A critical review: does thiopental continuous infusion warrant therapeutic drug monitoring in the critical care population?

Therapeutic Drug Monitoring
Fong HuynhMary H H Ensom


Thiopental is a barbiturate used in traumatic brain injuries (TBIs) to reduce intracranial pressure (ICP) and to manage cerebral ischemia. As thiopental follows Michaelis-Menten kinetics, therapeutic drug monitoring (TDM) has been used in practice to improve efficacy and reduce adverse effects. However, its role is still debatable, and TDM is not widely practiced. Current evidence suggests that thiopental therapy may improve mortality and functional outcome in a subpopulation of patients with severe TBI with elevated ICP refractory to conventional medical therapy. Several analytical methods are available to quantify thiopental concentrations. This review uses a previously published 9-step decision-making algorithm to determine whether TDM of thiopental in TBI is warranted. There seems to be poor correlation between thiopental concentration and pharmacological response in terms of neurological response, ICP, electroencephalography, and drug toxicity. There is no established therapeutic range for thiopental continuous infusion due to a wide range of plasma concentrations corresponding to efficacy (25-50 mg/L) and toxicity (30-70 mg/L) and the resulting overlap between the 2. Thiopental exhibits intrapatient and interpatient varia...Continue Reading


Sep 1, 1978·Critical Care Medicine·G C CarlonA Turnbull
Sep 1, 1979·Annals of Neurology·J D Miller
Feb 1, 1978·British Journal of Anaesthesia·M J Van Hamme, M M Ghoneim
Jul 1, 1978·Critical Care Medicine·D A BruceT W Langfitt
Sep 1, 1978·Anesthesiology·K E Becker
May 1, 1992·Acta Anaesthesiologica Scandinavica·W SchalénC H Nordström
Jan 1, 1985·British Journal of Anaesthesia·H M Shapiro
Mar 1, 1985·Journal of Neurosurgery·J D WardR Keenan
Jul 1, 1985·Anesthesiology·A TurcantP Allain
Nov 1, 1984·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·M L SchwartzD F Andrews
Apr 1, 1984·Journal of Pharmacokinetics and Biopharmaceutics·D R StanskiE Meathe
Dec 1, 1984·British Journal of Anaesthesia·E CoudercP Duvaldestin
Aug 1, 1983·Journal of Pharmaceutical Sciences·D R StanskiR K RICHARDS
Jan 13, 1984·Journal of Chromatography·M I Arranz Peña
Jun 1, 1983·Critical Care Medicine·A SidiA Perel
Apr 1, 1983·Neurosurgery·G L Rea, G L Rockswold
Aug 1, 1983·Anesthesiology·G PandeleP Duvaldestin
Mar 1, 1980·Anaesthesia·M Belopavlovic, A Buchthal
Apr 1, 1982·Developmental Medicine and Child Neurology·C R Steer
Jan 1, 1981·Surgical Neurology·W R SelmanR C Crumrine
Jan 1, 1980·Anaesthesia·M Helliwell, R J Flanagan
Aug 1, 1980·Anesthesiology·D R StanskiS M Kalman
Jul 1, 1993·European Journal of Drug Metabolism and Pharmacokinetics·P Le CorreR Le Verge
May 1, 1993·Journal of Pharmaceutical Sciences·H RussoH Maillols
Jan 1, 1995·European Journal of Clinical Pharmacology·H RussoB Roquefeuil
Jan 12, 1996·Journal of Chromatography. B, Biomedical Applications·D J JonesD J Morgan
Jan 1, 1995·European Journal of Clinical Pharmacology·H RussoB Roquefeuil
Jun 20, 1997·Journal of Chromatography. B, Biomedical Sciences and Applications·H RussoF Bressolle
Jul 1, 1997·Clinical Pharmacology and Therapeutics·H RussoS Urien
May 8, 1998·Clinical Pharmacokinetics·Mary H H EnsomR J Ensom
Jun 23, 1998·European Neurology·J F StoverT Kossmann
Sep 18, 1998·Clinical Pharmacokinetics·H Russo, F Bressolle
Oct 24, 1998·Clinical Pharmacokinetics·B A Boucher, S D Hanes
Mar 16, 2001·Clinica Chimica Acta; International Journal of Clinical Chemistry·G CoppaA R Bonfigli
Jul 1, 1954·Anesthesiology·J W DUNDEE, R K RICHARDS
Apr 1, 1952·British Journal of Anaesthesia·J W DUNDEE
Mar 1, 2005·Analytical Sciences : the International Journal of the Japan Society for Analytical Chemistry·Nashwa M H Rizk, Abdel-Hameed M Othman
Apr 6, 2005·Journal of Clinical Anesthesia·Andrea Casati, Marta Putzu
Feb 24, 2007·Pharmacotherapy·Sean P Spina, Mary H H Ensom
Dec 11, 2007·Intensive Care Medicine·Nino StocchettiKatia Canavesi
Sep 2, 2008·Critical Care : the Official Journal of the Critical Care Forum·Jon Pérez-BárcenaJordi Ibáñez


Oct 13, 2012·Journal of Neurotrauma·Ibrahim M AlharfiDouglas D Fraser
Jan 8, 2009·American Journal of Therapeutics·William H Frishman
Apr 2, 2013·Journal of Pharmaceutical and Biomedical Analysis·Praveen U SanganalmathBannur M Mohan
Apr 22, 2011·Journal of Pharmacy Practice·A Kendall GrossAaron M Cook
Feb 20, 2010·Current Opinion in Critical Care·Gabriel W LohMary H H Ensom
Jun 9, 2018·Critical Care : the Official Journal of the Critical Care Forum·Salia FarrokhMarek A Mirski
Oct 13, 2020·Substance Abuse : Official Publication of the Association for Medical Education and Research in Substance Abuse·Cornelis F VosArnt F A Schellekens

Related Concepts

Mild Traumatic Brain Injury
Clinical Trials
Psychogenic Coma
Care of Intensive Care Unit Patient
Clinical Prediction Rule
Intravenous Infusion Procedures
Intracranial Pressure
Therapeutic Drug Monitoring

Related Feeds

Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.

Brain Ischemia

Brain ischemia is a condition in which there is insufficient blood flow to the brain to meet metabolic demand. Discover the latest research on brain ischemia here.