Thiopental Sodium
| (thigh-oh-PEN-tahl SO-dee-uhm) |
Pentothal,  Pentothal Sodium |
| Class: General anesthetic/barbiturate |
Action Depresses CNS to produce hypnosis and anesthesia without analgesia.
Indications Induction of anesthesia; supplementation of other anesthetic agents; V anesthesia for short surgical procedures with minimal painful stimuli; nduction of hypnotic state; control of convulsions and increased intracranial pressure (IV administration); induction of preanesthetic sedation or basal narcosis (rectal administration).
Contraindications Hypersensitivity to barbiturates; variegate or acute intermittent porphyria; bsence of suitable veins for IV administration; status asthmaticus. Rectal administration: Patients undergoing rectal surgery; lesions of bowel.
Route/DosageTest Dose
ADULTS: IV 25–75 mg; observe for 60 sec.
Anesthesia
ADULTS: IV 50–75 mg slowly q 20–40 sec until anesthesia is established then 25–50 mg prn or continuous infusion of 0.2% or 0.4%. CHILDREN: IV 5–6 mg/kg then 1 mg/kg prn. INFANTS: IV 5–8 mg/kg then 1 mg/kg prn. NEONATES: IV 3–4 mg/kg then 1 mg/kg prn.
Convulsive States
ADULTS: IV 75–125 mg; may need 125–250 mg over 10 min. CHILDREN: IV 2–3 mg/kg/dose; repeat prn.
Increased Intracranial Pressure
ADULTS: IV 1.5–3.5 mg/kg. CHILDREN: IV 1.5–5 mg/kg/dose; repeat prn.
Psychiatric Disorders
ADULTS: IV 100 mg/min slowly with patient counting backwards or as infusion of 50 ml/min of 0.2% solution.
Preanesthetic Sedation
ADULTS: PR 1 g/34 kg (30 mg/kg).
Basal Narcosis
ADULTS: PR 1 g/22.5 kg (44 mg/kg) (maximum 3–4 g for adults weighing > 90 kg). CHILDREN > 3 MO: PR 25 mg/kg/dose; if not sedated within 15–20 min, may repeat with single dose of 15 mg/kg/dose (maximum 1.15 g for children > 34 kg). CHILDREN < 3 MO: PR 15 mg/kg/dose; if not sedated within 15–20 min, may repeat with single dose of < 7.5 mg/kg/dose.
InteractionsNarcotics: May cause additive barbiturate effects and increase risk of apnea. Phenothiazines: May increase frequency and severity of neuromuscular excitation and hypotension. Probenecid: May extend barbiturate effects or effects may be achieved at lower doses. Sulfisoxazole: May enhance barbiturate effects. INCOMPATIBILITIES: Tubocurarine, succinylcholine or other acid pH solutions.
Lab Test Interferences LFTs: Drug may falsely elevate results. Serum potassium: Drug may falsely elevate results.
Adverse ReactionsCV: Myocardial depression; arrhythmias. CNS: Delirium, headache; amnesia; seizures. DERM: Rash. GI: Abdominal pain; rectal irritation; diarrhea; cramping; rectal bleeding (rectal suspension). RESP: Apnea; laryngospasm; bronchospasm; hiccoughs; sneezing; coughing. OTHER: Thrombophlebitis; pain at injection site; salivation; shivering.
PrecautionsPregnancy: Category C; readily crosses placental barrier. Lactation: Excreted in breast milk. Elderly or debilitated patients: At increased risk of prolonged or potentiated hypnotic effects. Dosage reduction is required when administered rectally. Special risk patients: Use drug with caution in patients with severe cardiovascular, respiratory, renal, hepatic or endocrine disease, hypotension or shock, conditions in which hypnotic effects may be prolonged or potentiated, potential rectal surgery (rectal suspension) or presence of inflammatory, ulcerative, bleeding or neoplastic lesions of lower bowel (rectal suspension). Repeated doses: May result in prolonged drug effect due to accumulation. Severe renal impairment: Dosage reduction is required (75% of normal dose if creatinine clearance < 10 ml/min).
| PATIENT CARE CONSIDERATIONS |
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Administration/Storage- Use Sterile Water for Injection, Sodium Chloride Injection, or 5% Dextrose Injection as diluent.
- Avoid extravascular or intra-arterial injection since ulceration, necrosis and gangrene may result.
- Patients with renal dysfunction require dosage reduction.
- Use freshly prepared solutions promptly. Discard unused portions after 24 hr.
- When preparing rectal suspension, observe caution when filling applicator. Cleansing enema is not required.
- Dosage reduction of thiopental may be required if thiopental is administered concomitantly with narcotic analgesics.
- Store at room temperature, protected from light.
Assessment/Interventions- Obtain patient history, including drug history and any known allergies.
- Give test dose to assess reaction.
- Monitor vital signs before, during and after administration.
- Monitor ventilation carefully when drug is being administered to neurosurgical patients with increased intracranial pressure who are not receiving mechanical ventilation.
- Maintain airway patency at all times and have oxygen and resuscitation equipment nearby.
- Monitor respiration rate carefully.
- If patient is receiving drug intravenously, monitor cardiac function on cardiac monitor to assess for arrhythmias.
- Observe for thrombophlebitis, which may occur with IV administration.
- Observe for symptoms of anaphylaxis including pruritus, urticaria, and erythema.
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Patient/Family Education- Instruct patient to notify physician of any signs of hypersensitivity to barbiturates.
- Inform patient to avoid alcohol or other CNS depressants for 24 hr.
- Advise patient that drug can continue to impair abilities for 24 hr following administration and caution patient to avoid driving or performing other tasks requiring mental alertness.
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