DOSAGE AND ADMINISTRATION
Facilities for assisting ventilation and administering oxygen are necessary adjuncts for all routes of administration of anesthesia. Since cardiorespiratory arrest may occur, patients should be observed carefully during and after use of Brevital Sodium. Age- and size-appropriate resuscitative equipment (ie, intubation and cardioversion equipment, oxygen, suction, and a secure intravenous line) and personnel qualified in its use must be immediately available.
Preanesthetic medication is generally advisable. Brevital Sodium may be used with any of the recognized preanesthetic medications.
Preparation of Solution
FOLLOW DILUTING INSTRUCTIONS EXACTLY.
Solutions of Brevital Sodium should be freshly prepared and used promptly. Reconstituted solutions of Brevital Sodium are chemically stable at room temperature for 24 hours.
DO NOT USE DILUENTS CONTAINING BACTERIOSTATS.
Preferred diluent: Sterile Water for Injection
Acceptable diluents: 5% Dextrose Injection (for IV or rectal administration only), 0.9% Sodium Chloride Injection
Incompatible diluents: Lactated Ringer's Injection
1% solutions (10 mg/mL) should be prepared for intravenous use. Contents of vials should be diluted as follows:
FOR INTRAVENOUS ADMINISTRATION
|Strength ||Amount of Diluent to Be Added to the Contents of the Vial ||For 1% methohexital solution |
|500 mg ||50 mL ||no further dilution needed |
|2.5 g ||15 mL ||add to 235 mL for 250 mL total volume |
When the first dilution is made with the 2.5 g, the solution in the vial will be yellow. When further diluted to make a 1% solution, it must be clear and colorless or should not be used. For continuous drip anesthesia, prepare a 0.2% solution by adding 500 mg of Brevital Sodium to 250 mL of diluent. For this dilution, either 5% glucose solution or isotonic (0.9%) sodium chloride solution is recommended instead of distilled water in order to avoid extreme hypotonicity.
For intramuscular administration, contents of the vials should be diluted as follows:
FOR INTRAMUSCULAR ADMINISTRATION
|Strength ||Amount of DiluentSterile water for injection or 0.9% sodium chloride injection only. to Be Added to the Contents of the Vial ||Methohexital Concentration after Dilution |
|500 mg vial ||10 mL ||5% Solution (50 mg/mL) |
|2.5 g vial ||50 mL ||5% Solution (50 mg/mL) |
For recta l administration, contents of the vials should be diluted as follows:
FOR RECTAL ADMINISTRATION
|Strength ||Amount of Diluent to Be Added to the Contents of the Vial ||Methohexital Concentration after Dilution |
|500 mg vial ||50 mL ||1% Solution (10 mg/mL) |
|2.5 g vial |
(larger vial needed)
|250 mL ||1% Solution (10 mg/mL) |
Dosage is highly individualized; the drug should be administered only by those completely familiar with its quantitative differences from other barbiturate anesthetics.
Brevital Sodium is administered intravenously in a concentration of no higher than 1%. Higher concentrations markedly increase the incidence of muscular movements and irregularities in respiration and blood pressure.
Induction of anesthesia
For induction of anesthesia, a 1% solution is administered at a rate of about 1 mL/5 seconds. Gaseous anesthetics and/or skeletal muscle relaxants may be administered concomitantly. The dose required for induction may range from 50 to 120 mg or more but averages about 70 mg. The usual dosage in adults ranges from 1 to 1.5 mg/kg. The induction dose usually provides anesthesia for 5 to 7 minutes.
Maintenance of anesthesia
Maintenance of anesthesia may be accomplished by intermittent injections of the 1% solution or, more easily, by continuous intravenous drip of a 0.2% solution. Intermittent injections of about 20 to 40 mg (2 to 4 mL of a 1% solution) may be given as required, usually every 4 to 7 minutes. For continuous drip, the average rate of administration is about 3 mL of a 0.2% solution/minute (1 drop/second). The rate of flow must be individualized for each patient. For longer surgical procedures, gradual reduction in the rate of administration is recommended (see discussion of prolonged administration in WARNINGS). Other parenteral agents, usually narcotic analgesics, are ordinarily employed along with Brevital Sodium during longer procedures.
Brevital Sodium is administered intramuscularly in a 5% concentration and administered rectally as a 1% solution.
Induction of anesthesia
For the induction of anesthesia by the intramuscular route of administration, the usual dose ranges from 6.6 to 10 mg/kg of the 5% concentration. For rectal administration, the usual dose for induction is 25 mg/kg using the 1% solution.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Solutions of Brevital Sodium should not be mixed in the same syringe or administered simultaneously during intravenous infusion through the same needle with acid solutions, such as atropine sulfate, metocurine iodide, and succinylcholine chloride. Alteration of pH may cause free barbituric acid to be precipitated. Solubility of the soluble sodium salts of barbiturates, including Brevital Sodium, is maintained only at a relatively high (basic) pH.
Because of numerous requests from anesthesiologists for information regarding the chemical compatibility of these mixtures, the following chart contains information obtained from compatibility studies in which a 1% solution of Brevital Sodium was mixed with therapeutic amounts of agents whose solutions have a low (acid) pH.
|Active Ingredient ||Potency per mL ||Volume Used ||Immediate ||15 min ||Physical Change |
|1 h |
| Brevital Sodium || 10 mg || 10 mL || || || CONTROL || |
| Atropine Sulfate || 1/150 gr || 1 mL || None || Haze || || |
| Atropine Sulfate || 1/100 gr || 1 mL || None || Ppt || Ppt || |
| Succinylcholine chloride || 0.5 mg || 4 mL || None || None || Haze || |
| Succinylcholine chloride || 1 mg || 4 mL || None || None || Haze || |
| Metocurine Iodide || 0.5 mg || 4 mL || None || None || Ppt || |
| Metocurine Iodide || 1 mg || 4 mL || None || None || Ppt || |
| Scopolamine hydrobromide || 1/120 gr || 1 mL || None || None || None || Haze |
| Tubocurarine chloride || 3 mg || 4 mL || None || Haze || || |