Need help with coma inducing drugs.

Comainducing drugs

The first answer is there are no drugs which cause a coma in the medical sense of the word. That is a shutdown of the voluntary and conscious functions of the brain. Coma is the side effect of major trauma, systemic infection or toxin build.

Poisons such as anti-freeze, infections such as pneumonia, and head injuries typically, but not exclusively, cause coma due to a massive build up of toxins in the blood or damage to the brain. Frequently this is accompanied by renal (kidney) and Hepatic (liver) failure.

That said the class of drug you are looking for to induce a medical coma (which is a state of deep controlled sleep) are paralysing agents. Pancuronium is a common paralytic as is Curare- which is also found naturally in some Amazonian plants.

The typical dose, usually administered by vein but can be given intra muscularly, is 1-2 micrograms per kilogram. Thus a person of 120 pounds (we don't use the old system where I live but I think that is 55 kilograms) would be 110 - 220 micrograms.

A little extra want hurt but too little will have an awake patient. Usually considered to be a bad thing unless you are psychotic in which case you may enjoy the particularly horrible torture that this causes in the victim!

The trick is not the induction of the coma but the maintenance of the coma and keeping the patient alive.

To keep the patient asleep you will need a ventilator (often erroneously called "life support"), oxygen, a monitor to monitor - blood pressure, respiration rate, pulse rate and temperature- , syringe pumps to supply a continuous dose of the paralysing agent, and an uninterrupted supply of electricity.

To maintain the patients homeostasis you will need IV normal saline (salt water), 4% and a fifth (a solution of saline and 4% concentration of dextrose- a sugar), an IDC (indwelling catheter for urine), 2 hourly turns to prevent pressure areas (bed sores), a laxative may have to be administer every 3 days if bowels do not open regularly.

IV fluids are usually given at a rate of 1 litre (100ml) over a 8 to 10 hour period. The patient should be sedated with a benzodiazepam type drug (5 to 10 mls per hour in a solution of 100 milligrams in 50 millilitres of Normal saline).

Most comatosed patients are thought to be able to hear and therefore you have watch what is said near the patient and what is said to the patient. Most nurses will speak to the patient in a one sided conversation, telling the patient what is being done, when and why and having a 'normal' chat with the patient.

The eyes should be taped shut to prevent them from drying out, and regular saline drops should be applied to the eyes.

It takes 4 nurses to care for a comatosed patient over a 24 hour period. The nursing is one to one that is 1 nurse for every patient. Nurses should work shifts of 8 hours (including 1 hour of breaks) but no more than 10 hours. It is very stressful to nurse a comatosed patient.

This is a very specialised area of medicine and nursing so you will need trained staff. A minimum of 4 nurses at least one will have to be anaesthetic trained. Or you will have to have a doctor trained in aesthetics's and proficient in intubation. This is the placing of a tube down the oesophagus into the trachea to make sure the oxygen gets to the lungs. The position of the tube needs to checked by xray, so you will need access to a mobile xray machine and someone who knows how to use it.

The equipment and drugs are highly and strictly regulated and can only be purchased by a registered authorised medical practitioner. So you will have to have access to a specialist doctor.

However. If you can get the co-operation of a veterinarian then you can purchase the equipment and the drugs, and have a trained practitioner all in one. Vets are authorised to buy, use and own the drugs and the equipment. The same drugs and equipment are used for animals and for people.

So a vet could be an easier option especially if this is for a criminal enterprise.

I amnot anaesthetic trained but I an Critical Care trained and we use the same drugs. So I hope this helps.

You may want to search for anaesthetics, operating theatres, paralysing agents, muscle relaxants. Also check out any tertiary level medical library for the same information, the PDR (Physicians Desk Reference- the US Mimms) will give you doses and routes of administration and reversal agents, side effects and other stuff you need to know. The Royal College of Anaesthetists will also give you good information. Also the Oxford Encyclopaedia of Medicine will also give good information.

Poohcat said:

Most comatosed patients are thought to be able to hear and therefore you have watch what is said near the patient and what is said to the patient. Most nurses will speak to the patient in a one sided conversation, telling the patient what is being done, when and why and having a 'normal' chat with the patient.

