Editing Sodium thiopental (section)

==Uses==

===Anesthesia===
Sodium thiopental is an ultra-short-acting [[barbiturate]] and has been used commonly in the induction phase of [[general anesthesia]]. Its use has been largely replaced with that of [[propofol]], but may retain some popularity as an induction agent for [[Rapid sequence induction|rapid-sequence induction]] and [[intubation]], such as in [[obstetrics]].<ref>{{cite journal | vauthors = Çakırtekin V, Yıldırım A, Bakan N, Çelebi N, Bozkurt Ö | title = Comparison of the Effects of Thiopental Sodium and Propofol on Haemodynamics, Awareness and Newborns During Caesarean Section Under General Anaesthesia | journal = Turkish Journal of Anaesthesiology and Reanimation | volume = 43 | issue = 2 | pages = 106–112 | date = April 2015 | pmid = 27366476 | pmc = 4917150 | doi = 10.5152/TJAR.2014.75547 }}</ref> Following [[intravenous injection]], the drug rapidly reaches the brain and causes [[unconsciousness]] within 30–45 seconds. At one minute, the drug attains a peak concentration of about 60% of the total dose in the brain. Thereafter, the drug distributes to the rest of the body, and in about 5–10 minutes the concentration is low enough in the brain that consciousness returns.

A normal dose of sodium thiopental (usually 4–6&nbsp;mg/kg) given to a pregnant woman for operative delivery ([[caesarean section]]) rapidly makes her unconscious, but the baby in her [[uterus]] remains conscious. However, larger or repeated doses can depress the baby's consciousness.<ref name="GleasonJuul2011">{{cite book| vauthors = Gleason CA, Juul SE |title=Avery's Diseases of the Newborn|date=12 August 2011|publisher=Elsevier Health Sciences|isbn=9781455727148|page=169|url=http://www.us.elsevierhealth.com/averys-diseases-of-the-newborn-9781437701340.html|access-date=13 August 2016}}{{Dead link|date=August 2018 |bot=InternetArchiveBot |fix-attempted=yes}}</ref>

Sodium thiopental is not used to maintain anesthesia in surgical procedures because, in infusion, it displays [[order (chemistry)|zero-order]] elimination [[pharmacokinetics]], leading to a long period before consciousness is regained. Instead, anesthesia is usually maintained with an [[inhalational anesthetic|inhaled anesthetic]] (gas) agent. Inhaled anesthetics are eliminated relatively quickly, so that stopping the inhaled anesthetic will allow rapid return of consciousness. Sodium thiopental would have to be given in large amounts to maintain unconsciousness during anaesthesia due to its rapid redistribution throughout the body (as it has a high [[volume of distribution]]). Since its [[biological half-life|half-life]] of 5.5 to 26 hours is quite long, consciousness would take a long time to return.<ref name="Pharmacokinetics and plasma binding">{{cite journal | vauthors = Morgan DJ, Blackman GL, Paull JD, Wolf LJ | title = Pharmacokinetics and plasma binding of thiopental. II: Studies at cesarean section | journal = Anesthesiology | volume = 54 | issue = 6 | pages = 474–80 | date = June 1981 | pmid = 7235275 | doi = 10.1097/00000542-198106000-00006 | doi-access = free }}</ref>

In [[veterinary medicine]], sodium thiopental is used to induce [[veterinary anesthesia|anesthesia in animals]]. Since it is redistributed to fat, certain lean breeds of dogs such as [[sighthound]]s will have prolonged recoveries from sodium thiopental due to their lack of body fat and their lean body mass. Conversely, obese animals will have rapid recoveries, but it will take much longer for the drug to be entirely removed (metabolized) from their bodies. Sodium thiopental is always administered intravenously, as it can be fairly irritating to tissue and is a [[vesicant]]; severe [[tissue necrosis]] and sloughing can occur if it is injected incorrectly into the tissue around a vein.<ref>{{cite journal | vauthors = Shibata Y, Yokooji T, Itamura R, Sagara Y, Taogoshi T, Ogawa K, Tanaka M, Hide M, Kihira K, Matsuo H | display-authors = 6 | title = Injury due to extravasation of thiopental and propofol: Risks/effects of local cooling/warming in rats | journal = Biochemistry and Biophysics Reports | volume = 8 | pages = 207–211 | date = December 2016 | pmid = 28955958 | pmc = 5613958 | doi = 10.1016/j.bbrep.2016.09.005 | url = }}</ref>

