thiopentone - Intensive Care & Coordination Monitoring Unit
thiopentone - Intensive Care & Coordination Monitoring Unit
thiopentone - Intensive Care & Coordination Monitoring Unit
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Liverpool Health Service Drug Administration Protocol First Issued: December 2002<br />
<strong>Intensive</strong> <strong>Care</strong> <strong>Unit</strong><br />
Contraindications<br />
• Known hypersensitivity to <strong>thiopentone</strong> and other barbiturates.<br />
• Complete absence of suitable veins.<br />
• Threatened airway and upper airway obstruction.<br />
• Variegate or acute intermittent porphyria.<br />
• Constrictive pericarditis, severe cardiovascular disease.<br />
• Uncorrected hypovolaemia, hypotension or shock.<br />
• Addison's disease, myxoedema, myasthenia gravis.<br />
• Hepatic or renal dysfunction, increased blood urea.<br />
• Severe anaemia.<br />
Precautions<br />
• Potassium disturbances – measure levels regularly.<br />
• Keep resuscitative and endotracheal intubation equipment and oxygen readily available.<br />
• Avoid extravasation or intra-arterial injection.<br />
• There is an increased risk of paracetamol toxicity and thus hepatotoxicity (secondary to enzyme<br />
induction) when a patient receives paracetamol in conjunction with large doses of <strong>thiopentone</strong>.<br />
Significant Interactions<br />
• Probenecid prolongs the action of <strong>thiopentone</strong>.<br />
• Benzodiazepines have a synergistic action when used with <strong>thiopentone</strong>.<br />
• Ethanol increases the CNS depressant effects of <strong>thiopentone</strong> and ethanol and diazepam increase<br />
its hypotensive effects.<br />
• Rapid or high doses of ketamine will increase the incidence of hypotension and respiratory<br />
depression.<br />
• Magnesium sulphate IV increases CNS depressant effects.<br />
• Phenothiazines potentiate hypotensive and CNS excitatory effects.<br />
• Aminophylline antagonizes <strong>thiopentone</strong>.<br />
• Thiopentone is incompatible in solution with many drugs – flush well and use a dedicated line for<br />
infusions.<br />
Adverse Effects<br />
• Hypotension, tachycardia.<br />
• Respiratory depression, apnoea.<br />
• Myocardial depression, reduced cardiac output.<br />
• Bronchospasm, laryngospasm.<br />
• Hypersensitivity reactions – sneezing, pruritus.<br />
• Tissue necrosis with extravasation.<br />
• Shivering (increased sensitivity to cold) and hypothermia.<br />
• Inadequate T lymphocyte function, leading to iatrogenic infections (in large doses, prolonged<br />
infusions).<br />
• Excitatory phenomena - involuntary muscle movements, coughing, hiccups have been reported.<br />
Presentation<br />
Thiopentone 500mg ampoule (powder) with 20mL sterile water ampoule for reconstitution.<br />
Administration Guidelines<br />
• Thiopentone is administered by the intravenous route only.<br />
• Individual response to the drug is so varied that there can be no fixed dosage.<br />
• Younger patients require relatively larger doses than middle aged and elderly people; the latter<br />
metabolise the drug more slowly.<br />
• Prepuberty requirements are the same for both sexes, women require less than men.<br />
• Dose is usually proportional to bodyweight and for infusions: obese patients require a larger dose<br />
than relatively lean people of the same weight.<br />
• For induction, the dosage is calculated on the lean body mass.<br />
• Discard cloudy solutions or solutions showing a precipitate.<br />
• Patients receiving <strong>thiopentone</strong> for the management of raised intracranial pressure should have<br />
continuous EEG monitoring where available.<br />
Reviewed: September 2004 Authors: M. Edgtton-Winn Page 2 of 4<br />
Review Date: September 2005