Among the various sleeping pills and painkillers of a narcotic nature, a special place is occupied by “Thiopental sodium”. Instructions for the use of this serious potent drug are of interest to many patients. What is this pharmacological agent? In what cases is its appointment justified? What is the mechanism of action of sodium thiopental and how should it be used? Can the drug cause side effects and what to do in case of an overdose? The answers to these questions are given by the instructions for the use of "Thiopental sodium".
Briefly about the drug
Before you buy the drug, you will need to take a Latin prescription for sodium thiopental from your doctor. This drug has a strong narcotic effect, so it cannot be purchased without a doctor's prescription.
What is a medication? On the pharmacological market, it is sold in the form of a light hygroscopic powder, from which a solution for intravenous administration can be prepared. The powder, one or half a gram, is packaged in glass bottles with a capacity of tenor twenty milliliters.
Quick line-up
The active component of the pharmacological agent of interest to us is the substance of the same name - Thiopental sodium. This is how the name will be written in the recipe for “Sodium Thiopental” in Latin.
The active ingredient is a derivative of barbituric acid. It is used as a non-inhalation anesthesia. What achieves the desired effect of the drug?
Effect on the body
What happens when a drug enters the bloodstream? How does sodium thiopental affect the human body? The pharmacological group of this drug is anesthesia for intravenous administration with a short-acting general anesthetic and hypnotic effect.
Getting into the bloodstream, the active substance inhibits the respiratory and vasomotor centers, as well as the myocardium itself. Gradually, as a result of this effect, the patient's blood pressure and pulse decrease, and muscle relaxation is felt.
“Thiopental sodium” slows down the opening of channels that depend on the effects of gamma-aminobutyric acid, and also increases the time for chloride ions to enter the nerve cell. Also, the drug reduces the stimulating effect of amino acids such as glutamate and aspartate.
It is noteworthy that the medication we are interested in has an anticonvulsant effect. This is achieved by increasing the threshold of excitability of neurons and blocking the conduction and propagation of convulsive impulses throughout the brain. The drug also reducesthe intensity of some processes occurring in the brain.
How long does it take for Sodium Thiopental to work? The drug, when administered intravenously, begins to act within thirty seconds, when used rectally, after eight to ten minutes.
How long does the medication last? As the instructions show, the duration of anesthesia varies between twenty to thirty minutes. After this period, the patient wakes up. According to the instructions, sodium thiopental does not cause drowsiness after waking up. The duration of the analgesic effect ends the moment the patient wakes up.
Pharmacokinetic features
When administered intravenously, the drug travels through the bloodstream to the brain, adipose tissue, liver, skeletal muscle and kidneys in forty to sixty seconds. Due to the fact that the active substance spreads quickly throughout all tissues of the body, its effect wears off fairly soon.
The drug's plasma protein binding averages eighty percent. With a single administration, the half-life of the active substance ranges from three to eight hours. In children, this process is the fastest - a little more than an hour. This time period increases in women carrying babies (up to 26 hours) and in obese people (about 27 hours).
The agent of interest to us is metabolized in the liver, excreted through the kidneys. It is noteworthy that the drug has a cumulative effect. This is possible with the repeated introduction of anesthesia. In this case, sodium thiopentalaccumulates in fatty tissues.
When is this anesthetic justified?
Indications for use of the drug
Most often, the drug is prescribed for short-term surgical interventions as a general anesthesia. In some cases, the drug acts as an introductory or basic anesthesia. That is, after its introduction, it will be necessary to use other, more potent drugs for anesthesia or pain relief.
In some cases, Sodium Thiopental may be used to treat a patient with status epilepticus or increased intracranial pressure. Sometimes injections are prescribed as a prevention of cerebral hypoxia. This is usually justified in neurosurgical operations performed on the vessels of the brain, with artificial circulation or carotid endarterectomy.
Of course, the drug has contraindications.
When not to use the drug
Among the main contraindications of the drug, doctors note serious pathologies of the kidneys and liver, diabetes mellitus, bronchial asthma, collapse, severe exhaustion of the body, inflammatory diseases of the nasopharynx, fever, acute circulatory disorders, attacks of acute porphyria in anamnesis both in the patient himself and and his relatives.
