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th brain swelling causing elevation of intracranial pressure either secondary to trauma or following surgery may benefit from this drug sodium thiopental and the barbiturate class of drugs decrease neuronal activity thereby decreasing cerebral metabolic rate of oxygen consumption cmro 2 thus decreasing the cerebrovascular response to carbon dioxide which in turn decreases intracranial pressure patients with refractory elevated intracranial pressure rich due to traumatic brain injury tbi may have improved long term outcome when barbiturate coma is added to their neurointensive care treatment 14 reportedly thiopental has been shown to be superior to pentobarbital in reducing intracranial pressure 15 this phenomenon is also called an inverse steal or robin hood effect as cerebral perfusion to all parts of the brain is reduced due to the decreased cerebrovascular response to carbon dioxide allowing optimal perfusion to ischaemic areas of the brain which have higher metabolic demands since vessels supplying ischaemic areas of the brain would already be maximally dilated because of the metabolic demand 16 euthanasia edit sodium thiopental is used intravenously for the purposes of euthanasia in both belgium and the netherlands where active euthanasia is allowed by law the standard protocol recommends sodium thiopental as the ideal agent to induce coma followed by pancuronium bromide to paralyze muscles and stop breathing 17 intravenous administration is the most reliable and rapid way to accomplish euthanasia death is quick a coma is first induced by intravenous administration of 20 mg kg thiopental sodium nesdonal in a small volume 10 ml physiological saline then a triple dose of a non depolarizing neuromuscular blocking drug is given such as 20 mg pancuronium bromide pavulon or 20 mg vecuronium bromide norcuron the paralytic should be given intravenously to ensure optimal bioavailability but pancuronium bromide may be administered intramuscularly at an increased dosage level of 40 mg 17 lethal injection edit further information lethal injection along with pancuronium bromide and potassium chloride thiopental is used in 34 us states to execute prisoners by lethal injection a large dose is given to ensure rapid loss of consciousness although death usually occurs within ten minutes of the beginning of the injection process some have been known to take longer 18 in december 2009 ohio became the first state in the us to use a single dose of sodium thiopental for an execution following the failed use of the standard three drug cocktail during a prior execution due to inability to locate suitable veins kenneth biros was executed using the single drug method 19 washington became the second state in the us to use the single dose sodium thiopental injections for executions in september 2010 the execution of cal coburn brown was the first in the state to use a single dose single drug injection his death was pronounced approximately one and a half minutes after the intravenous administration of five grams of the drug 20 after its use for the execution of jeffrey landrigan in the us the united kingdom introduced a ban on the export of sodium thiopental in december 2010 21 after it was established that no european supplies to the us were being used for any other purpose 22 the restrictions were based on the european union torture regulation including licensing of drugs used in execution by lethal injection 23 from 21 december 2011 the eu extended trade restrictions to prevent the export of certain medicinal products for capital punishment stating that the union disapproves of capital punishment in all circumstances and works towards its universal abolition 24 truth serum edit further information truth serum thiopental is still used in some places as a truth serum to weaken the resolve of a subject and make the individual more compliant to pressure 25 barbiturates decrease both higher cortical brain function and inhibition it is thought that because lying is a more involved process than telling the truth suppression of the higher cortical functions may lead to the uncovering of the truth the drug tends to make subjects verbose and cooperative with interrogators however the reliability of confessions made under thiopental is questionable 26 psychiatry edit psychiatrists have used thiopental to desensitize patients with phobias 27 and to facilitate the recall of painful repressed memories 28 one psychiatrist who worked with thiopental is jan bastiaans who used this procedure to help relieve trauma in surviving victims of the holocaust 29 another notable psychiatrist using thiopental for