thiopental sodium: clinical use

Prescribing considerations

• Restrict administration to professionals trained in anaesthesia, with airway, oxygen and resuscitation equipment continuously available.
• Consider general condition, age, premedication and hepatic or renal impairment because sensitivity varies.
• Use particular caution with cardiovascular or respiratory disease, asthma, potential airway compromise and raised intracranial pressure.
• Confirm secure intravenous placement because extravasation or intra-arterial injection can cause severe tissue injury.
• Plan appropriate analgesia because thiopental produces hypnosis without analgesia.

Contraindications and cautions

• Hypersensitivity to thiopental or other barbiturates
• Respiratory obstruction
• Acute asthma
• Severe shock
• Myotonic dystrophy
• Porphyria

Monitoring

• Continuously monitor ventilation, oxygenation, blood pressure, heart rate and anaesthetic effect.
• Inspect the intravenous site and limb for pain, swelling, pallor or vascular spasm.
• During prolonged use for raised intracranial pressure, monitor potassium during treatment and after withdrawal.
• Provide controlled ventilation when used to reduce raised intracranial pressure.

Clinical pharmacology

A highly lipid-soluble thiobarbiturate that depresses central nervous system activity, particularly GABA-dependent transmission. Rapid brain uptake produces hypnosis, while redistribution contributes to the brief initial effect. Metabolism occurs mainly in the liver and plasma protein binding is high.

Formulation and product differences

• The selected product is a yellowish-white powder for solution for intravenous injection.
• It requires aseptic reconstitution with an authorised diluent and contains no bacteriostatic agent.
• Prepared solutions are strongly alkaline and incompatible with acidic anaesthetic adjuncts and some volume-replacement solutions because precipitation may occur.

Injection

Route: Parenteral

Strengths: 500 mg