===Medically-induced coma===
In addition to anesthesia induction, sodium thiopental was historically used to induce [[induced coma|medical comas]].<ref>{{cite web |url= http://www.trauma.org/archive/anaesthesia/barbcoma.html |title=TRAUMA.ORG: Critical Care: Barbiturate Coma| vauthors = Takeko T |website=trauma.org|access-date=18 August 2016|archive-url= https://web.archive.org/web/20160819000601/http://www.trauma.org/archive/anaesthesia/barbcoma.html |archive-date=19 August 2016|url-status=dead}}</ref> It has now been superseded by drugs such as propofol because their effects wear off more quickly than thiopental.
Patients with [[Brain edema|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<sub>2</sub>), decrease 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.<ref name="pmid29058090">{{cite journal | vauthors = Abraham P, Rennert RC, Gabel BC, Sack JA, Karanjia N, Warnke P, Chen CC | title = ICP management in patients suffering from traumatic brain injury: a systematic review of randomized controlled trials | journal = Acta Neurochirurgica | volume = 159 | issue = 12 | pages = 2279–2287 | date = December 2017 | pmid = 29058090 | doi = 10.1007/s00701-017-3363-1 | s2cid = 3013248 }}</ref>  Reportedly, thiopental has been shown to be superior to [[pentobarbital]] in reducing intracranial pressure.<ref name="pmid23235573">{{cite journal | vauthors = Roberts I, Sydenham E | title = Barbiturates for acute traumatic brain injury | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | pages = CD000033 | date = December 2012 | issue = 12 | pmid = 23235573 | pmc = 7061245 | doi = 10.1002/14651858.CD000033.pub2 }}</ref> 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.<ref>{{cite web |vauthors=Trickey D |title=Anesthetic Management of Head-injured Patients |url=http://www.amcresidents.com/lectures/Dr_Trickey/Physiology_of_CBF_and_CSF.htm |access-date=2020-10-13 |website=www.amcresidents.com |archive-date=2020-10-18 |archive-url=https://web.archive.org/web/20201018124821/http://www.amcresidents.com/lectures/Dr_Trickey/Physiology_of_CBF_and_CSF.htm |url-status=dead }}</ref>

===Status epilepticus===
In refractory [[status epilepticus]], thiopental may be used to terminate a seizure.

===Euthanasia===
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.<ref name=euthanasics>{{cite web |url=http://wweek.com/html/euthanasics.html |title=Administration and Compounding of Euthanasic Agents |access-date=2008-07-18 |author=Royal Dutch Society for the Advancement of Pharmacy |publisher=[[The Hague]] |year=1994 |archive-url=https://web.archive.org/web/20080821133010/http://www.wweek.com/html/euthanasics.html |archive-date=2008-08-21 |url-status=dead }}</ref>

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&nbsp;mg/kg thiopental sodium (Nesdonal) in a small volume (10&nbsp;mL physiological saline). Then, a triple dose of a non-depolarizing [[Neuromuscular blocking agents|neuromuscular blocking]] drug is given, such as 20&nbsp;mg pancuronium bromide (Pavulon) or 20&nbsp;mg [[vecuronium bromide]] (Norcuron). The muscle relaxant should be given intravenously to ensure optimal [[bioavailability]] but pancuronium bromide may be administered intramuscularly at an increased dosage level of 40&nbsp;mg.<ref name=euthanasics/>

===Lethal injection===
{{Further|Lethal injection}}

Along with [[pancuronium bromide]] and [[potassium chloride]], thiopental is used in 34 states of the US to execute prisoners by [[lethal injection]]. A very 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.<ref name="OHIO">{{cite news
|date= December 2001
|url= https://nypost.com/2009/12/08/ohio-executes-inmate-with-1-drug-lethal-injection/
|title= Ohio executes inmate with 1-drug lethal injection
|agency= Associated Press
|access-date= 2009-12-08
}}</ref> The use of sodium thiopental in execution protocols was challenged in court after a study in the medical journal ''[[The Lancet]]'' reported [[Autopsy|autopsies]] of executed inmates showed the level of thiopental in their bloodstream was insufficient to cause unconsciousness although this is dependent on different factors and not just on the drug itself. 

