Dude, you win a huge 👍👍👍 for even asking for it.
This is a great induction agent that has been squeezed outta the market by propofol and etomidate, and not necessarily rightfully so. If you've got a good, well-functioning, patent IV line, there's no reason not to use it. The problem with it is that it has been around since the 1940's, has a much-maligned and undeserved reputation of being a "dangerous" drug (e.g. extravasation issues, hemodynamic instability, etc.), and is not routinely stocked at many pharmacies.
I don't think the benefits in head trauma/surgery are theoretical. It has an excellent side-effect profile, it almost immediately drastically reduces the CMRO2 and does it better than propofol and etomidate, and also provides better cerebral protection than most other agents.
We, in this era of cost containment, should be thinking about equally effective and less costly alternatives. Droperidol is another one that comes to mind (unless your patient is going home the same day). But, we are compelled by those that purchase the drugs - and the pharmaceutical companies marketing them - that somehow certain meds (ondansetron, propofol, etc.) are somehow inherently better than other meds. We never stop to fully question why we believe this; we just believe it.
I'm not at all suggesting that you use thiopental for every case. But, in certain select cases, especially those where there is some sort of space occupying lesion inside the calvarium, you should give it a try. You don't slam it in like I see a lot of my resident and physician colleauges do with other meds, and probably the standard 5mg/kg induction dose is WAY too liberal and unnecessary. But, have a good fast-flowing IV, use it, push it slow, be patient, and watch how smooth you can induce someone with it.
I'm grateful that I have had at least one attending who lets me use this drug in crani's, and I feel like I'm pretty damn good with it and have a good feel for what it can do. I've never had a surgeon complain, and my brains are always soft when it comes time to do some whackin'. Does it make a huge difference in the longterm outcome? Probably not. But, you can do cookie-cutter anesthesia or you can actually try to have a few more guns in your arsenal. I choose the latter.
-copro
