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marcy2022

marcy2022

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Oct 19, 2022
151
To anyone who may have had thiopental IV or injection or anyone with medical knowledge, I want to ask how painful is thiopental when administered using intravenous route?

In one article I've found online its said "If injected intravenously prior to the loss of consciousness, hot and burning sensations develop, and even if injected after the loss of consciousness by induction agents, a severe withdrawal movement, such as withdrawing the injected hand or arm, may occur due to pain."

On a scale of 10 how painful is it?
Is it bearable for 10-30 seconds before one becomes unconscious?

I'm just guessing, probably the concentration of the solution matters too as in how many mg/grams per ml is in the mixture that's being administered. At a dosage of 200mg/ml how painful would it be?
Would something like tropical anesthetic such as lidocaine 10% help with the pain? (applied 30 minutes before on the skin surrounding the IV cannula so its numb at the time of administration) I was thinking that cuz based on the above quote it sounds to me that the initial pain should be on the injected spot or the same arm. Or does it not matter as pain will be throughout the body cuz of its in the blood stream)
 
jodes2

jodes2

I'm pro CHOICE. Don't start on me. PLEASE
Aug 28, 2022
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That sounds nasty.
 
k1w1

k1w1

Member
Feb 16, 2022
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To anyone who may have had thiopental IV or injection or anyone with medical knowledge, I want to ask how painful is thiopental when administered using intravenous route?

In one article I've found online its said "If injected intravenously prior to the loss of consciousness, hot and burning sensations develop, and even if injected after the loss of consciousness by induction agents, a severe withdrawal movement, such as withdrawing the injected hand or arm, may occur due to pain."

On a scale of 10 how painful is it?
Is it bearable for 10-30 seconds before one becomes unconscious?

I'm just guessing, probably the concentration of the solution matters too as in how many mg/grams per ml is in the mixture that's being administered. At a dosage of 200mg/ml how painful would it be?
Would something like tropical anesthetic such as lidocaine 10% help with the pain? (applied 30 minutes before on the skin surrounding the IV cannula so its numb at the time of administration) I was thinking that cuz based on the above quote it sounds to me that the initial pain should be on the injected spot or the same arm. Or does it not matter as pain will be throughout the body cuz of its in the blood stream)
Hi there Marcy. Look....I come from a background in harm reduction, working with addicts, been one etc. having talked to you previously,concerning a failed oral administration attempt....could you tell me what pharmacodynamic caused this? Eg.. bioavailability oral vs parenteral is lower maybe? This is just a guess but a lot of people end up "boosting" opiods as the bioavailability is so much higher...like 30%+. Now, all Im doing is giving a line of inquiry but it is one simpler way if the theory plays out. https://ascpt.onlinelibrary.wiley.com/doi/abs/10.1002/cpt197314112
 
Sunset Limited

Sunset Limited

I believe in Sunset Limited
Jul 29, 2019
968
I don't think injection of thiopental in therapeutic doses is painful. I have never read that lidocaine injection was discussed prior to thiopental. Propofol is usually not painful when administered slowly through a large vein. However, since some people are hypersensitive, lidocaine is administered before propofol. 40 mg of lidocaine is injected over 30 seconds.

However, considering that you will be using a high concentration of thiopental for CTB, this will most likely hurt. Pre-thiopental IV lidocaine can resolve this. You should read about how long lidocaine works in a vein. 3-4 minutes as I remember but I'm not sure.
 
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marcy2022

marcy2022

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Oct 19, 2022
151
Hi there Marcy. Look....I come from a background in harm reduction, working with addicts, been one etc. having talked to you previously,concerning a failed oral administration attempt....could you tell me what pharmacodynamic caused this? Eg.. bioavailability oral vs parenteral is lower maybe? This is just a guess but a lot of people end up "boosting" opiods as the bioavailability is so much higher...like 30%+. Now, all Im doing is giving a line of inquiry but it is one simpler way if the theory plays out. https://ascpt.onlinelibrary.wiley.com/doi/abs/10.1002/cpt197314112
I've tried to find the thiopental oral bioavailability so many times but so far I haven't found anything promising. After failure I sort of gave up and stopping looking into it. Recently I've started to look into it again and results are almost the same. Whatever little that I've found aren't that accurate, precise or proper to say the least. I've checked the link in your post before. I remember there was a website called Toxnet which had some data but I can't find it.
This suggests LD50 Mouse oral 600 mg/kg, I'm unable to find link to the document but if I remember correctly oral toxicity for people are much lower. But I could be wrong and without proper documentation to back it up, I wouldn't take the above comment seriously.
PPeh suggests that 10g sodium thiopental for IV can be reconstructed in 50ml water and should be effective for ctb purposes if taken orally or if administered intravenously.
However with my failure at almost double the suggested dosage and without proper medical data supporting the theory of oral thiopental, I personally feel doubtful about oral thiopental thing.
 