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When I was put into an induced coma, I do not recall anything said to me, around me or anything until the moment I was brought out of the coma. To me, a week was the same as a night.

(there is one memory of that time period, but this was before the coma was induced, and in talking with the hospital staff, I've determined this period of 'wakefulness' was in the moments leading up to the incident that necessitated the coma)

However, when I normally sleep, I am not aware of what is said to me, around me or anything until I am 'awake' again. Also, while in the coma some friends that would come visit me said they would note reactions in me when they said certain things. Such as how much I twitched when one friend was threatened to be thrown out the window. (jokingly of course) but they said I reacted strongly when they said that. They also said I had some reactions when they talked about one of my favorite performers.

But I don't recall any of this or even being aware of it. So if I had been even remotely 'awake' during this time, I would have remembered it. Though that may not be typical. I've not spoken with a lot of people who were in comas to share experiences.

Though the information you give concerning the dextrose does actually support my theory as to why the hospital suddenly declared me to be diabetic.

Also, did you forget to mention feeding tubes? Talk about completely annoying.

Less annoying, though, was the catheter (until it was taken out). However, I wonder how often staff would get bored explaining to newly woken patients how to 'use the bathroom' at this point.

Rabe...

Ok- I am sticking my neck out here as a newbie- But I am a 23 year vetren of critical nursing- I work in alevel one trauma center and agree and disagree with some of the above-

The definition of a coma is as follows- a state of prolonged unconsciousness, including a lack of response to stimuli, from which it is impossible to rouse a person. So with apologies to the above poster- it is possible to artifically induce a coma

We do put people into chemically induced comas to preserve brain function- they are most likely head injured or have had an anoxic hit (oxygen deprivation)

The drug used for this is pentabarbatol administered at a rate of mg/kg/min. we do not use a benzo along with this as it would make it impossible to determine if the brain functions are inhibited. we do not want the person sedated we want them in a coma. to make certain the person is down deep enough we use a train of four- a small electric current to initate nerve function- or not- for a pent coma we would not to see a twitch or 0/4. Also this is always given through a vien at a constant rate. And as long as liver and kideny functiona are normal or near normal.

the first poster was correct the person would need mechanical ventalation as they would not breath on their own- however where I work this pt would not require a 4-1 nurse pt ratio- in fact I have taken care of these pts as well as have another intabated pt to care for (I want a job where that poster works!) Yes a feeding tube, yes a urinary cather, yes a central line, yes need to turn every two hours- we put every pt in ICU on a bowel regiment- every day they get a stool softener and a laxitive - we induce diarrhea and insert a rectal trumpet (A indwelling rectal tube) to collect the feces.

Perhaps it depends on the level of the hospital- but where I work this is common and really not that big of a deal. Not to trivialize the condition or make light of it or the info already given- but these pts are actually easy to care for- if they were stable to begin with and the only reason you put them in a coma is to preserve brain function- the whole idea behind this is to reduce brain function and keep it cold- we also make the pt hypothermic keeping the body at a core temp of about 32-35 degrees celcius. both of these keep the brain from being taxed. Sometimes a pressor may be needed to help mantain blood pressure- which would require every 15 minute vital signs- but I have still had another pt in these cases- not ideal but there is the nursing shortage at its ugliest-

just so you know - as well as having worked in this unit for 23 years I also hold my CCRN certification (Critical care registered Nurse)

burgy61 said:

I am looking for a drug that once injected will induce a coma in the victim. I also need to know how much to use on a person of about 120 pounds. It would have to be something only a doctor has access to.

Would it have to be injected into a vein or can it go into the muscle?

Thanks for any help you can give.

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I know Roofies put you in a coma.

Just a couple of things. I worked in a level 6 Trauma Centre, the highest level, we were the busiest in New South Wales. So we used 1:1. True you don't need 1:1 unless you are treating serious conditions and using inotrophic and haemo- dynamic support but if you do then you must have 1:1 as the work load is just too great to manage more than one patient. The 4:1 ratio is 1 nurse per patient per shift plus one nurse to cover for breaks/ holidays and things. No you wouldn't want a job down here. The hours are long and we don't get paid half of what you in the US get paid.

