Thiopental (Pentothal)

Category:

General anesthetic

Description:

Barbiturate general anesthetic

Indications:

General anesthesia
Increased intracranial pressure
Narcoanalysis
Sedation induction
Status epilepticus

Contraindications:

Acute porphyria
Porphyria history

Precautions:

Pregnancy category C; do not breast feed
Hepatic disease
Preexisting respiratory depression

Adverse Reactions (Side Effects):

CV: cardiac disease, hypertension, hypotension, myxedema, peripheral vascular disease
MISC: respiratory insufficiency, anemia, adrenal insufficiency, shock, uremia

Dosage:

Administered intravenously, rectally

General anesthesia induction and maintenance:
- Adult:
  - IV 50-100mg initially, intermittent dose 20-40 seconds intervals, or 3-5 mg/kg IV as single dose.
  - May give additional doses up to 500mg max.
  - Once anesthesia established, 25-50mg each time patient moves.
  - Alternatively, a 0.2%-0.4% solution can be used as continuous drip; adjust drip rate as necessary.
- Child 1-12 years:
  - IV 5-6 mg/kg over 10-60 minutes, followed by maintenance dose 1 mg/kg as needed
- Infants:
  - IV 5-8 mg/kg over 10-60 minutes
- Neonates:
  - IV 3-4 mg/kg over 10-60 minutes
Preanesthetic induction:
- Adult: 30 mg/kg PR prior to anesthesia
Basal narcosis:
- Adult: 9 mg/kg PR, max 3-4g for adult > 90 kg
Child:
- 9 mg/kg PR, max 1-1.5g for child > 34 kg
Treatment of increased intracranial pressure:
- Adult:
  - IV bolus 1.5-3.5 mg/kg, ventilation must be provided
Treatment of status epilepticus:
- Adult:
  - IV 50-125mg as soon as possible after onset of seizures,
  - Seizures caused by local anesthetics may require up to 250mg IV over 10 minutes
Narcoanalysis:
- Adult: IV slow injection 100 mg/min (4ml/min of a 2.5% solution) with patient counting backwards from 100.
- Stop infusion after patient becomes confused, but before sleep.
- All patients to return to semidrowsy state where conversation is coherent.
- Alternatively, a 0.2% solution in D5W may be given by rapid IV drip not greater than 50 ml/min

Source: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300