(1) Thiopental sodium

Thiopental sodium, also known as thiobarbital sodium, is an ultra-short-acting barbiturate drug and is a light yellow powder that is easily Soluble in water and ethanol, it is mainly used clinically for intravenous anesthesia and is suitable for short-term surgical operations. Poisoning is mostly caused by high concentration or too fast injection speed, or by those with existing heart, liver, and kidney diseases, shock, and anemia.

Pharmacology and Toxicology

Thiopental sodium is highly toxic, and its toxicity is positively related to concentration and intravenous injection speed. This product can inhibit the sympathetic nerve and make the parasympathetic nerve relatively excited. When stimulating the throat or pulling the hilus and internal organs during surgery, it can cause nerve reflexes and induce laryngospasm and bronchospasm. When the injection speed is too fast, it can cause respiratory depression, decreased myocardial contractility, and reduced cardiac output.

This product has high fat solubility. Patients with rich fat will accumulate a large amount in the body and release it slowly. It is mainly detoxified and destroyed in the liver and excreted from the body in the urine. Therefore, when the liver and kidney functions are poor, the tolerance to this drug is reduced and poisoning is easily caused.

Key points of diagnosis

1. Medical history includes a history of application of sodium thiopental.

2. Clinical manifestations: Laryngospasm and bronchospasm can be caused by stimulation of the larynx or visceral traction reaction under light anesthesia. Severe cases can cause respiratory and circulatory failure and death. Some patients may develop allergic reactions such as rash, angioedema, and joint swelling and pain.

First aid treatment and prevention

(1) When laryngospasm occurs, immediately pressurize and give oxygen. Intravenous atropine 0.5~1mg for adults, 0.03~0.05mg/kg for children, such as If relief still persists, intravenously inject 1 to 2 mg/kg of succinylcholine chloride, perform tracheal intubation, and perform artificial respiration until spontaneous respiration is restored. If bronchospasm occurs, give dexamethasone 10 to 20 mg and aminophylline 5 to 7 mg/kg, and stop stimulating procedures.

(2) Those with respiratory depression should inhale oxygen and perform assisted or artificial respiration. For patients with circulatory failure, the volume should be expanded in time, and vasopressor drugs and other first-aid treatments should be added.

(3) Adrenocortical hormones and antihistamines should be used in patients with allergic reactions.

(4) The concentration and dosage of preventive clinical applications should be moderate. People with some chronic diseases, satiety, and intestinal obstruction should use this medicine with caution. Do not use spoiled medicine or ampoules that are broken. Inject 0.5 mg of atropine intramuscularly half an hour before medication.

(2) Ketamine

Ketamine is a white crystal, easily soluble in water, and its aqueous solution is colorless and transparent. It is a widely used anesthetic in my country.

Pharmacology and Toxicology

Ketamine is characterized by shallow nerve inhibition and strong analgesia. It has sympathetic nerve excitability and can increase blood pressure, heart rate and peripheral blood. Resistance increases, and increasing the dose can inhibit the myocardium. Those with hemodynamic instability and significantly low cardiac function may have negative cardiac inotropic effects, causing blood pressure to drop, heart rate to accelerate, and aggravating heart failure. This drug has little effect on the respiratory system, but respiratory depression may occur when the dose is too large, the intravenous infusion rate is too fast, or it is combined with respiratory depressants. Furthermore, this drug can hyperpharyngeal reflexes, induce laryngospasm or bronchospasm, and increase respiratory secretions. Adults can also experience hallucinations and psychosis. The drug has a distribution half-life of 2 to 11 minutes and an elimination half-life of 2 to 3 hours. It is mainly metabolized by the liver.

Key points of diagnosis

1. Medical history includes a history of ketamine anesthesia.

2. Patients with clinical manifestations of overdose have shallow and slow breathing, reduced tidal volume or even cessation; laryngospasm or bronchospasm, pale complexion, and difficulty breathing. It is often accompanied by increased blood pressure and rapid heart rate. Severe patients may experience delirium, agitation, convulsions or even epileptic seizures, accompanied by hallucinations, visual hallucinations, auditory hallucinations and other mental abnormalities, which are more common in adults. Some patients have skin plaques, laryngeal edema, conjunctival edema or high fever, coma, urinary retention, decreased blood pressure, respiratory and circulatory depression, etc.

First aid treatment and prevention

(1) Stop medication immediately and provide oxygen, assisted or artificial respiration; suction immediately if sputum accumulates.

(2) Those who experience convulsions, elevated blood pressure, mental symptoms, high fever, laryngospasm or bronchospasm should be treated symptomatically. If you have allergic symptoms, add anti-allergic drugs.

(3) For prevention, the dosage should be strictly controlled and should be used in combination with other anesthetics or sedatives and analgesics. Use anticholinesterase drugs before surgery to reduce secretion. People with high blood pressure, glaucoma or a history of asthma should use this drug with caution or should not use it.