Goodbye Thiopental. We'll Miss You, Not

Hospira Corp., the last remaining manufacturer of sodium pentothal, has decided to stop making the barbiturate. The company had hoped to start up production of the drug at its manufacturing plant in Italy this year. The Italian government had other ideas. Knowing the drug's reputation as a means for executing convicts in prison, their legislature decreed that no drugs made in their country can be used for executions. Hospira decided it was not worth the fight to persist in making the drug so has decided to hang it up permanently.

I for one am not the least bit sentimental about the passing of pentothal. It says something about a drug's reputation where its only viable market is for people who are about to die. But I certainly have a lot of memories of using pentothal. In the late 1990's, when propofol was already in wide circulation in hospitals around the country, our residency program director said propofol was too expensive to be used in our department. Instead we all had to use pentothal for induction. In some ways it was equal to or superior to propofol. Pentothal was just as effective in putting patients to sleep. Plus it seemed to have less cardiovascular instability in sick patients.

But its problems were legion.  The drug came as a powder form. The box it came with included a large syringe of saline that you had to mix by hand every morning. Pentothal was also caustic in tissue. If your IV accidentally infiltrated while injecting pentothal, it would cause extreme pain to the patient. Finally pentothal and rocuronium could not coexist in the same IV line. If you were in a rush to start a rapid sequence induction and pushed roc immediately after pentothal, a hard precipitate would form in the IV and you would have to change the line completely or start a new IV. This usually occurred at the worst possible moments, like putting a trauma patient to sleep.

So goodbye pentothal. You've had your run for a good long time. But somebody better has come along. Propofol is the new love of anesthesiologists' hearts and we won't be looking back to rekindle a bad relationship. As for all the prisons looking for an alternative for putting their inmates to death humanely, I say that a humane execution is an oxymoron. If your going to kill somebody in the name of justice, any method that's quick and effective will suffice. Think about it, they are not going to come back and complain about it. And it's better treatment than the convicts gave to their victims.