marcy2022
Student
- Oct 19, 2022
- 151
This is going to be a long read. I apologize for that.
Its said that thiopental has no analgesic properties. Some online articles suggest that there maybe severe withdrawal symptoms. This one article suggests: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810589/
"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."
"However in the 45 experimental patients pretreated with 2 mL (50 mg) thiopental, only 2 patients (4.4%) showed severe withdrawal movement (p<0.05)."
What does it mean by severe withdrawal movement in arms? Does it mean that because of pain one feels an extreme urge to move their arm by voluntary or involuntary response? The dosage for the trial was really low, could it be that with a really high dosage of 5-10g may result in extreme pain as well as extreme withdrawal movement in arms or throughout the body?
Regarding the pain "hot burning sensations", which as its suggested above that may happen even when unconscious. That would be fine if I could have the full dosage in my systems in go but with an active IV line I'm thinking that the movement may misplace the IV tubing or the cannula or something. Is there anything that can be done to help with this or to prevent this?
Some additional research on the topic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876417/
"SW2005 was noted to be breathing 3 min after thiopental, but not at the time of pancuronium bromide injection; the exact time respiration ceased was not recorded. DR2000 was noted to have chest movements two minutes after respiration was noted to have ceased."
If I understand it correctly after thiopental injection one person was still breathing after 3mins and somehow there was movements in another person after their breathing stopped. How is that possible to have physical movements when there's no breathing?
"Most US executions are beset by procedural problems that could lead to insufficient anesthesia in executions. This hypothesis has been supported by findings of low postmortem blood thiopental levels and eyewitness accounts of problematic executions. Herein we report evidence that the design of the drug scheme itself is flawed. Thiopental does not predictably induce respiratory arrest, nor does potassium chloride always induce cardiac arrest. Furthermore, on the basis of execution data and clinical, veterinary, and laboratory animal studies, we posit that the specified quantity of thiopental may not provide surgical anesthesia for the duration of the execution."
According the above, 5g of thiopental isn't significant enough for respiratory arrest or other words to stop breathing. Nor is it enough to keep anesthesia for more than 9 minutes. Idk but this is confusing!
"Moreover, in legal challenges to the death penalty, the leading expert witness testifying on behalf of the states routinely asserts that 3 g of thiopental alone is a lethal dose in almost all cases [14]. The data presented here, however, suggest that thiopental alone might not be lethal. First, extrapolating from clinical use, the lowest dosages used in some jurisdictions would not be expected to kill. Calculated dosages in North Carolina executions using 3 g of thiopental ranged from 10 to 45 mg/kg. Assuming inmates are roughly the same size across jurisdictions, the dose range would be 17–75 mg/kg in California, where 5 g of thiopental is used, and 6.6–30 mg/kg in Virginia and other jurisdictions, which use 2 g. Thus, at the lowest doses, thiopental would be given near the upper range of that recommended for clinical induction of anesthesia (3–6.6 mg/kg)—clearly not a dose designed to be fatal [20]. Second, the calculated doses used across lethal injections are only 0.1–2 times the LD50 (dose required to kill 50% of the tested population) of thiopental in dogs (37 mg/kg), rabbits (35 mg/kg), rats (57.8 mg/kg), and mice (91.4 mg/kg) [21, 22]. Third, intravenous delivery of thiopental alone is not recommended by The Netherlands Euthanasics Task Force, which concluded "it is not possible to administer so much of it that a lethal effect is guaranteed" [23], even in their population of profoundly ill patients."
The above suggests that eye witness reports and clinical data doesn't match. Although it should be noted that the eye witness reports are of thiopental used on people vs clinical data based on dog, mice etc. Dutch organization mentioned above suggests thiopental simply isn't a good choice because as it was said above "its not possible to administer the required dosage necessary for lethal effect".
"The most compelling evidence that even 5 g of thiopental alone may not be lethal, however, is that some California inmates continued to breathe for up to 9 min after thiopental was injected. This observation directly contradicts testimony of that state's expert witness, who asserted that "this dose of thiopental sodium will cause virtually all persons to stop breathing within a minute of drug administration" and that "virtually every person given 5 grams of thiopental sodium will have stopped breathing prior to the administration of the pancuronium bromide" [24]. The witness has made identical statements regarding 3 g of thiopental [14]. Indeed, the clinical literature is replete with examples of patients experiencing respiratory failure after even low doses of thiopental [25]. Others, however, experience merely transient, nonfatal apnea. Of course, for inmates who did not stop breathing with thiopental alone, it is impossible to know whether the thiopental solution was correctly mixed, whether the entire dose was administered intravenously, or whether the apparent resistance was due to bolus dosing or individual variation. It remains possible, however, that bolus dosing of 5 g of thiopental alone might not be fatal in all persons. Indeed, nonhuman primates given as much as 60 mg/kg (the mass equivalent of 6 g for a 100 kg man) experienced prolonged sleep, but ultimately recovered [26]."