the first time in the 1960s in psychoanalytic therapy setting in a somewhat similar way to psycholytic psychotherapy was the hungarian australian psychiatrist imre zádor 30 he administered thiopental to psychotherapy patients to reduce transferential resistance in cases of anorexia nervosa as well as to resolve unconscious blockages in other cases mechanism of action edit main article barbiturate sodium thiopental is a member of the barbiturate class of drugs which are relatively non selective compounds that bind to an entire superfamily of ligand gated ion channels of which the gaba a receptor channel is one of several representatives this superfamily of ion channels includes the neuronal nicotinic acetylcholine receptor nachr the 5 ht3 receptor the glycine receptor and others surprisingly while gaba a receptor currents are increased by barbiturates and other general anesthetics ligand gated ion channels that are predominantly permeable for cationic ions are blocked by these compounds for example neuronal nachr are blocked by clinically relevant anesthetic concentrations of both sodium thiopental and pentobarbital 31 such findings implicate non gabaergic ligand gated ion channels e g the neuronal nachr in mediating some of the side effects of barbiturates 32 the gaba a receptor is an inhibitory channel that decreases neuronal activity and barbiturates enhance the inhibitory action of the gaba a receptor 33 controversies edit following a shortage that led a court to delay an execution in california a company spokesman for hospira the sole american manufacturer of the drug objected to the use of thiopental in lethal injection hospira manufactures this product because it improves or saves lives and the company markets it solely for use as indicated on the product labeling the drug is not indicated for capital punishment and hospira does not support its use in this procedure 34 on january 21 2011 the company announced that it would stop production of sodium thiopental from its plant in italy because it could not provide italian authorities with guarantees that exported doses would not be used in executions according to a company spokesperson italy was the only viable place where it could produce the drug leaving the us without a supplier 35 in october 2015 the us food and drug administration fda confiscated an overseas shipment of thiopental destined for the states of arizona and texas the fda said in a statement courts have concluded that sodium thiopental for the injection in humans is an unapproved drug and may not be imported into the country 36 metabolism edit thiopental rapidly and easily crosses the blood brain barrier as it is a lipophilic molecule as with all lipid soluble anaesthetic drugs the short duration of action of sodium thiopental is due almost entirely to its redistribution away from central circulation into muscle and fatty tissue due to its very high lipid water partition coefficient approximately 10 leading to sequestration in fatty tissue once redistributed the free fraction in the blood is metabolized in the liver by zero order kinetics sodium thiopental is mainly metabolized to pentobarbital 37 5 ethyl 5 1 methyl 3 hydroxybutyl 2 thiobarbituric acid and 5 ethyl 5 1 methyl 3 carboxypropyl 2 thiobarbituric acid 38 dosage edit the usual dose range for induction of anesthesia using thiopental is from 3 to 6 mg kg however there are many factors that can alter this premedication with sedatives such as benzodiazepines or clonidine will reduce requirements due to drug synergy as do specific disease states and other patient factors among patient factors are age sex and lean body mass 39 specific disease conditions that can alter the dose requirements of thiopentone and for that matter any other intravenous anaesthetic are hypovolemia burns azotemia liver failure hypoproteinemia etc 40 contraindications edit thiopental should be used with caution in cases of liver disease addison s disease myxedema severe heart disease severe hypotension a severe breathing disorder or a family history of porphyria 41 42 co administration of pentoxifylline and thiopental causes death by acute pulmonary edema in rats this pulmonary edema was not mediated by cardiac failure or by pulmonary hypertension but was due to increased pulmonary vascular permeability 43 history edit sodium thiopental was discovered in the early 1930s by ernest h volwiler and donalee l tabern working for abbott laboratories it was first used in human beings on march 8 1934 by dr ralph m waters 44 in an investigation of its properties which were short term anesthesia and surprisingly little analgesia 45 three months later 46 dr john s lundy started a clinical