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[Thiopental kinetics in high-dose use]
Anasthesie, Intensivtherapie, Notfallmedizin
|October 1, 1986
Summary
High-dose thiopentone administration requires careful monitoring due to variable clearance and protein binding. Continuous infusions with decreasing rates are recommended over bolus doses for effective tissue saturation in patients with elevated intracranial pressure or cerebral ischemia.
Area of Science:
- Pharmacokinetics
- Neuroanesthesia
- Critical Care Medicine
Background:
- Thiopentone is used for elevated intracranial pressure and cerebral ischemia.
- Understanding thiopentone kinetics is crucial for safe and effective patient management.
Purpose of the Study:
- To investigate the pharmacokinetics of high-dose thiopentone in patients with elevated intracranial pressure and focal cerebral ischemia.
- To determine optimal administration strategies and identify factors influencing thiopentone levels.
Main Methods:
- Investigated thiopentone kinetics in five patients (two with elevated intracranial pressure, three with focal cerebral ischemia).
- Analyzed drug concentrations, clearance, distribution volumes, protein binding, and biotransformation.
- Monitored EEG and intracranial pressure.
Main Results:
- Initial tissue saturation is best achieved with decreasing infusion rates; bolus administration is unsuitable.
- High inter- and intra-individual variability in clearance led to prolonged elimination half-times (mean 23.2 h).
- Thiopentone exhibited significant plasma protein binding (75-80%), which varied over time.
Conclusions:
- Thiopentone administration requires individualized control based on EEG and intracranial pressure due to variable clearance and protein binding.
- Plasma drug concentration monitoring is recommended for optimizing thiopentone therapy.
- Continuous infusion with decreasing rates is a preferred administration method.