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NERVOUS SYSTEM › ANESTHETICS › ANESTHETICS, GENERAL › Barbiturates, plain
thiopental
N01AF03
Forms & Strengths
- Powder for reconstitution: 500 mg, 1 g, 2.5 g, 5 g
Adult Dosing
- Induction of anesthesia: 3 to 5 mg/kg IV administered over 10 to 15 seconds
- Convulsions (status epilepticus/local anesthetic toxicity): 75 to 250 mg IV
- Raised intracranial pressure: 1.5 to 3.5 mg/kg IV as needed
Pediatric Dosing
- Induction of anesthesia (infants > 6 months and children): 3 to 5 mg/kg IV
- Neonates: 3 to 4 mg/kg IV
Indications
- Induction of general anesthesia prior to maintenance
- Control of convulsive states during or after anesthesia or other CNS stimulation
- Reduction of elevated intracranial pressure in neurosurgical patients
- Narcoanalysis or narcosynthesis in psychiatric disorders
Mechanism of Action
- Ultra-short-acting barbiturate that binds to GABA-A receptor complexes in the CNS
- Enhances GABA-mediated inhibitory neurotransmission and prolongs channel opening
- Decreases reticular activating system arousal, leading to rapid anesthesia and decreased CMRO2
Contraindications
- Hypersensitivity to barbiturates
- Acute intermittent porphyria or variegate porphyria
- Absence of suitable conditions for emergency artificial ventilation
- Status asthmaticus
Adverse Reactions
- Respiratory depression and apnea
- Myocardial depression, hypotension, and arrhythmias
- Laryngospasm and bronchospasm
- Extravasation tissue necrosis, pain, and thrombophlebitis
- Emergence delirium and prolonged somnolence
Drug Interactions
- Synergistic CNS and respiratory depression with opioids, sedatives, alcohol, and general anesthetics
- Enhanced hypotensive effects with antihypertensives and diuretics
- Enzyme induction may decrease efficacy of warfarin, corticosteroids, and oral contraceptives
- Neuromuscular blockers may exhibit altered potency
Curated Content: Needs Vetting Before Put to Clinical Use