티오펜탈 나트륨

초단기 작용 티오바르비투르산계 마취제

티오펜탈 나트륨은 주로 전신 마취 유도 또는 매우 짧은 시술을 위한 단독 마취제로 사용되는 초단기 작용 티오바르비투르산계 약물입니다. **임상 요점:** * **재분포 역학:** 작용 시간이 짧은 것(10-30분)은 빠른 대사 때문이 아니라 혈류가 풍부한 중추신경계에서 근육 및 지방 조직으로 빠르게 재분포되기 때문입니다. * **시각 하운드 민감성:** 그레이하운드 및 기타 시각 하운드는 대사 처리의 차이와 낮은 체지방으로 인해 회복이 지연됩니다. 프로포폴, 알팍살론 또는 메토헥시탈과 같은 대체 유도제가 일반적으로 선호됩니다. * **조직 독성:** 티오펜탈 용액은 강알칼리성(pH > 10)입니다. **혈관 외 유출은 심각한 조직 자극 및 괴사를 유발합니다.** 반드시 안전한 정맥 카테터를 통해 투여해야 합니다. * **부정맥 유발:** 심근을 카테콜아민에 민감하게 만들어 개에서 일시적인 심실 이단맥을 흔히 유발합니다.

작용 기전: Thiopental is a highly lipid-soluble thiobarbiturate. * **Mechanism:** It binds to the **GABA_A receptor** complex in the central nervous system. * **Pathway:** Binding → increases the duration of chloride ion channel opening → enhances chloride influx → hyperpolarization of the postsynaptic neuronal membrane → profound CNS depression, hypnosis, and anesthesia. * Due to its high lipid solubility, it rapidly crosses the blood-brain barrier, resulting in anesthesia within 15-30 seconds of IV injection.

동물 종별 용량

Sheep

Anesthesia · 9.9-15 mg/kg · IV · once · depending on depth required

Goats

Anesthesia · 20-22 mg/kg · IV · once · Given after atropine (0.7 mg/kg) IM

Cats

Anesthesia · 13.2-26.4 mg/kg · IV · once · depending on duration of anesthesia required
Anesthesia (unpremedicated) · 22 mg/kg · IV · once
Anesthesia (after tranquilization) · 15.4 mg/kg · IV · once
Anesthesia (after narcotic premedication) · 11 mg/kg · IV · once
Anesthesia induction · 12-15 mg/kg · IV · once · One-third administered rapidly, additional amount to effect

Cattle

Anesthesia · 8.14-15.4 mg/kg · IV · once
Deep surgical anesthesia (unweaned calves fasted 6-12h) · no more than 6.6 mg/kg · IV · once
Anesthesia (calves under 2 weeks of age) · 15-22 mg/kg · IV · once · 10-12 minutes · Administer slowly until complete muscular relaxation

투여 경로

IVIP

금기

Absence of suitable veins for IV administration (Absolute)
History of hypersensitivity to barbiturates (Absolute)
Status asthmaticus (Absolute)
Preexisting leukopenia in horses
Use with extreme caution or avoid in greyhounds and other sight hounds
Relative: Severe cardiovascular disease, ventricular arrhythmias, shock, increased intracranial pressure, myasthenia gravis, severe hepatic disease

이상반응

Ventricular bigeminy (dogs)
Apnea (especially in cats)
Arterial hypotension
Excitement and severe ataxia during recovery (horses, if used alone)
Transient leukopenia and hyperglycemia (horses)
Vascular dilatation and hypoglycemia (with rapid IV administration)
Severe tissue necrosis (if administered perivascularly)
Prolonged recovery with repeated doses

약물 상호작용

Clonidine · IV clonidine prior to induction may reduce thiopental dosage requirements by up to 37%
CNS Depressants · May enhance respiratory and CNS depressant effects
Diazoxide · Potential for hypotension
Epinephrine / Norepinephrine · Ventricular fibrillatory effects may be potentiated when used with thiobarbiturates and halothane
Metoclopramide · Given prior to induction may reduce thiopental dosage requirements
Midazolam · May potentiate hypnotic effects
Opiates · Given prior to induction may reduce thiopental dosage requirements
Phenothiazines · May potentiate thiopental effects; hypotension possible
Probenecid · May displace thiopental from plasma proteins
Sulfonamides · Thiopental and sulfas may displace one another from plasma proteins

모니터링

Level of hypnosis/anesthesia
Respiratory status (rate, depth, apnea)
Cardiac status (heart rate, rhythm, blood pressure)

과용량

Treatment of thiobarbiturate overdosage consists of: * **Respiratory Support:** Provide oxygen (O2) and mechanical ventilation. * **Cardiovascular Support:** Provide IV fluids and supportive care. > **Note:** Do NOT use catecholamines (e.g., epinephrine) as they may induce fatal ventricular arrhythmias in the presence of thiobarbiturates.

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