marcy2022

marcy2022

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Oct 19, 2022
151
I don't think injection of thiopental in therapeutic doses is painful. I have never read that lidocaine injection was discussed prior to thiopental. Propofol is usually not painful when administered slowly through a large vein. However, since some people are hypersensitive, lidocaine is administered before propofol. 40 mg of lidocaine is injected over 30 seconds.

However, considering that you will be using a high concentration of thiopental for CTB, this will most likely hurt. Pre-thiopental IV lidocaine can resolve this. You should read about how long lidocaine works in a vein. 3-4 minutes as I remember but I'm not sure.
As you said at a high concentration of 1g/10ml or 200mg/ml it'll probably hurt a lot, specially when considering people found it painful at regular dosage which is so much lower than that above. While researching lidociane before thiopental I didn't find much.
If I can't acquire lidocaine or can't manage to find the right way to do it, With the level of highly probable pain involved in the concentrated thiopental solution, how likely it'll work or fail with thiopental by itself?

I don't know too much about lidocaine injection. Can it be administered straight into the vein or just under the skin next to the vein or maybe IM. Is this where/how it should be administered:


For lidocaine onset of action
Lidocaine acts faster (within 2-5 minutes of injection) and for this reason is often favored in outpatient setting for pre-incisional injection. However its effects only last up to 2 hours, without epinephrine, and 3 hours, with epinephrine.
2-5mins onset of action.


I've found the following:
Its about comparison between two anesthetic agents for a different purpose however pain was mentioned and the agent used pain was fentanyl. I don't see myself getting fentanyl so that's not happening.
The topic isn't about pain induced from thiopental but rather how they found it easy on patients when tropical/spray lidocaine was used with thiopental for LMA insertion. Idk if this can taken seriously for the purpose of IV induction of thiopental at a high concentration. Tropical lidocaine, maybe it would work for the area where its applied but if or when the burning sensation spreads, it would be really painful. In almost every article I can find, they use thiopental as the agent for pain reduction and here the idea is to reduce pain induced from IV thiopental. As for lidocaine administered via IV route for pain, there are some articles which mentions the use of thiopental, lidocaine, fentanyl etc for the purpose of reduction of pain from propofol injection.

It says Extravascular injection should be avoided and it also says if f extravasation occurs, the local irritant effects can be reduced by injection of 1% lidocaine locally to relieve pain and enhance vasodilatation.
It also says Accidental intra-arterial injection may cause arteriospasm and severe pain along the course of the artery with blanching of the arm and fingers. Among the few suggested measures the following is mentioned Inject the artery with a dilute solution of papaverine, or lidocaine, to inhibit smooth muscle spasm.
I suppose lidocaine can be used along with thiopental for pain.

However this document suggests otherwise
Lidocaine 2% was serially diluted with normal saline. A volume of 0.9 ml of the solution was mixed with 0.1 ml of thiopental. Presence of precipitation was noted.
If precipitation occurs when lidocaine and thiopental is mixed how to administer both without complications?
Lidocaine formed a precipitate at all dilutions except for 0.045%
Lidocaine, when diluted to a concentration equivalent to morphine concentrations commonly used for epidural dosing (0.5 mg/ml), does not result in a precipitate
The above sounds fine however if lidocaine is mixed at a dosage of 0.5mg/ml and mixed with a unpredictably high concentration of thiopental how do they interact remains a question.




Little bit off topic
Gastrointestinal drugs: Metoclopramide and droperidol reduce the dose of thiopental sodium required to induce anaesthesia.
It suggests the meto is sort of potentiates by reducing the dosage required. I guess its a good thing?

