thiopentone - Intensive Care & Coordination Monitoring Unit

Liverpool Health Service Drug Administration Protocol First Issued: December 2002
Intensive Care Unit
(1 gram in 50mL sterile water, 20mg/mL) and highlighted to both medical and nursing staff.
Clinical Considerations
• Patients receiving thiopentone infusions are to receive vigilant attention to all aspects of infection
control due to their increased susceptibility to opportunistic infection.
• Patients receiving prolonged infusions should be nursed away from patients with MRSA and other
infections that may be spread by droplet or hand contact.
• Thiopentone does not have analgesic properties.
• Daily serum levels are required to assess for a return of possible consciousness/responsiveness.
A zero level is required before responsiveness is likely.
• For patients receiving large doses of thiopentone, concomitant use of paracetamol must be
regulated and liver enzymes assessed regularly.
• Potassium levels are known to fall with thiopentone infusions. Replace to a low-normal value.
• Use caution when weaning or ceasing infusions as rebound hyperkalaemia may result.
• Always monitor potassium levels regularly during weaning and for 24 hours post cessation of
drug therapy.
References
Carlton, J.B. 1997. The handbook of parenteral drug administration. (4
th . Ed.). William’s Printers. Shepparton
MIMS Online. CIAP: NSW Health Department. 1 May 2002 - 31 July 2002. http://www.mims.hcn.net.au/
Krier, C. et al 1984 Hazards of high dose barbiturate therapy in head injured patients. Acta Anaesthesiolo gie Belgique. 35: 361
– 365.
Piatt, J. et al 1984 High dose barbiturate therapy in neurosurgery and intensive care. Neurosurgery. 15. (3): 427- 441.
Megilli, C. 1985 Cerebral protection, pathophysiology and treatment of intracranial pressure. Chest. 87. (1): 85-93
Mirr at al. 1983 Nursing management for barbiturate therapy in acute head injury. Heart and Lung. 12. (1): 52
Stover, J.P. et al. 1998 Thiopental in CSF and serum correlates with prolonged loss of cortical activity. European Neurologique.
39. (4):223-228.
Nadal, P. et al. 1995 Pneumonia in ventilated head trauma patients: the role of thiopental therapy. European Journal of
Emergency Medicine. 2.(1): 14-16.
Roberts, I. Barbiturates in the management of severe brain injury. (Cochrane Review) In: The Cochrane Library, Issue 2.
Oxford: Update Software; 1998. Updated quarterly.
Schwab, S. et al. 1997 Barbiturate coma in severe h emispheric stroke: useful or obsolete? Neurology. 48. (6): 1608-1613
Toyama, T. 2001 Anaesthesia and critical care: Barbiturate coma. http://www.trauma.org/anaesthesia/barbcoma.html
Cairns, C., Thomas, B., Fletcher, S., Parr, M. and Finfer, S. 2002 Life threatening hyperkalaemia following therapeutic
barbiturate come. Intensive Care Medicine 28:1357-1360.
Policy Author(s)
Policy Reviewers:
M. Edgtton-Winn, ICU – CNC, and see “Pharmacology Acknowledgements.doc”
ICU Director, ICU – CNC.
Reviewed: September 2004 Authors: M. Edgtton-Winn Page 4 of 4
Review Date: September 2005