More information which suggests that some people continued to breath 9 minutes after 5g thiopental administration. But then it does mention some the unknown factors which may help shed some light on this but without more information maybe 5g should be considered inadequate I think?
Further into the topic it's said that "The North Carolina and California data together suggest that potassium chloride might not be the lethal agent in lethal injection."
"Indeed, pancuronium might have been the agent of death even in inmates who ceased breathing coincident with or shortly after injection of pancuronium, rendering permanent the thiopental-induced apnea."
Afterwards it's said that the pancuronium maybe the lethal agent in the protocol.
"Court documents and news reports indicate that at least Virginia [32], California [10], and Florida [31] have administered additional potassium chloride in multiple executions when the inmate failed to die as expected. If a Virginia execution takes too long and if the inmate fails to die, the protocol indicates that additional pancuronium and potassium chloride should be injected, although there is no provision for additional thiopental [32]. In cases such as Diaz's, additional drugs may have been required due to technical problems with delivery, but it remains possible that in others, the standard drug protocol failed to kill."
Further evidence suggesting that thiopental may not be the lethal agent. Atleast not at the given dosage of 5g.
"Medical experts on both sides of the lethal injection debate have asserted that 3 g of thiopental properly delivered should reliably result in either death or a long, deep surgical plane of anesthesia [13,14]. In support of this contention, continuous or intermittent thiopental administration was formerly used for surgical procedures lasting many hours. In one study, 3.3–3.9 g given to patients over 25–50 min resulted in sleep for 4–5.5 h [33]. Depth and duration of thiopental anesthesia depends greatly upon dose and rate of administration, however, and bolus dosing results in significantly different pharmacokinetics and duration of efficacy than administration of the same quantity of drug at a lower rate [22]"
First its said that properly delivered 3g of thiopental maybe lethal. It's also said that 3.3-3.9g thiopental administered over 25-50min resulted in 4-5.5h sleep. Does it mean thiopental really isn't a good agent for lethal puposes? Then again its suggesting dosage and rate of administration matters. Bolus dosage or administration in a short time period matters is whats being suggested above. Does it mean as per ppeh guidelines 10g thiopental in 50ml IV solution could be enough? But then I've failed before with almost double the suggested dosage of thiopental and phenytoin sodium (this isn't part of the lethal drug protocol, its from ppeh but I feel like phenytoin sodium adds another unknown variable to this complicated matter) via oral route. I was found after around 8 hours, so 8 hours wasn't enough.
"Not only are available data limited, however, medical literature addressing the effects of these drugs at high doses and in combination is nonexistent, emphasizing the failure of lethal injection practitioners to design and evaluate rigorously a process that ensures reliable, painless death, even in animals. In consequence, the adequacy of anesthesia and mechanism of death in the current lethal injection protocol remains conjecture."
So basically there aren't enough data regarding thiopental to suggest at dosage, concentration and rate of administration is lethal.
"Diaz's. Better training of execution personnel and altering delivery conditions may not "fix" the problem [41, 42], however, because the drug regimen itself is potentially inadequate. Our analysis indicates that as used, thiopental might be insufficient both to maintain a surgical plane of anesthesia and to predictably induce death. Consequently, elimination of pancuronium or both pancuronium and potassium, as has been suggested in California [41], could result in situations in which inmates ultimately awaken."
Based on available data they are concluding that thiopental alone may not be as lethal as it's considered to be.
Now I'm really confused. So thioeptal isn't really the "dream peaceful" lethal drug as its deemed to be? So far my plan was to use 30g thiopental mixed with 150-300ml 0.9% Sodium Chloride and maybe 1-3g phenytoin sodium and 3x10mg meto taken 45 minutes before but it feels like with 300ml the concentration might be too low, may have to go with 150ml. And with higher dosage of phenytoin sodium injection it could result in toxic epidermal nercosis (the pictures are really scary and I wonder if I should use this at all, specially intervenous at large dosage as its more effective that way). Meto itself also could screw things up. The whole topic above is making me wonder even at that dosage whether intervenous thiopental should work or it'll be a long long deep sleep or maybe I become a vegetable. Any idea's how to make it effective?
