Index of drugs

Short-term general anesthesia. Introduction to general anesthesia.

1 vial contains 500 mg or 1000 mg thiopental sodium as a dry substance.

Thiobarbituric acid derivative - barbiturate from the ultra-short-acting group. After intravenous administration in a few seconds, it causes drowsiness, calming, deep sleep (general anesthesia); time and effect of action depend on the dose administered. The mechanism of action is related to the inhibition of retinal neurons in the brainstem. Does not have analgesic effect - in low doses lowers the pain threshold, this is manifested by the stimulation of the adrenergic system - in such a situation, the effect of strong stimuli (pain, surgery) may be stimulation of the cholinergic system and reflex cardiac arrest. It reduces the sensitivity of the respiratory system to hypercapnia and hypoxia, causes hypoventilation, after rapid intravenous administration - apnea. Reduces vascular peripheral resistance, reduces myocardial contractility and ejection volume, causes a drop in blood pressure (low in cardiopulmonary normovolemic patients, very dangerous in patients with hypovolaemia, in states with a reduced minute throw eg in pericarditis, pericardial tamponade, PK block , narrowing of the left arterial outlet, sepsis, in conditions where blood pressure is maintained due to high vascular peripheral resistance). It lowers cerebral flow (by about 48%), intracranial pressure, reduces oxygen consumption (by about 25%) and brain metabolism, reduces metabolism. It reduces glomerular filtration (shrinks kidney vessels). Has an anticonvulsant effect. The loss of consciousness occurs not later than within 30 to 40 s after intravenous administration of the drug. The anesthetic effect lasts for 5-10 minutes, followed by a dormant period after anesthesia (10-30 min.). After intravenous administration, blood-brain concentrations are quickly equalized (deep sleep phase), followed by rapid redistribution of the thiopental to the muscles, viscera, adipose tissue and slow decomposition of the drug (phase of the so-called post-residual sleep). Slowly metabolized in the liver (eg to pentobarbital): about 1% of the administered dose is broken down over 1 hour; in a small part excreted in the urine in unchanged form. It penetrates into the fetal circulation, it penetrates into breast milk.

Hypersensitivity to thiopental or other barbiturates. acute intoxication with alcohol, hypnotics, analgesics or psychoactive drugs. Gravity, respiratory insufficiency or vagotonia, asthmatic status, severe dyspnoea, severe cardiomyopathies, arrhythmias, severe shock, acute hepatic porphyria, severe liver or kidney failure, severe metabolic disturbances.

Anesthesia should be performed by a properly trained physician, with access to equipment and medicines for resuscitation. Caution should be exercised in elderly patients and in patients with cardiovascular disease, bronchial asthma, adrenal insufficiency, hypovolemia, sepsis and muscular dystrophy.

The medicine can be used during pregnancy only if in the doctor's opinion the benefit for the mother outweighs the potential risk to the fetus. A reduced dose should be administered (do not exceed the total dose of 250 mg). The concentration of the drug in breast milk is low.

During the introduction of general anesthesia (especially for rapid injection), coughing, sneezing, hiccups, laryngeal spasm and bronchospasm may occur. A hasty introduction to anesthesia may result in inhibition of the respiratory center and apnea, cardiac arrest, acceleration of the heart rhythm and reduction of minute capacity and blood pressure. Shortly after the injection, attention deficit hyperactivity is observed. Occasionally, allergic reactions (from mild to anaphylactic shock), respiratory or circulatory arrest and arrhythmias were observed. In several cases, immunohemolytic anemia with renal failure and radial nerve palsy has been reported.Sometimes, when awakening and after anesthesia, muscle twitching, chills, hypothermia, prolonged sleepiness, confusion and lack of memory are observed. Vomiting after surgery is rare. Intravenous injection of a higher concentration solution may cause thrombophlebitis. There may be pain at the injection site.

Intravenously. The recommended dose is 2-5 mg / kg mc; for correct assessment of the individual sensitivity of the patient to the drug, it is helpful to observe for 60 seconds the reaction to a test dose (25-75 mg in adults) before administering higher doses. General anesthesia: introduction of anesthesia - 200-400 mg of the drug; in repeated injections - 3-5 mg / kg m.c. intravenously for 10-15 seconds until the desired depth of anesthesia is obtained; short-term surgical procedures - 400-800 mg of the drug. The maximum dose of 1000 mg. Children up to 6 years of age: 2-7 mg / kg m.c. intravenously.