We also nursed our surgical patients open, ie their wounds were not closed but covered with plastic wrap until just before discharge out of the unit.

I didn't mention feeding tubes because they are only used in long term (longer than 7-10 days) patients, as the infection risk is high and the paralytic illeus is a problem.

I did say you could induce a coma medically in the second paragraph. Patients are generally induced in a coma for any condition which is likely to have a system effect: infection, head injury, major internal injury and such things.

I assumed perhaps wrongly, that the original poster was after a drug which would put someone into a coma. And that can't happen. You can only induce a coma-like state.

The head injury thing it is true barbiturates reduce the ability to access the patient reaction to stimuli as you said, but in a head injury it is more important to reduced the intra cranial pressure. By sedating the patient you reduce the ICP by reducing the blood pressure and the haemo-dynamic stress. and thus prevent death by coning. Generally thought to be a bad thing, unless you are a Nazi!! It comes down to priorities.

The priority is always: First preserve life, Second prevent deteriation, and then third preserve function as able.

The chap who said he couldn't remember hearing anything while induced. That is probably due to the fact of the barbiturates they use to sedate you, but you will most likely have deep memory of what was said. I have been in a coma three times. Twice induced and once a natural coma due to trauma. I can't remember two months of my life, except when they brought me out of the coma to test reaction etc, and then only bits. But I do think I remember snippits of conversation one still stays with me 23 years later "Well you have really done it this time." I remember the surgeon standing at the foot of the bed when he said this and then bits of the transfer trip to a tertiary level hospital for the next few weeks.

So we tend to err on the side of caution better safe then sued.

The dextrose would be unlikely to cause diabetes unless you were in a pre-diabetic state. The more likely explanation would be you have suffered some degree of liver compromise, most likely effecting the glucagon cascade or in the pancreas.

Also there is no guarantee that you had a dextrose drip. That would depend on your electrolyte balance, your blood sugars and the length of time you were induced.

Also patients are by protocol routinely monitored for blood glucose levels routinely when on a dextrose drip. An insulin infusion would have been started if you blood sugar showed a longitudinal increase

Yes ruffees do induce a coma, it is also known as a pre moribund state. Any illegally used drug will frequently induced a coma called death!

The stuff from Colorado Guy is usually pretty accurate he is a consultant ???anaethetist or something at some big hospital- perhaps Colorado.

Poohcat said:

busiest in New South Wales. .

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That's the difference. In America we are experiencing a national shortage of physicians and nurses, so the nursing ratios aren't what they were during my training. 1:1 is almost unheard of now. The percapita number of physicians is 1/2 what it was when I was a med student. There are few places that are adequately or even over-served but most of the nation is getting rationed my market forces instead of the government.

with regard to the original post, there are many drugs available to knock someone out to varrying degrees but none that are irreversible...(but I vaguely remember a toxin that is irreversible maybe). To maintain the altered level of consciousness would require continued administration of the medications.

We too have a major specialist nursing and medical shortage. We lose a nurse a month from Critical Care units through out the country. Being a small country NZ doctors and Nurses staff the hospitals of the world. I have friends working in Saudi, US, Canada, UK, France and one even works in Gabon!!


Our staffing levels within lower level ICU/CCU is not as good but we operate a tiered system with base hospitals referring to regional specialists centres and tertiary level hospitals. But most senior level units have adequate staffing but the grass is always greener.

The money certainly is.

While I wouldn't swap our State support Health care for a straight 100% user pays system, there is a price to pay. We get free health care but we have to wait for a spot on the routine list. So every emergency puts you one down the list.

The trade off is everyone, especially the poor and the deprived, gets the same level of health care. It doesn't matter how rich or how poor you are, what colour you are or religion, whether you work or not- very socialist and communial.

The other problem is of course the government sets the priority for the Queens money and this can change from government to government.
This can mean that your place goes to other funding priorities but hey thats democracy for you.

No ethnocentrism please!!!!?????

Yeah sorry mate but "Usually" stands. No offence but where I come from we usually qualify absolute statements. Cultural differences and national eccentricities make the world a wonderful place.

No-one can absolutely state anything, except God ......................... or the Pope. (I state definitively!!!!!!!!!)