Midazolam potentiates the anaesthetic effects of thiopental sodium
If midazolam potentiates thiopental, why isn't it mentioned in ppeh or used in most lethal injection protocols?

Analgesics: Pretreatment with aspirin has been shown to potentiate thiopental sodium anaesthesia. Opioid analgesics can potentiate the respiratory depressant effect of barbiturate anaesthetics and the dose of anaesthetic may need to be reduced. The analgesic effect of pethidine can be reduced by thiopental sodium.
If something as simple as aspirin can potentiate thiopental why isn't it used?
 
Sunset Limited

Sunset Limited

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Jul 29, 2019
968
It is not tropical, it is topical. We are not talking about topical anesthesia here. I mentioned IV lidocaine injection before thiopental injection. Thiopental and lidocaine should not be mixed. Before thiopental, 40 mg of lidocaine is injected over 30 seconds.
 
marcy2022

marcy2022

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Oct 19, 2022
151
It is not tropical, it is topical. We are not talking about topical anesthesia here. I mentioned IV lidocaine injection before thiopental injection. Thiopental and lidocaine should not be mixed. Before thiopental, 40 mg of lidocaine is injected over 30 seconds.
When you say IV lidocaine, you mean intravenous and not subcutaneous or intradermal injection right? The videos I’ve found suggests something which looks to me like intradermal lidocaine injection before anesthesia.
 
Sunset Limited

Sunset Limited

I believe in Sunset Limited
Jul 29, 2019
968
When you say IV lidocaine, you mean intravenous and not subcutaneous or intradermal injection right? The videos I’ve found suggests something which looks to me like intradermal lidocaine injection before anesthesia.
IV lidocaine is administered for injection pain of propofol. It is the same with the euthanasia protocol of Spain and Canada.
 
Cathy Ames

Cathy Ames

Ephemeral Machine
Mar 11, 2022
1,779
In one article I've found online its said "If injected intravenously prior to the loss of consciousness, hot and burning sensations develop, and even if injected after the loss of consciousness by induction agents, a severe withdrawal movement, such as withdrawing the injected hand or arm, may occur due to pain."
Can you give a link? When I searched on this phrase I came up with this article here. In this instance, the hot burning sensations (etc) were not caused by thiopental. They were caused by Rocuronium. Is that the same article?
 
marcy2022

marcy2022

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Oct 19, 2022
151
Can you give a link? When I searched on this phrase I came up with this article here. In this instance, the hot burning sensations (etc) were not caused by thiopental. They were caused by Rocuronium. Is that the same article?
If you look into my previous posts, you'll find a few mentioning pain related to thipental, such as this one:


Also it should be noted that its said in a number of medical articles that Thiopental has no analgesic properties.
IV lidocaine is administered for injection pain of propofol. It is the same with the euthanasia protocol of Spain and Canada.
So it can be administered in the same cannula (dorsum of hand/arm, wherever it works) before thiopental with a saline flush and a few minutes waiting period between lidocaine and thiopental administration? In which order it seems ideal, lidocaine + waiting period for a few minutes + saline flush + thiopental or lidocaine + saline flush + waiting for a few minutes + saline flush?
For 30g thiopental in 150-200ml saline solution, any idea how much lidocaine is ideal for such a highly concentrated dosage?
 
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Cathy Ames

Cathy Ames

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Mar 11, 2022
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If you look into my previous posts, you'll find a few mentioning pain related to thipental, such as this one:
Okay, thanks. The first article you mentioned in that post is the same one as the one I found. In that study Thiopental was given pre-emptively... because they wanted the patient to be sufficiently unconscious not to feel the pain from the rocuronium. The last sentence of the abstract says, "We concluded that pretreatment with 2 mL (50 mg) thiopental is effective in reducing pain caused by the intravenous injection of rocuronium."