trial of thiopental at the mayo clinic at the request of abbott 47 abbott continued to make the drug until 2004 when it spun off its hospital products division as hospira thiopental is famously associated with a number of anesthetic deaths in victims of the attack on pearl harbor these deaths relatively soon after the drug s introduction were said to be due to excessive doses given to shocked trauma patients however evidence available through the freedom of information legislation 48 suggested that the story was exaggerated of the 344 wounded that were admitted to the tripler army hospital only 13 did not survive and it is unlikely that thiopentone overdose was responsible for more than a few of them references edit anvisa 31 march 2023 rdc nº 784 listas de substâncias entorpecentes psicotrópicas precursoras e outras sob controle especial collegiate board resolution no 784 lists of narcotic psychotropic precursor and other substances under special control in brazilian portuguese diário oficial da união published 4 april 2023 archived from the original on 3 august 2023 retrieved 16 august 2023 pentothal dailymed retrieved 15 september 2025 russo h brès j duboin mp roquefeuil b 1995 pharmacokinetics of thiopental after single and multiple intravenous doses in critical care patients european journal of clinical pharmacology 49 1 2 127 37 doi 10 1007 bf00192371 pmid 8751034 s2cid 24285007 1 2 morgan dj blackman gl paull jd wolf lj june 1981 pharmacokinetics and plasma binding of thiopental ii studies at cesarean section anesthesiology 54 6 474 80 doi 10 1097 00000542 198106000 00006 pmid 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thiopental sodium and propofol on haemodynamics awareness and newborns during caesarean section under general anaesthesia turkish journal of anaesthesiology and reanimation 43 2 106 112 doi 10 5152 tjar 2014 75547 pmc 4917150 pmid 27366476 gleason ca juul se 12 august 2011 avery s diseases of the newborn elsevier health sciences p 169 isbn 978 1 4557 2714 8 archived from the original on 26 november 2022 retrieved 13 august 2016 shibata y yokooji t itamura r sagara y taogoshi t ogawa k et al december 2016 injury due to extravasation of thiopental and propofol risks effects of local cooling warming in rats biochemistry and biophysics reports 8 207 211 doi 10 1016 j bbrep 2016 09 005 pmc 5613958 pmid 28955958 takeko t trauma org critical care barbiturate coma trauma org archived from the original on 19 august 2016 retrieved 18 august 2016 abraham p rennert rc gabel bc sack ja karanjia n warnke p et al december 2017 icp management in patients suffering from traumatic brain injury a systematic review of randomized controlled trials acta neurochirurgica 159 12 2279 2287 doi 10 1007 s00701 017 3363 1 pmid 29058090 s2cid 3013248 roberts i sydenham e december 2012 barbiturates for acute traumatic brain injury the cochrane database of systematic reviews 2012 12 cd000033 doi 10 1002 14651858 cd000033 pub2 pmc 7061245 pmid 23235573 trickey d anesthetic management of head injured patients www amcresidents com archived from the original on 18 october 2020 retrieved 13 october 2020 1 2 royal dutch society for the advancement of pharmacy 1994 administration and compounding of euthanasic agents the hague archived from the original on 21 august 2008 retrieved 18 july 2008 ohio executes inmate with 1 drug lethal injection associated press december 2001 retrieved 8 december 2009 martinez e 8 december 2009 kenneth biros execution ohio man first to die under 1 drug thiopental sodium method cbs news sullivan j 10 september 2010 killer on death row 16 1 2 years is executed the seattle times drug sold in uk to be used for execution in georgia bbc co uk bbc news 24 january 2011 retrieved 18 august 2016 casciani d 29 november 2010 us lethal injection drug faces uk export restrictions bbc co uk bbc news retrieved 18 august 2016 controls on torture goods detailed guidance gov uk gov uk retrieved 18 august 2016 eu council regulation eu no 1352 2011 truth serum used on serial child killers sydney morning herald reuters 12 january 2007 bannon a stevens sd 2007 the howdunit book of poisons howdunit cincinnati writers digest books isbn 978 1 58297 456 9 pearlman t december 1980 behavioral desensitization of phobic anxiety using thiopental sodium the american journal of psychiatry 137 12 american psychiatric association 1580 2 doi 10 1176 ajp 137 12 1580 pmid 6108082 drugged future time 24 february 1958 archived from the original on 10 september 2023 retrieved 16 june 2019 snelders s 1998 the lsd therapy career of jan bastiaans m d newsletter of the multidisciplinary 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