On December 8, 2009, Ohio became the first state 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.<ref>{{cite news |url= https://www.cbsnews.com/news/kenneth-biros-execution-ohio-man-first-to-die-under-1-drug-thiopental-sodium-method/ |title= Kenneth Biros Execution: Ohio Man First to Die Under 1-Drug Thiopental Sodium Method | vauthors = Martinez E |date= 8 December 2009 |work= [[CBS News]]}}</ref>

Washington State became the second state in the US to use the single-dose sodium thiopental injections for executions. On September 10, 2010, the execution of [[Uttecht v. Brown|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.<ref>{{cite news |url= http://seattletimes.nwsource.com/html/localnews/2012856652_execution10m.html |title= Killer on death row 16-1/2 years is executed |work= [[The Seattle Times]] |date= 10 September 2010 | vauthors = Sullivan J }}</ref>

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,<ref>{{cite web|url=https://www.bbc.co.uk/news/uk-12263460|title=Drug sold in UK to be used for execution in Georgia|website=bbc.co.uk|publisher=[[BBC News]]|date=24 January 2011|access-date=18 August 2016}}</ref> after it was established that no European supplies to the US were being used for any other purpose.<ref>{{cite web|url=https://www.bbc.co.uk/news/uk-11865881|title=US lethal injection drug faces UK export restrictions|website=bbc.co.uk|publisher=[[BBC News]]| vauthors = Casciani D |date=29 November 2010|access-date=18 August 2016}}</ref> The restrictions were based on "the European Union Torture Regulation (including licensing of drugs used in execution by lethal injection)".<ref>{{cite web|url=https://www.gov.uk/controls-on-torture-goods|title=Controls on torture goods - Detailed guidance - GOV.UK|website=gov.uk|access-date=18 August 2016}}</ref> 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".<ref>{{cite web| url = https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:338:0031:0034:EN:PDF| title = EU Council Regulation (EU) No 1352/2011}}</ref>

===Truth serum===
{{Further|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.<ref name="SMH_truth_serum">{{cite news|url=https://www.smh.com.au/world/truth-serum-used-on-serial-child-killers-20070113-gdp8d6.html|newspaper=Sydney Morning Herald|title=Truth serum used on 'serial child killers'|date=January 12, 2007|agency=Reuters}}</ref> 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.<ref>{{cite book | vauthors = Bannon A, Stevens SD |title=The Howdunit Book of Poisons (Howdunit) |publisher=Writers Digest Books |location=Cincinnati |year=2007 |isbn=978-1-58297-456-9}}</ref>

===Psychiatry===
Psychiatrists have used thiopental to desensitize patients with [[phobia]]s<ref>{{cite journal | vauthors = Pearlman T | title = Behavioral desensitization of phobic anxiety using thiopental sodium | journal = The American Journal of Psychiatry | volume = 137 | issue = 12 | pages = 1580–2 | date = December 1980 | pmid = 6108082 | doi = 10.1176/ajp.137.12.1580 | publisher = [[American Psychiatric Association]] }}</ref> and to "facilitate the recall of painful repressed memories."<ref>{{cite magazine |url= http://content.time.com/time/magazine/article/0,9171,863001,00.html |title= Drugged Future? |date= February 24, 1958 |magazine= [[TIME]]}}</ref> One psychiatrist who worked with thiopental is [[Jan Bastiaans]], who used this procedure to help relieve trauma in surviving victims of the [[Holocaust]].<ref>{{cite journal |url= http://www.maps.org/news-letters/v08n1/08118sne.html |title= The LSD Therapy Career of Jan Bastiaans, M.D | vauthors = Snelders S |journal= Newsletter of the Multidisciplinary Association for Psychedelic Studies |publisher= [[Multidisciplinary Association for Psychedelic Studies]] |volume= 8 |issue= 1 |year= 1998 |pages= 18–20}}</ref>