Also it should be noted that its said in a number of medical articles that Thiopental has no analgesic properties.
Okay, but a lack of analgesic properties does not equate to the drug itself CAUSING pain.
 
marcy2022

marcy2022

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Oct 19, 2022
151
The last sentence of the abstract says, "We concluded that pretreatment with 2 mL (50 mg) thiopental is effective in reducing pain caused by the intravenous injection of rocuronium."
That simply means thiopental helps reducing pain from rocuronium. However same article also mentions that thiopental itself does cause burning pain sensations as well as withdrawal movement on the same arm where the medication is being administered. My guess is the withdrawal movement is a response to the pain.
The difference is that while thiopental may help reduce pain induced from other drug administration, almost no article can be found regarding how to reduce pain induced by thiopental itself.

Note: The dosage used for the trial above is regular dosage following medical guidelines. The dosage I'll be using is much higher and much more concentrated. That makes me think the pain might be way too much and complications may arise from it.
 
Cathy Ames

Cathy Ames

Ephemeral Machine
Mar 11, 2022
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That simply means thiopental helps reducing pain from rocuronium. However same article also mentions that thiopental itself does cause burning pain sensations as well as withdrawal movement on the same arm where the medication is being administered.
No. No, it absolutely does not say that.

 
marcy2022

marcy2022

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Oct 19, 2022
151
Maybe that's not the right article, it could be that I've misinterpreted that one (actually it would be great if it was a mistake then I won't have to worry about pain associated with it) but just to be sure, I'll try to find the right one or I could be mistaken.

Some common side effects of this medicine are skin rash or pain at the site of injection
Pentothal may cause serious side effects including:
  • severe pain,
 
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Cathy Ames

Cathy Ames

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Mar 11, 2022
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Yup. I'm seeing that one of those does state that "severe pain" is possible. That's certainly very interesting. Possibly @Sunset Limited knows more about why that might happen. It seems very strange to me.

But yeah... you misread what was going on in that rocuronium article. Which is understandable. The protocol was odd and poorly explained in some ways.
 
marcy2022

marcy2022

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Oct 19, 2022
151
Yup. I'm seeing that one of those does state that "severe pain" is possible. That's certainly very interesting. Possibly @Sunset Limited knows more about why that might happen. It seems very strange to me.

But yeah... you misread what was going on in that rocuronium article. Which is understandable. The protocol was odd and poorly explained in some ways.
Its good mistake I'll say that.
However as you said severe pain mentioned on the other link does makes me wonder too.
 
Sunset Limited

Sunset Limited

I believe in Sunset Limited
Jul 29, 2019
968
Yup. I'm seeing that one of those does state that "severe pain" is possible. That's certainly very interesting. Possibly @Sunset Limited knows more about why that might happen. It seems very strange to me.

But yeah... you misread what was going on in that rocuronium article. Which is understandable. The protocol was odd and poorly explained in some ways.
Probably because it is alkaline, it irritates the vein. Lidocaine can be used to prevent this pain. 200mg/ml thiopental is a hypothetical dose beyond all scientific studies, injection can still be painful.
 
marcy2022

marcy2022

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Oct 19, 2022
151
Probably because it is alkaline, it irritates the vein. Lidocaine can be used to prevent this pain. 200mg/ml thiopental is a hypothetical dose beyond all scientific studies, injection can still be painful.
I feared that too. Most medical studies sticks to the guideline dosage. Although there are animal euthanasia mixtures which contains much more concentrated dosage or around 200mg/ml (pentobarbital). I haven’t found any proper medical or veterinary journals trying to address the possibility of pain associated with such highly concentrated dosage or trying to measure pain on animal euthanasia.

Regardless this pain part worries me, what if it’s so much that SI just takes over and my hands take out the cannula (just like ripping off exit bag or trying to get out of water from drowning, maybe here taking the cannula out is the way to stop the pain and unconsciously you may do so. If the pain is really that much.

Can I ask, you’ve mentioned that your method involves propofol. It’s usually painful by itself or so it says. What’s your plan to deal with the pain? Specially with the higher dosage for ctb purposes
 
Cathy Ames

Cathy Ames

Ephemeral Machine
Mar 11, 2022
1,779
I haven’t found any proper medical or veterinary journals trying to address the possibility of pain associated with such highly concentrated dosage or trying to measure pain on animal euthanasia.
There is at least one. They were evaluating whether intraperitoneal injection was painful in mice, as it previously had been found to be so in rats. I believe they found that mice were not affected in the same way as rats were. That seems odd to me, so perhaps I am misremembering.
 
