THIOPENTAL SODIUM (Pentothal)

THIOPENTAL IS NOT CURRENTLY AVAILABLE  IN CANADA

Pentobarbitol is available for use in status epilepticus and intracranial hypertension hrough special access. SEE LHSC  Parenteral Drug Administration Manual for dosing, special access requirements and administration of pentobarbitol (internal only)

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
 

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

• 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; laryngospasm, respiratory 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

• 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

• 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