serum levels: TOXIC: thiopental >618 uM/L, pentobarbital 31 uM/L
CCTC Protocol:
  • May be administered IV direct by a nurse in Adult Critical Care provided that the first dose is given by an MD
  • May be administered by IV infusion by a nurse in Adult Critical Care
  • Must be administered via Central Venous Line
  • Continuous infusions must be administered by infusion device and the pump library must be enabled
  • May be titrated by a nurse in Adult Critical Care to achieve an ordered ICP target or interburst interval on the EEG (suppression period)
  • Patient requires the placement of an arterial line for continuous blood pressure monitoring
  • Patient requires full mechanical ventilation with continuous End Tidal CO2 monitoring
  • Patient requires continuous subhairline or full montage EEG monitoring

Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: October 11, 2018