Its said that thiopental has no analgesic properties. Some online articles suggest that there maybe severe withdrawal symptoms. This one article suggests: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810589/
"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."
"However in the 45 experimental patients pretreated with 2 mL (50 mg) thiopental, only 2 patients (4.4%) showed severe withdrawal movement (p<0.05)."
What does it mean by severe withdrawal movement in arms? Does it mean that because of pain one feels an extreme urge to move their arm by voluntary or involuntary response? The dosage for the trial was really low, could it be that with a really high dosage of 5-10g may result in extreme pain as well as extreme withdrawal movement in arms or throughout the body?
Regarding the pain "hot burning sensations", which as its suggested above that may happen even when unconscious. That would be fine if I could have the full dosage in my systems in go but with an active IV line I'm thinking that the movement may misplace the IV tubing or the cannula or something. Is there anything that can be done to help with this or to prevent this?
Some additional research on the topic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876417/
"SW2005 was noted to be breathing 3 min after thiopental, but not at the time of pancuronium bromide injection; the exact time respiration ceased was not recorded. DR2000 was noted to have chest movements two minutes after respiration was noted to have ceased."
If I understand it correctly after thiopental injection one person was still breathing after 3mins and somehow there was movements in another person after their breathing stopped. How is that possible to have physical movements when there's no breathing?
"Most US executions are beset by procedural problems that could lead to insufficient anesthesia in executions. This hypothesis has been supported by findings of low postmortem blood thiopental levels and eyewitness accounts of problematic executions. Herein we report evidence that the design of the drug scheme itself is flawed. Thiopental does not predictably induce respiratory arrest, nor does potassium chloride always induce cardiac arrest. Furthermore, on the basis of execution data and clinical, veterinary, and laboratory animal studies, we posit that the specified quantity of thiopental may not provide surgical anesthesia for the duration of the execution."
According the above, 5g of thiopental isn't significant enough for respiratory arrest or other words to stop breathing. Nor is it enough to keep anesthesia for more than 9 minutes. Idk but this is confusing!
"Moreover, in legal challenges to the death penalty, the leading expert witness testifying on behalf of the states routinely asserts that 3 g of thiopental alone is a lethal dose in almost all cases [14]. The data presented here, however, suggest that thiopental alone might not be lethal. First, extrapolating from clinical use, the lowest dosages used in some jurisdictions would not be expected to kill. Calculated dosages in North Carolina executions using 3 g of thiopental ranged from 10 to 45 mg/kg. Assuming inmates are roughly the same size across jurisdictions, the dose range would be 17–75 mg/kg in California, where 5 g of thiopental is used, and 6.6–30 mg/kg in Virginia and other jurisdictions, which use 2 g. Thus, at the lowest doses, thiopental would be given near the upper range of that recommended for clinical induction of anesthesia (3–6.6 mg/kg)—clearly not a dose designed to be fatal [20]. Second, the calculated doses used across lethal injections are only 0.1–2 times the LD50 (dose required to kill 50% of the tested population) of thiopental in dogs (37 mg/kg), rabbits (35 mg/kg), rats (57.8 mg/kg), and mice (91.4 mg/kg) [21, 22]. Third, intravenous delivery of thiopental alone is not recommended by The Netherlands Euthanasics Task Force, which concluded "it is not possible to administer so much of it that a lethal effect is guaranteed" [23], even in their population of profoundly ill patients."
The above suggests that eye witness reports and clinical data doesn't match. Although it should be noted that the eye witness reports are of thiopental used on people vs clinical data based on dog, mice etc. Dutch organization mentioned above suggests thiopental simply isn't a good choice because as it was said above "its not possible to administer the required dosage necessary for lethal effect".
"The most compelling evidence that even 5 g of thiopental alone may not be lethal, however, is that some California inmates continued to breathe for up to 9 min after thiopental was injected. This observation directly contradicts testimony of that state's expert witness, who asserted that "this dose of thiopental sodium will cause virtually all persons to stop breathing within a minute of drug administration" and that "virtually every person given 5 grams of thiopental sodium will have stopped breathing prior to the administration of the pancuronium bromide" [24]. The witness has made identical statements regarding 3 g of thiopental [14]. Indeed, the clinical literature is replete with examples of patients experiencing respiratory failure after even low doses of thiopental [25]. Others, however, experience merely transient, nonfatal apnea. Of course, for inmates who did not stop breathing with thiopental alone, it is impossible to know whether the thiopental solution was correctly mixed, whether the entire dose was administered intravenously, or whether the apparent resistance was due to bolus dosing or individual variation. It remains possible, however, that bolus dosing of 5 g of thiopental alone might not be fatal in all persons. Indeed, nonhuman primates given as much as 60 mg/kg (the mass equivalent of 6 g for a 100 kg man) experienced prolonged sleep, but ultimately recovered [26]."