In addition, this medication should not be used as an anesthetic for women who are breastfeeding, as well as for patients diagnosed with intolerancesodium thiopental or intoxication of various origins (due to an increased dose of alcohol, sleeping pills, painkillers, etc.).
With caution, it is recommended to prescribe this remedy to pregnant women, children under twelve years of age, as well as people suffering from anemia, muscular dystrophy, chronic obstructive respiratory diseases, obesity, severe diseases of the cardiovascular system (failure, myocardial disease) and so next.
In addition to contraindications, the drug has a number of side effects, which will be discussed in the next subheading.
Adverse drug reactions
Before using this drug as an anesthetic, the attending physician will acquaint the patient with possible negative manifestations that may occur during the use of Sodium Thiopental.
First of all, we are talking about dizziness and lethargy, as well as memory impairment. These symptoms are most often observed in the postoperative period after the use of anesthesia. This is due to dose-dependent depression of the central nervous system. What do patients say about the use of sodium thiopental? In reviews of this drug, people note that they have encountered such unpleasant phenomena as convulsive seizures, muscle twitching, drowsiness and anxiety. Quite rarely, patients were disturbed by such negative reactions to anesthesia as hallucinations, back pain, confusion, and so on.
Also, according to patients, after using the drug, they were worried about interruptions in the heart rhythm, lowering pressure, collapse.
The respiratory system may react negatively to the use of anesthesia with bronchospasms, difficulty breathing, sneezing or coughing.
After using the medication, a person may experience abdominal pain, nausea, and vomiting.
Among other unpleasant symptoms, patients note skin rashes, urticaria, redness of the epidermis, hiccups.
Directly with the injection of the drug, a person may experience pain or burning at the injection site, redness on the skin in the injection area, peeling, vasospasm.
How should an anesthetic be used to minimize the number and severity of the symptoms mentioned above?
General information
As mentioned above, the drug is administered intravenously. Manipulation should be carried out very carefully and slowly. Injections are carried out only in specialized conditions, that is, within the walls of medical institutions, where the necessary devices are located to maintain cardiac activity and respiration.
Children are allowed to use the drug rectally, that is, inject the solution into the rectum.
What is the required dose of Sodium Thiopental to ensure quality anesthesia? According to the instructions for use, adults are prescribed 2-2.5% solution, but in some cases the dosage can be increased to five percent. Elderly patients, debilitated people and children are given a one percent solution.
How to dilute Sodium Thiopental to the required dosage?
Recommendations forsolution preparation
The powder is diluted with special sterile water for injection, 5% glucose solution or saline sodium chloride solution. The prepared product must be used immediately after dilution. It is unacceptable to save or freeze it.
To prepare a five percent solution, you need to dilute one gram of powder in twenty milliliters of injection water. To prepare 1.25% of the drug, it is recommended to add forty milliliters of water to 0.5 grams of powder.
How does the breeding process itself take place? It's very simple.
The required amount of liquid is drawn into the syringe, and then added to the vial of powder, after which everything is thoroughly mixed by vigorously shaking the container with the medicine. The medicine must completely dissolve and become clear, otherwise it cannot be used.
Specific dosage
And now let's talk about the specific dosages of the drug that can be prescribed by an anesthesiologist. As anesthesia for adults, at the first stage of anesthesia, a trial amount of the drug is administered - about 25-75 milligrams. Then, after a minute, the so-called main dose is administered at the rate of three to five milligrams of the drug per kilogram of the patient's body weight. On average, this is two hundred to four hundred milligrams of the drug. Usually this dosage is divided into two to four times and injected into a vein every thirty to forty seconds until the desired effect is obtained.
However, as mentioned above,"Thiopental sodium" is used not only as an anesthetic. For the treatment of complex specific conditions, the drug is prescribed in the following dosages:
- To stop a seizure, administer 75-125 milligrams of medication over ten minutes.
- For the relief of convulsions caused by local anesthesia, 125-250 milligrams are also prescribed for ten minutes.
- In case of cerebral hypoxia, the medication of interest to us is administered at the rate of 1.5-3.5 milligrams per kilogram of the patient's weight. The injection is carried out within a minute, until a temporary circulatory arrest begins.
- In some cases, the drug can be used for drug analysis, when a person is put into a semi-conscious state in order for him to answer the necessary questions. In such situations, one hundred milligrams of sodium thiopental is administered over one minute until the desired state is reached.
