Related Experiment Video
Updated: Jul 9, 2025
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Evaluation for Blood Concentration and Efficacy/Safety of Continuous Administration of Thiamylal in Children
Kenshiro Hirata1, Takafumi Obara2,3, Tokunori Ikeda1
1Faculty of Pharmaceutical Sciences, Sojo University, Kumamoto, Japan.
Insights
This study determined optimal thiamylal dosing for pediatric refractory status epilepticus. A target blood concentration of 20-30 mcg/mL and an infusion rate of 3 mg/kg/h are recommended for effective sedation with manageable adverse effects.
Area of Science:
- Pediatric Anesthesiology
- Clinical Pharmacology
- Neurocritical Care
Background:
- Thiamylal offers potent sedation but is underutilized due to safety concerns.
- Establishing safe and effective dosing parameters in pediatric populations is crucial.
Purpose of the Study:
- To define the target blood concentration range for thiamylal in children.
- To determine the optimal infusion rate for thiamylal in pediatric patients.
- To correlate thiamylal blood concentrations with efficacy and adverse effects.
Main Methods:
- Continuous intravenous infusion of thiamylal in 10 pediatric patients (1-7 years) with refractory status epilepticus.
- Blood concentration monitoring via high-performance liquid chromatography.
- Efficacy assessed by State Behavioral Scale and bolus injection frequency; adverse effects by blood pressure and heart rate.
Main Results:
- Sufficient sedation (State Behavioral Scale score ≤ -2) was achieved in all patients.
- Reduced need for additional bolus injections at thiamylal concentrations ≥ 20 mcg/mL.
- An infusion rate of 3 mg/kg/h is suggested to reach target concentrations, while 4 mg/kg/h may cause rapid increases and adverse events.
Conclusions:
- Recommended target blood concentration for thiamylal in children is 20-30 mcg/mL.
- Recommended initial infusion rate for thiamylal in children is 3 mg/kg/h.
- Higher concentrations and doses correlate with delayed awakening.
Background:
Thiamylal exerts excellent sedative effects. However, it is not routinely used because of its serious adverse effects. This study aimed to clarify the target blood concentration range and infusion rate of thiamylal in children by measuring its blood concentration and evaluating its relationship with efficacy and adverse effects.
Methods:
This study was approved by the Ethics Committee of Japanese Red Cross Kumamoto Hospital. The authors included 10 children aged between 1 and 7 years who had received continuous intravenous (IV) infusion of thiamylal for the management of refractory status epilepticus, excluding those who met the exclusion criteria. After a 2 mg/kg bolus injection of thiamylal, continuous IV infusion was initiated at a rate of 2-3 mg/kg/h. Thiamylal concentration in the blood was measured using high-performance liquid chromatography. The State Behavioral Scale and the frequency of bolus injections were used to evaluate efficacy. Blood pressure and heart rate were measured to evaluate adverse effects. Statistical analyses of the time to awakening and the factors affecting it were also conducted.
Results:
The State Behavioral Scale score during thiamylal administration was -2 or lower in all cases, suggesting that the depth of sedation was sufficient. The frequency of bolus injections decreased in a blood concentration-dependent manner, suggesting that the frequency tended to decrease, especially at thiamylal blood concentrations of 20 mcg/mL or higher. An increase of the infusion rate to 3 mg/kg/h was recommended, because the blood concentration may not reach 20 mcg/mL at an infusion rate of 2 mg/kg/h. There was also a case in which a rapid increase in blood concentration accompanied by a decrease in blood pressure and heart rate was observed when the infusion rate was increased to 4 mg/kg/h. Furthermore, the time to awakening after the end of administration correlated with the highest blood concentration during administration; therefore, delayed awakening was noted when using a high dose of thiamylal.
Conclusions:
The target blood concentration of thiamylal in children should be 20-30 mcg/mL, and the infusion rate should be based on 3 mg/kg/h.
More Related Videos
07:02A Computerized Test Battery to Study Pharmacodynamic Effects on the Central Nervous System of Cholinergic Drugs in Early Phase Drug Development
Published on: February 11, 2019
10:07High-throughput Screening for Small-molecule Modulators of Inward Rectifier Potassium Channels
Published on: January 27, 2013
Related Concept Videos
01:21Factors Affecting Drug Response: Overview
01:18Drug Delivery: Enteral Route
01:25Drug Regulation
01:15Drug Concentration Versus Time Correlation
Two pivotal parameters are the minimum effective concentration (MEC) and the minimum toxic concentration (MTC). The MEC is the...
01:24Rational Dosage Regimen: Maintenance Dose and Loading Dose
In most cases, drugs are administered repetitively or infused continuously to maintain a steady-state concentration in the body. At a steady...
01:14Time Course of Drug Effect