Introductory anesthesia. As an additional tool for basic anesthesia (followed by the use of analgesics and muscle relaxants). As an additional tool for the relief of convulsive conditions of various etiologies, including caused by the use of local anesthesia. To reduce intracranial pressure in patients with increased intracranial pressure during mechanical ventilation.
Active ingredient: 1 bottle contains sodium thiopental 1.0 g.
Thiopental sodium belongs to the means for non-inhalation anesthesia. Under the action of the drug, the opening period of GABA (γ-aminobutyric acid) -dependent channels on the postsynaptic membranes of brain neurons, the time of entry of chlorine ions into the nerve cell, and hyperpolarization of the membranes occurs. Suppresses the excitatory effect of amino acids (aspartate and glutamate). In large doses, directly activating GABA receptors, it has a GABA mimetic effect. Shows anticonvulsant activity, increasing the excitability threshold of neurons and blocking the conduction and propagation of convulsive impulses in the brain. Promotes muscle relaxation, suppressing polysynaptic reflexes, and slows down conduction along the interneurons of the spinal cord. Slows down metabolic processes in the brain, utilization of glucose and oxygen by the brain. Has a hypnotic effect, which is manifested by the acceleration of the process of falling asleep and changes in the structure of sleep. Oppresses the respiratory center and reduces its sensitivity to carbon dioxide. Has a negative inotropic effect: reduces stroke volume, cardiac output and blood pressure. Increases the capacity of the venous system, reduces hepatic blood flow and glomerular filtration rate.
Indications for use
As an additional agent for basic anesthesia (followed by the use of analgesics and muscle relaxants).
As an additional agent for the relief of convulsive conditions of various etiologies, incl. caused by the use of local anesthetics.
To reduce intracranial pressure in patients with increased intracranial pressure during mechanical ventilation.
Method of administration and dosage
- The use of Thiopental is possible only in a hospital setting.
For intravenous administration only, slowly.
- Intravenous injection
Prepare the solution only immediately before use with sterile water for injection. Solutions must be completely transparent.
A cloudy solution or a solution with incompletely dissolved contents of the vial should not be administered.
Thiopental is used as a solution of 25 mg / ml. In some cases, Thiopental can be used as a 50 mg / ml solution.
- Application in anesthesia
The dose of the drug is always determined by the effect, therefore the data below are used only as a general guide. In general, the dose required is proportional to the patient’s body weight.
For induction of anesthesia, as a rule, a dose of 100-150 mg of Thiopental should be used, which is administered slowly intravenously over 10-15 seconds in the form of a solution of 25 mg / ml. If necessary, it is possible to re-enter a dose of 100-150 mg after 1 minute.
The dose of the drug should be carefully adjusted depending on the patient’s response to minimize the risk of respiratory depression or the possibility of overdose, while factors such as age, gender and weight of the patient should also be taken into account. Thiopental sodium reaches an effective concentration in brain tissue within 30 seconds, and anesthesia usually occurs within 1 minute after intravenous administration.
The average dose for an adult weighing 70 kg is 200-300 mg (8-12 ml of a 25 mg / ml solution), the maximum dose is 500 mg
The average dose of Thiopental solution 25 mg / ml is 2-7 μ / kg of body weight, administered intravenously slowly over 10-15 seconds. If necessary, it is possible to repeat the dose of 2-7 mg / kg of body weight after 1 minute. The dose of the drug should be carefully adjusted depending on the patient’s response. The maximum dose of Thiopental should not exceed 7 mg / kg.
- Elderly patients
Reduced doses for adults are recommended.
Application for the relief of convulsive states.
The average dose is 75-125 mg (3-5 ml of a 25 mg / ml solution). The drug should be administered as soon as possible after the onset of seizures. Re-administration of the drug may be required in order to relieve convulsive conditions caused by the use of local anesthetics.
Other treatment regimens such as intravenous or rectal diazepam may also be used to relieve seizure conditions.
- Use in neurological patients to reduce intracranial pressure
Intermittent bolus injections of the drug are used at a dose of 1.5-3 mg / kg of body weight in order to reduce increased intracranial pressure during mechanical ventilation.
- Induction with thiopental, as with any barbiturates, may cause coughing and sneezing.
- From the immune system: allergic reactions, including skin rash, hives, itching, Quincke’s edema, skin flushing, chills, anaphylactic shock. There is information about the development of hemolytic anemia and renal failure associated with an increase in antibodies to thiopental.
- From the digestive system: hypersalivation, nausea, vomiting.
- From the side of metabolism and nutrition: anorexia, hypo- and / or hyperkalemia are possible.
- From the side of the central and peripheral nervous system: muscle hypertonicity, drowsiness, headache, confusion, amnesia, dizziness.
- Mental disorders: Delirium is possible in elderly patients.
- From the respiratory system: depression or cessation of breathing, laryngospasm, bronchospasm.
- From the side of the cardiovascular system: arterial hypotension, tachycardia, arrhythmia, heart failure, decreased myocardial contractility.
- Others: malaise, fatigue.
- Local reactions: in the case of extravasation with barbiturates (penetration of the drug into the surrounding soft tissues during intravenous administration), there is a risk of necrosis and severe pain. With the introduction of a 5% solution, thrombophlebitis may develop. Accidental intra-arterial administration of sodium thiopental develops severe arterial spasm and intense burning pain around the injection site.
Hypersensitivity to thiopental and / or to other barbiturates, attacks of acute intermittent porphyria (in the patient’s history or in his immediate family), exacerbation of asthma, severe circulatory disorders, Addison’s disease, collapse, end-stage shock, febrile conditions.
Caution should be exercised in patients with severe diseases of the cardiovascular system, severe bronchopulmonary diseases of hypertension of various etiologies.
Barbiturates are contraindicated for dyspnea or airway obstruction, such as acute severe asthma, or when airway maintenance cannot be guaranteed.
In case of an overdose, respiratory depression up to apnea, laryngospasm, arterial hypotension, collapse, tachycardia, cardiac arrest, pulmonary edema are noted; post-narcotic delirium.
Treatment: inject a specific antagonist – bemegrid. When breathing stops, use artificial ventilation, 100% oxygen; with laryngospasm – muscle relaxants and 100% oxygen under pressure; with arterial hypotension – plasma-substituting solutions, hypertensive drugs.
Application during pregnancy or lactation
Thiopental sodium easily penetrates the placental barrier, and is also found in breast milk. Therefore, breastfeeding should be temporarily suspended or breast milk expressed before induction of anesthesia. It has been proven that sodium thiopental can be used without adverse reactions during pregnancy, but the total dose should not exceed 250 mg. Thiopental can be prescribed during pregnancy only if the expected benefit outweighs the potential risk.
The ability to influence the reaction rate when driving or operating other mechanisms
Postoperative dizziness, disorientation and sedation can be observed for a long time after the use of Thiopental, therefore, you should refrain from driving vehicles or performing work that requires increased attention and speed of psychomotor reactions, especially in the first 24-36 hours after using the drug.
Store at a temperature not exceeding 25 ° C. Keep out of the reach of children.
Do not use after the expiration date.