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Sunset Limited

Sunset Limited

I believe in Sunset Limited
Jul 29, 2019
968
I feared that too. Most medical studies sticks to the guideline dosage. Although there are animal euthanasia mixtures which contains much more concentrated dosage or around 200mg/ml (pentobarbital). I haven’t found any proper medical or veterinary journals trying to address the possibility of pain associated with such highly concentrated dosage or trying to measure pain on animal euthanasia.

Regardless this pain part worries me, what if it’s so much that SI just takes over and my hands take out the cannula (just like ripping off exit bag or trying to get out of water from drowning, maybe here taking the cannula out is the way to stop the pain and unconsciously you may do so. If the pain is really that much.

Can I ask, you’ve mentioned that your method involves propofol. It’s usually painful by itself or so it says. What’s your plan to deal with the pain? Specially with the higher dosage for ctb purposes
Propofol injection pain is rare. Although phenols are irritating to the vein but 10mg/ml solution is too small to cause pain. An induction dose of 2mg/kg is injected within 30 seconds. Lidocaine is not used before propofol in most clinics. They do it if the patient has a previous painful experience of sedation with propofol.

I will infuse propofol with two IV accesses. 3 grams of propofol in total. 150mg/min infusion rate. This is slower than induction of anesthesia. So lidocaine is not needed. I have an injection system that I made myself. Works with 3 x 60 cc syringes. If CTB at home, I would use it but I have to do it at hotel room so I can't.
 
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marcy2022

marcy2022

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Oct 19, 2022
151
There is at least one. They were evaluating whether intraperitoneal injection was painful in mice, as it previously had been found to be so in rats. I believe they found that mice were not affected in the same way as rats were. That seems odd to me, so perhaps I am misremembering.
These studies suggest that sodium pentobarbital is painful to rats when administered intraperitoneally and that this pain can be ameliorated by including a local anesthetic to the solution.
The above quote confirms what @Sunset Limited said about thiopental related pain before.


In addition, locomotion, rearing, urination, and defecation were recorded
One thing should be noted urination and deification was mentioned in the article following administration of thiopental.
This makes me wonder, is it normal to urinate and/or defecate with Nembutal or in single drug lethal injection protocols? Now that it’s been mentioned, I would like to know if it’s a possibility, how to maybe not do that or atleast less of it? Fasting maybe?


Furthermore, recent research demonstrated writhing in rats euthanized by intraperitoneal injection of sodium pentobarbital at concentrations of 80 and 240 mg/mL.28 It is possible that the threshold for writhing occurs at a concentration higher than the 50-mg/mL solution we used and that the 390-mg/mL solution that we used resulted in LORR prior to the development of pain. Perhaps the 80- to 240-mg/mL concentrations used in the other studies28 could result in the development of pain prior to the loss of consciousness. Alternatively the difference might be attributable to one of the other components in the solutions. One previous study2used a commercially available product that is a solution of sodium pentobarbital in propylene glycol, ethanol, blue dye, and water; this product was diluted in either water or a commercially available lidocaine solution. Another study24 was conducted with a solution formulated in the lab, containing 96% ethanol with propylene glycol, and at a dose that resulted in anesthesia, not euthanasia; the duration of anesthesia or the high concentration of ethanol may have contributed to the study findings. Still another study28 used a solution that is commercially available in Canada and that contains sodium pentobarbital in propylene glycol, ethanol, rhodamine B, benzyl alcohol, and water. The solutions used in the European and Canadian studies were not directly evaluated in our current study due to the lack of availability in the United States; therefore, no definitive conclusions regarding writhing can be made between our study in mice and the studies in rats.
This is interesting as well as inconclusive however it is said that maybe 80-280mg/ml might cause pain based on what other components are in the solution.

