硫喷妥钠

本文由“小麻哥的日常"授权转载

硫喷妥钠

药物水平和影响

哺乳期使用总结

母乳中硫喷妥钠的含量很少。

现有数据表明，硫喷妥钠麻醉后恢复母乳喂养前无需等待时间。

一旦母亲从全身麻醉充分恢复到哺乳期，即可恢复母乳喂养。[1,2]

当手术中使用复合麻醉药时，请遵循手术中使用的最有问题药物的建议。

监测婴儿是否镇静、喂养不良和体重增加不良。

药物水平

母体水平。

一名妇女连续输注硫喷妥钠。

在输注期间和开始输注后25分钟，并且已经给予约800mg，在母乳中测量到的浓度位7.5mg/L。

在完成总共1125mg的输注后14分钟采集的第二份母乳样品的浓度为20mg/L。[3] 

这种旧的分析技术的准确性和特异性没有很好的定义。

四名在剖宫产术前接受硫喷妥钠静脉麻醉诱导的女性在产后第1天和第2天采集了母乳样本。

具体剂量没有测定，但在200至500 mg范围内。

第1天的平均母乳浓度为1.96 mg/L，第2天为0.55 mg/L。[4]

8名接受剖宫产手术的妇女平均静脉注射硫喷妥钠5 mg/kg（范围3.8至6.3 mg/kg）用于麻醉诱导。

最高的初乳水平出现在麻醉终止后的第一次护理中（给药后约4小时），估计为0.34 mg/L。

另外8名产后至少2周的妇女平均静脉注射硫喷妥钠5.4 mg/kg（范围4.4至7 mg/kg）用于麻醉诱导。

在麻醉终止后的第一次护理中（给药后约4小时）出现最高母乳水平，估计为0.9 mg/L。

作者得出结论，婴儿接受的剂量可以忽略不计，不太可能影响婴儿。[1]

20名接受剖宫产手术的妇女静脉注射硫喷妥钠5mg/kg用于麻醉诱导。

30分钟时平均初乳水平为1.98 mg/L（范围0.6至4.7 mg/L），4小时时为0.91 mg/L（范围0.4至1.9 mg/L），剂量结束后9小时时为0.59 mg/L（范围0.3至1.4 mg/L）。[5]

婴儿水平。

七位母亲在剖宫产前接受了硫喷妥钠静脉麻醉诱导。

根据尿液排泄数据计算婴儿的药物半衰期。

母乳喂养的婴儿在尿液中的排泄量平均为母体剂量的0.0067%，而非母乳喂养的婴幼儿在尿液中平均为0.008%。

4名母乳喂养婴儿的硫喷妥钠半衰期与3名配方奶粉喂养婴儿的半衰期无差异。

这些发现表明，婴儿在分娩期间给母亲服用硫喷妥钠后的头2天，母乳中会摄入少量硫喷妥铵。[4]

母乳喂养婴儿的影响

截至修订日期，未找到相关发布信息。

对泌乳和母乳的影响

一项针对剖宫产女性的随机但非盲性研究比较了布比卡因硬膜外麻醉与静脉注射硫喷妥钠4mg/kg和琥珀胆碱1.5mg/kg的全身麻醉，然后进行一氧化二氮和异氟醚诱导。

与全身麻醉相比，硬膜外麻醉的首次母乳喂养时间明显更短（107分钟vs 228分钟）。

这种差异可能是由于麻醉对婴儿的影响造成的，因为全身麻醉组婴儿的Apgar评分、神经系统评分和适应性评分明显较低。[6]

要考虑的替代药物

右旋美托咪定、依托咪酯、甲氧苄啶、异丙酚

原文摘要

Thiopental

Drug Levels and Effects

Summary of Use during Lactation

Amounts of thiopental in milk are very small. Existing data indicate that no waiting period is required before resuming breastfeeding after thiopental anesthesia. Breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse.[1,2] When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. Monitor the infant for sedation, poor feeding and poor weight gain.

Drug Levels

Maternal Levels. A woman was given a continuous infusion of thiopental sodium. During the infusion and 25 minutes after its initiation and about 800 mg had been given, a milk level of 7.5 mg/L was measured. A second milk sample taken 14 minutes after completion of the infusion of a total of 1125 mg contained 20 mg/L.[3] The accuracy and specificity of this old analytic technique were not well defined.

Four women who received intravenous thiopental for anesthesia induction prior to cesarean section had breastmilk samples taken on days 1 and 2 postpartum. Exact doses were not specified, but were in the range of 200 to 500 mg. The average milk concentrations were 1.96 mg/L on day 1 and 0.55 mg/L on day 2.[4]

Eight women admitted for cesarean section were given an average of 5 mg/kg (range 3.8 to 6.3 mg/kg) of intravenous thiopental for induction of anesthesia. The highest colostrum level occurred in the first nursing after the termination of anesthesia (about 4 hours after the dose) and was estimated to be 0.34 mg/L. Eight other women who were at least 2 weeks postpartum were given an average of 5.4 mg/kg (range 4.4 to 7 mg/kg) of intravenous thiopental for induction of anesthesia. The highest milk level occurred in the first nursing after the termination of anesthesia (about 4 hours after the dose) and was estimated to be 0.9 mg/L. The authors concluded that the doses received by the infant were negligible and unlikely to affect the infant.[1]

Twenty women undergoing cesarean section received 5 mg/kg of thiopental intravenously for induction of anesthesia. Average colostrum levels were 1.98 mg/L (range 0.6 to 4.7 mg/L) at 30 minutes, 0.91 mg/L (range 0.4 to 1.9 mg/L) at 4 hours, and 0.59 mg/L (range 0.3 to 1.4 mg/L) at 9 hours after the end of the dose.[5]

Infant Levels. Seven mothers received intravenous thiopental for anesthesia induction prior to cesarean section. The half-lives of the drug were calculated in their infants from urinary excretion data. The breastfed infants excreted an average of 0.0067% of the maternal dose in their urine while the nonbreastfed infants excreted an average of 0.008% in their urine. The half-life of thiopental in the 4 infants who were breastfed was not different from that of the 3 formula-fed infants. These findings indicate that trivial amounts of thiopental are received in breastmilk by infants in the first 2 days of life after administration to their mothers during delivery.[4]

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

A randomized, but nonblinded, study in women undergoing cesarean section compared epidural anesthesia with bupivacaine to general anesthesia with intravenous thiopental 4 mg/kg and succinylcholine 1.5 mg/kg for induction followed by nitrous oxide and isoflurane. The time to the first breastfeed was significantly shorter (107 vs 228 minutes) with the epidural anesthesia than with general anesthesia. This difference was probably caused by the anesthesia's effects on the infant, because the Apgar and neurologic and adaptive scores were significantly lower in the general anesthesia group of infants.[6]

Alternate Drugs to Consider

Dexmedetomidine, Etomidate, Methohexital, Propofol

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