Anesthesia<unk>  is a synthetic ultra-short-acting barbiturate and has been used commonly in the induction phase of general anesthesia. Its use has been largely replaced with that of propofol, but may retain some popularity as an induction agent for rapid-sequence induction and intubation, such as in obstetrics. Following intravenous injection, the drug rapidly reaches the brain and causes unconsciousness within 30–45 seconds. At one minute, the drug attains a peak concentration of about 60% of the total dose in the brain. Thereafter, the drug distributes to the rest of the body, and in about 5–10 minutes the concentration is low enough in the brain that consciousness returns. A normal dose of<unk>  (usually 4–6 mg/kg) given to a pregnant woman for operative delivery (caesarean section) rapidly makes her unconscious, but the baby in her uterus remains conscious. However, larger or repeated doses can depress the baby's consciousness.<unk>  is not used to maintain anesthesia in surgical procedures because, in infusion, it displays zero-order elimination pharmacokinetics, leading to a long period before consciousness is regained. Instead, anesthesia is usually maintained with an inhaled anesthetic (gas) agent. Inhaled anesthetics are eliminated relatively quickly, so that stopping the inhaled anesthetic will allow rapid return of consciousness.<unk>  would have to be given in large amounts to maintain unconsciousness during anaesthesia due to its rapid redistribution throughout the body (as it has a high volume of distribution). Since its half-life of 5.5 to 26 hours is quite long, consciousness would take a long time to return. In veterinary medicine,<unk>  is used to induce anesthesia in animals. Since it is redistributed to fat, certain lean breeds of dogs such as sighthounds will have prolonged recoveries from<unk>  due to their lack of body fat and their lean body mass. Conversely, obese animals will have rapid recoveries, but it will be some time before it is entirely removed (metabolized) from their bodies.<unk>  is always administered intravenously, as it can be fairly irritating to tissue and a vesicant; severe tissue necrosis and sloughing can occur if it is injected incorrectly into the tissue around a vein. Medically-induced coma In addition to anesthesia induction,<unk>  was historically used to induce medical comas. It has now been superseded by drugs such as propofol because their effects wear off more quickly than<unk> . Patients with brain swelling, causing elevation of intracranial pressure, either secondary to trauma or following surgery, may benefit from this drug.<unk> , and the barbiturate class of drugs, decrease neuronal activity thereby decreasing cerebral metabolic rate of oxygen consumption (CMRO2), decrease the cerebrovascular response to carbon dioxide, which in turn decreases intracranial pressure. Patients with refractory elevated intracranial pressure (RICH) due to traumatic brain injury (TBI) may have improved long term outcome when barbiturate coma is added to their neurointensive care treatment. Reportedly,<unk>  has been shown to be superior to pentobarbital in reducing intracranial pressure. This phenomenon is also called an inverse steal or Robin Hood effect as cerebral perfusion to all parts of the brain is reduced (due to the decreased cerebrovascular response to carbon dioxide) allowing optimal perfusion to ischaemic areas of the brain which have higher metabolic demands, since vessels supplying ischaemic areas of the brain would already be maximally dilated because of the metabolic demand. Status epilepticus In refractory status epilepticus,<unk>  may be used to terminate a seizure. Euthanasia<unk>  is used intravenously for the purposes of euthanasia. In both Belgium and the Netherlands, where active euthanasia is allowed by law, the standard protocol recommends<unk>  as the ideal agent to induce coma, followed by pancuronium bromide to paralyze muscles and stop breathing. Intravenous administration is the most reliable and rapid way to accomplish euthanasia. Death is quick. A coma is first induced by intravenous administration of 20 mg/kg<unk> <unk>  (Nesdonal) in a small volume (10 ml physiological saline). Then, a triple dose of a non-depolarizing neuromuscular blocking drug is given, such as 20 mg pancuronium bromide (Pavulon) or 20 mg vecuronium bromide (Norcuron). The muscle relaxant should be given intravenously to ensure optimal bioavailability but pancuronium bromide may be administered intramuscularly at an increased dosage level of 40 mg. Lethal injection Along with pancuronium bromide and potassium chloride,<unk>  is used in 34 states of the US to execute prisoners by lethal injection. A very large dose is given to ensure rapid loss of consciousness. Although death usually occurs within ten minutes of the beginning of the injection process, some have been known to take longer. The use of<unk>  in execution protocols was challenged in court after a study in the medical journal The Lancet reported autopsies of executed inmates showed the level of<unk>  in their bloodstream was insufficient to cause unconsciousness. On December 8, 2009, Ohio became the first state to use a single dose of<unk>  for its capital execution, following the failed use of the standard three-drug cocktail during a recent execution, due to inability to locate suitable veins. Kenneth Biros was executed using the single-drug method. Washington State became the second state in the US to use the single-dose<unk>  injections for executions. On September 10, 2010, the execution of Cal Coburn Brown was the first in the state to use a single-dose, single-drug injection. His death was pronounced approximately one and a half minutes after the intravenous administration of five grams of the drug. After its use for the execution of Jeffrey Landrigan in the US, the United Kingdom introduced a ban on the export of<unk>  in December 2010, after it was established that no European supplies to the US were being used for any other purpose. The restrictions were based on "the European Union Torture Regulation (including licensing of drugs used in execution by lethal injection)". From 21 December 2011, the EU extended trade restrictions to prevent the export of certain medicinal products for capital punishment, stating that "the Union disapproves of capital punishment in all circumstances and works towards its universal abolition". Truth serum<unk>  is still used in places such as India as a truth serum to weaken the resolve of a subject and make the individual more compliant to pressure. Barbiturates decrease both higher cortical brain function and inhibition. Some psychiatrists hypothesize that because lying is more complex than telling the truth, suppression of the higher cortical functions may lead to the uncovering of the truth. The drug tends to make subjects verbose and cooperative with interrogators; however, the reliability of confessions made under<unk>  is questionable. Psychiatry Psychiatrists have used<unk>  to desensitize patients with phobias and to "facilitate the recall of painful repressed memories." One psychiatrist who worked with<unk>  is Jan Bastiaans, who used this procedure to help relieve trauma in surviving victims of the Holocaust.
Sodium thiopental
Etomidate
Metharbital
Ketamine
Propofol
Esketamine
Alfentanil
Sevoflurane