The time to LORR in the study using 150 mg/kg was 212 ± 10.5 to 213 ± 18.1 s, whereas the time to LORR using 250 mg/kg in our study ranged from 74.3 ± 4.9 to 98.5 ± 4.7 s, and the use of 1300 to 1600 mg/kg in resulted in a time to LORR of 66.4 ± 4.5 s. Similarly, other colleagues found that a higher dose of sodium pentobarbital results in shorter time to unconsciousness in rats, and writhing was reported in some animals of each treatment group, including the saline-injected mice.28 In our current study, by simply using an appropriately high dose to produce rapid and reliable unconsciousness in mice, we avoided producing a prolonged death that allowed for the development of pain. This achievement directly answers another of the questions in the AVMA Guidelines, specifically, identifying means to ameliorate the pain seen in the earlier studies.3
Based on the above 2 quotes I guess 200mg/ml may result in pain and possibly should Either be increased to above 280mg/ml or 390mg/ml. Am I correct to assume that?
But then this data is for other animals and not humans. The actual dosage amount may or may not be the same when applied to people.

One important note: intraperitoneal injection was used for the trial and for people mostly intravenous administration is the way to go for thiopental.
 
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Sunset Limited

Sunset Limited

I believe in Sunset Limited
Jul 29, 2019
968
Marcy, maybe you should choose another method. I discovered propofol on this site. I had no IV experience when I took it. I started reading about anesthesia and I loved it. I was in no rush for CTB. I did IV exercises. I've done many drip IV infusion setups and flow rate testing. This was a challenge for me and now not hard to do because I have enough experience. It takes time to experience about IV. This is really not an easy method. Especially this is not easy to manage when SI kicks.
 
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marcy2022

marcy2022

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Oct 19, 2022
151
Marcy, maybe you should choose another method. I discovered propofol on this site. I had no IV experience when I took it. I started reading about anesthesia and I loved it. I was in no rush for CTB. I did IV exercises. I've done many drip IV infusion setups and flow rate testing. This was a challenge for me and now not hard to do because I have enough experience. It takes time to experience about IV. This is really not an easy method. Especially this is not easy to manage when SI kicks.
Ya I just might.

Also I would like to note that the previous link which discusses pain associated with thioental dosage, the route of administration was intraperitoneal injection which skips the intravenous/whole vein IV administration part and possibly any pain associated with that route. However based on the above article maybe it can be said that the thiopental may still cause some pain or discomfort when it gets to where it needs to for it to metabolize itself but I could be wrong about this. And if that is correct, with intravenous administration maybe we're looking at initial pain and another surge of pain or discomfort afterwards.

I was thinking maybe making the dosage more concentrated by using the same 30g or may 29.5g (I might do a trial with 0.5g or less at a similar or exact same high concentration as the actual dosage for later). The idea is to mix 30g thiopental in 75ml saline solution. The concentration will be 400mg/ml. I'll have to use 2.5ml for to reconstruct each vial containing 1g sodium thiopental powder. Not sure if 2.5ml is enough fluid for 1g. It would nice to find sodium thiopental solubility in 0.9% saline solution. I was unable to find 0.9% saline solubility for thiopental. I found some articles mentioning water solubility:

Water Solubility0.049 mg/mL
The above contradicts with ppeh guidelines for sodium thiopental which suggests 10g/10,000mg in 50ml water where the concentration would be 200mg/ml. Maybe my math is wrong.

Solubility: Freely soluble in water and ethanol (~750 g/l) TS; practically insoluble in ether R
What does it mean by "TS" and "R" here?
Based on the above the highest concentration can be somewhere around 750mg/ml

Water Solubility0.04 g/L
I don't get it, here again the suggested concentration is much lower

So if I'm not mistaken none of the above matches? or am I wrong?

The 390-mg/mL solution was a commercially available euthanasia solution that does not contain phenytoin (Fatal-Plus, Vortech Pharmaceuticals, Dearborn, MI)

12121212

This solution has other compounds which is not found in 0.9% Sodium Chloride IV bags. I don't know but maybe those compounds makes a difference regarding pain or how it interacts when compared to sodium thioepental mixed with 0.9% Sodium Chloride/normal saline solution.

I can try experimenting with maybe 1/2 vials to try and figure out the solubility but I don't want to waste too much of it.

Now new question is whether sodium thiopental is soluble at the following concentration of 1g/2.5ml

Also another question, if I manage to do it at the above concentration or whichever works, can I safely do a trial with thiopental only at low dosage of around 400/500mg (at whichever concentration it works)?
Like maybe idk just use a injection of it and try to make note of pain, discomfort or any other feelings and try to make note from the time its administered to falling unconscious as well as when consciousness is back again.