Children and drug
Although they try not to use the drug to treat small patients, if anesthesia is necessary, the drug is prescribed at a dosage of three to five milligrams per kilogram of weight. The drug is administered by jet intravenously for three to five minutes once. This dosage applies to babies up to a year.
Children from one to twelve years of age are administered the drug at the rate of five to eight milligrams per kilogram of body weight.
A five percent solution of sodium thiopental is administered rectally. The dosage of the medicine is calculated as follows: 0.04-0.05 grams for one year of life of a small patient (if the age of the child is notexceeds three to seven years).
Use cautions
Since "Thiopental sodium" is a serious potent agent for general anesthesia, only professionals should administer it based on the appointment of an anesthesiologist. The specialist decides on the dosage of the drug not only on the basis of the duration and depth of anesthesia required, but also on the individual sensitivity of the patient.
You can only administer the drug intravenously. The ingress of the solution into the artery can provoke vessel thrombosis, necrosis and even gangrene.
How to determine in time that the medication has entered the artery? This can be detected if a conscious patient complains of a burning sensation in the vessel. If the person is unconscious, then the darkening of the epidermis, transient blanching or spotty cyanosis will indicate the incorrect administration of anesthesia. In this case, it is necessary to urgently stop the manipulation, and inject a solution of "Heparin" into the site of the lesion. Anticoagulant therapy and blockade of the brachial plexus should also be performed.
If the drug got under the skin, then it is necessary to introduce a local anesthetic, as well as to warm the surface of the epidermis. This activates blood circulation and promotes the resorption of the infiltrate.
When prescribing the drug, one should take into account the fact that people suffering from alcoholism do not respond well to its effects, so the anesthetic effect may be short-lived.
During the action of the drug, that is, the introduction of general anesthesia, it is necessary to provide the patient with access to oxygen.
When using the drug for medicinal purposes, you must be aware that it is addictive.
Anesthetic overdose
This is very rare, but it is still important to know the unpleasant symptoms that accompany the administration of too high a dose of the drug. What should I pay attention to?
First of all, the patient may experience a sharp drop in blood pressure, tachycardia, respiratory depression, bronchospasm. Even pulmonary edema and cardiac arrest are possible.
In such cases, as experienced anesthesiologists say, it is important to introduce bemegride, which is the antipode of sodium thiopental, on time. Appropriate therapy is used to eliminate unwanted symptoms. For example, when breathing stops, oxygen or artificial ventilation of the lungs is prescribed, with convulsions, diazepam is administered, and so on. In some exceptional cases, muscle relaxants may be needed.
Interaction with other medicines
According to the instructions, "Thiopental sodium" is able to reduce the effect of contraceptives, coumarin derivatives (indirect anticoagulants), glucocorticosteroids and griseofulvin. It is strictly forbidden to take this medication with muscle relaxants, ascorbic acid, atropine, antibiotics, tranquilizers, tubocurarine chloride, scopolamine, ephedrine, and so on.
If an anesthetic is used together with antihypertensive drugs, ganglionic blockers, or diuretics, it is possiblea sharp drop in pressure. This is also possible with the parallel appointment of the drug of interest to us and diazoxide.
The intake of antidepressants and analeptics reduces the effect of “Sodium Thiopental”. H1-histamine blockers and drugs that block tubular secretion (this may be, for example, probenecid) increase the effect of an anesthetic medication.
Reviews of “Sodium Thiopental”
Many people agree that this tool is really effective and efficient, especially when it comes to anesthesia for the period of surgery. The drug practically did not cause side effects, was tolerated relatively easily even by children.
However, there are cases when the use of the drug caused strong side effects and negative reactions of the body to the introduction of anesthesia. It is difficult to find out what this was due to: the negligence of doctors, the individual sensitivity of the patient, or the negative features of the anesthetic itself.
Be that as it may, this drug should only be used for medical purposes and only in specialized medical intensive care facilities.
Analogues of “Sodium Thiopental”
Among the main substitutes for the drug we are interested in, it is necessary to single out such as Pentotal and Thiopental KMP. These funds have the same active ingredient and are a powder for the preparation of an injection solution. Therefore, it is not surprising that the instructions for using these medicines are almost identical.