More information which suggests that some people continued to breath 9 minutes after 5g thiopental administration. But then it does mention some the unknown factors which may help shed some light on this but without more information maybe 5g should be considered inadequate I think?
Further into the topic it's said that "The North Carolina and California data together suggest that potassium chloride might not be the lethal agent in lethal injection."
"Indeed, pancuronium might have been the agent of death even in inmates who ceased breathing coincident with or shortly after injection of pancuronium, rendering permanent the thiopental-induced apnea."
Afterwards it's said that the pancuronium maybe the lethal agent in the protocol.
"Court documents and news reports indicate that at least Virginia [32], California [10], and Florida [31] have administered additional potassium chloride in multiple executions when the inmate failed to die as expected. If a Virginia execution takes too long and if the inmate fails to die, the protocol indicates that additional pancuronium and potassium chloride should be injected, although there is no provision for additional thiopental [32]. In cases such as Diaz's, additional drugs may have been required due to technical problems with delivery, but it remains possible that in others, the standard drug protocol failed to kill."
Further evidence suggesting that thiopental may not be the lethal agent. Atleast not at the given dosage of 5g.
"Medical experts on both sides of the lethal injection debate have asserted that 3 g of thiopental properly delivered should reliably result in either death or a long, deep surgical plane of anesthesia [13,14]. In support of this contention, continuous or intermittent thiopental administration was formerly used for surgical procedures lasting many hours. In one study, 3.3–3.9 g given to patients over 25–50 min resulted in sleep for 4–5.5 h [33]. Depth and duration of thiopental anesthesia depends greatly upon dose and rate of administration, however, and bolus dosing results in significantly different pharmacokinetics and duration of efficacy than administration of the same quantity of drug at a lower rate [22]"
First its said that properly delivered 3g of thiopental maybe lethal. It's also said that 3.3-3.9g thiopental administered over 25-50min resulted in 4-5.5h sleep. Does it mean thiopental really isn't a good agent for lethal puposes? Then again its suggesting dosage and rate of administration matters. Bolus dosage or administration in a short time period matters is whats being suggested above. Does it mean as per ppeh guidelines 10g thiopental in 50ml IV solution could be enough? But then I've failed before with almost double the suggested dosage of thiopental and phenytoin sodium (this isn't part of the lethal drug protocol, its from ppeh but I feel like phenytoin sodium adds another unknown variable to this complicated matter) via oral route. I was found after around 8 hours, so 8 hours wasn't enough.
"Not only are available data limited, however, medical literature addressing the effects of these drugs at high doses and in combination is nonexistent, emphasizing the failure of lethal injection practitioners to design and evaluate rigorously a process that ensures reliable, painless death, even in animals. In consequence, the adequacy of anesthesia and mechanism of death in the current lethal injection protocol remains conjecture."
So basically there aren't enough data regarding thiopental to suggest at dosage, concentration and rate of administration is lethal.
"Diaz's. Better training of execution personnel and altering delivery conditions may not "fix" the problem [41, 42], however, because the drug regimen itself is potentially inadequate. Our analysis indicates that as used, thiopental might be insufficient both to maintain a surgical plane of anesthesia and to predictably induce death. Consequently, elimination of pancuronium or both pancuronium and potassium, as has been suggested in California [41], could result in situations in which inmates ultimately awaken."
Based on available data they are concluding that thiopental alone may not be as lethal as it's considered to be.
Now I'm really confused. So thioeptal isn't really the "dream peaceful" lethal drug as its deemed to be? So far my plan was to use 30g thiopental mixed with 150-300ml 0.9% Sodium Chloride and maybe 1-3g phenytoin sodium and 3x10mg meto taken 45 minutes before but it feels like with 300ml the concentration might be too low, may have to go with 150ml. And with higher dosage of phenytoin sodium injection it could result in toxic epidermal nercosis (the pictures are really scary and I wonder if I should use this at all, specially intervenous at large dosage as its more effective that way). Meto itself also could screw things up. The whole topic above is making me wonder even at that dosage whether intervenous thiopental should work or it'll be a long long deep sleep or maybe I become a vegetable. Any idea's how to make it effective?