If its too risky maybe I can do the trial with 50mg/ml which would require 10ml for 500mg. However at this concentration the total dosage with 30g thiopental would be 600ml which I think is a lot and would take almost 40-50mins (more or less) to administer all of it. It feels like too long and asking for complications. It should be noted the difference is that the mice were unable to move when the drug was being administered while for me I'll be able to move and that leaves room for complications. And most importantly if this dosage isn't sufficient enough, maybe I just go on a long coma and wake up a week later at a hospital with my arms and legs tied to the bed cuz the concentration of the dosage was too low.

Or I just go with the initial dosage as suggested in ppeh guide which has concentration of 200mg/ml. Maybe I'll try 400mg/ml or 500mg/2.5ml.


If none of it is ideal and doesn't seem viable, and moving to a different method I can think of a few ideas:
What about using vecuronium 60mg/30ml as sole agent? how reliable is it? Some pain and panic but ultimately once the drug is administered not much can be done about it. If not found, it may result in death. is this correct and is 60mg enough?
I've also found some evidence which suggests that lidocaine can be used with vecuronium
120 patients who were scheduled for elective surgery were randomly assigned in 6 groups (Group I, II, III, IL, IIL, IIIL). For groups I, II and III vecuronium was administered only 0.10 mg/kg, 0.12 mg/kg, and 0.15 mg/kg, respectively. For each member of groups IL, IIL and IIIL, lidocaine 1.5 mg/kg was added to the dose of vecuronium of groupI, II and III. The vecuronium or vecuronium- lidocaine mixture was injected for 15 seconds
CONCULUSIONS: The results suggest that administration of a vecuronium-lidocaine mixture administraion improves the intubation condition score during a rapid sequence induction of general anesthesia and shortens the time of the disapprearance of the TOF response.
This may help make things faster as well as reduce any possible pain from the administration of vecuronium itself (not sure how it would interact with the pain but the above article does say it makes things faster).

Ideally it would nice to use vecuronium and thiopental both (I've both) but there's risk of precipitation when they mix together which may render one or the other or both drugs ineffective or may result in other complications. Idk how by myself I can do both. One idea is to use a tourniquet set tightly around elbow (before or after) and thiopental is to be administered in the same arm and then saline flush. Afterwards vecuronium is to be administered on the other arm. Now some delay between vecuronium and tourniquet release would be nice and ideal. However due to the risk of getting the other arm paralyzed before being able to open the tourniquet I'm guessing I'll probably have to release the tourniquet on the other arm right away. This too I think may have the risk of precipitation or maybe I'm wrong.

Or I go with SN following the guidelines of ppeh and/or stan's, both of which leaves chances of failure or other complications due to vomit.
Or SN following the guidelines and right after SN (if I don't vomit) administer either thiopental or vecuronium iva IV route.
SN With thiopental may result in being unconscious rather quickly but the chances of vomiting is still there even while unconscious. And also that means no chances of taking another SN drink and possibly getting caught with no explanation and getting hospitalized.
SN with vecuronium leaves unknown interaction with vomiting(idk how paralyzed person vomit or if they can) may result in being paralyzed and chocking in vomit as well as suffocation at the same time resulting in extreme discomfort and possibly pain and panic. And ofcourse if for whatever reasons it doesn't work where vomiting does occur somehow, there'll be no chances of taking another SN drink due to paralysis and If someone hears the sound of vomiting and gets curious that could complicate things cuz I won't be able to respond while being paralyzed and the possiblity involuntary hospitalization seems inevitable after that.

It comes down to figure out a way to make one of the above work somehow
Or, make thiopental work somehow
Or, SN following the guidelines and taking chances with vomiting and any complications that may follow
Or, vecuronium as a sole agent (provided the dosage is right and administration is done properly)
 
Last edited:
marcy2022

marcy2022

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Oct 19, 2022
151
I just tried to setup cannula and failed twice. I guess I’ll try again tomorrow. Strange thing though, for whatever reason I felt a little lightheaded afterwards. I didn’t lose that much blood, maybe around 10-15 drops, possibly less.
One question, how do I continue to practice on the same spot, I feel like I have to wait for it to heal or anything else I can do to help the process maybe?