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Pentobarbital induced coma

Naresh Mullaguri, Nakul Katyal, Aarti Sarwal, Jonathan M Beary, Pravin George, Naresh Karthikeyan, Premkumar Nattanamai, Christopher R Newey
Although a neurological examination is fundamental to the evaluation of comatose patients, it is less reliable in a medically induced coma. A commonly misinterpreted finding in patients in a pentobarbital coma is altered pupillary reactivity secondary to an exaggerated ciliospinal reflex. Recognizing an exaggerated ciliospinal reflex in patients in a pentobarbital coma is important and may prevent unnecessary intervention. We present a patient induced in a pentobarbital coma for the treatment of status epilepticus who exhibited a nonreactive pupil secondary to an exaggerated ciliospinal reflex confirmed by pupillometry...
December 30, 2017: Curēus
Todd Rabkin Golden, Veronika Solnicky, Rita Wadeea, Sehem Ghazala
We present a rare case of pentobarbital infusion causing propylene glycol-induced lactic acidosis, during refractory status epilepticus treatment in a 66-year-old man without seizure history.
February 22, 2018: BMJ Case Reports
Yoshimasa Kanawaku, Keiko Hirakawa, Kaoru Koike, Jun Kanetake, Youkichi Ohno
Cerebrospinal fluid (CSF) is routinely subjected to gross evaluation in postmortem investigations; however, its use in chemical evaluations has not been fully realized. Analysis of nuclear magnetic resonance (NMR) spectra with pattern recognition methods was applied to CSF samples. Rats were treated with pentylenetetrazol (PTZ) to induce seizure or pentobarbital (PB) to induce coma, and postmortem CSF was collected after CO2 gas euthanization. Pattern recognition analysis of the NMR data was performed on individual postmortem CSF samples...
March 2017: Legal Medicine
Christopher R Newey, Dolora Wisco, Premkumar Nattanmai, Aarti Sarwal
BACKGROUND: Refractory status epilepticus is often treated with third-line therapy, such as pentobarbital coma. However, its use is limited by side effects. Recognizing and preventing major and minor adverse effects of prolonged pentobarbital coma may increase good outcomes. This study retrospectively reviewed direct and indirect medical and surgical pentobarbital coma. METHODS: Retrospective chart review of all patients with refractory status epilepticus treated with pentobarbital over a 1 year period at a large tertiary care center...
October 2016: Therapeutic Advances in Drug Safety
Anne Minert, Marshall Devor
The molecular agents that induce loss of consciousness during anesthesia are classically believed to act by binding to cognate transmembrane receptors widely distributed in the CNS and critically suppressing local processing and network connectivity. However, previous work has shown that microinjection of anesthetics into a localized region of the brainstem mesopontine tegmentum (MPTA) rapidly and reversibly induces anesthesia in the absence of global spread. This implies that functional extinction is determined by neural pathways rather than vascular distribution of the anesthetic agent...
January 2016: Experimental Neurology
Bong Su Kang, Keun-Hwa Jung, Jeong-Won Shin, Jang Sup Moon, Jung-Ick Byun, Jung-Ah Lim, Hye Jin Moon, Young-Soo Kim, Soon-Tae Lee, Kon Chu, Sang Kun Lee
General anesthetic-induced coma therapy has been recommended for the treatment of refractory status epilepticus (RSE). However, the influence of electroencephalographic (EEG) burst suppression (BS) on outcomes still remains unclear. This study investigated the impact of intravenous anesthetic-induced BS on the prognosis of RSE using a retrospective analysis of all consecutive adult patients who received intravenous anesthetic treatment for RSE at the Seoul National University Hospital between January 2006 and June 2011...
May 2015: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Elviira Corsi, Subramanian Sathishkumar, Riaz Ali Shah, Zakiyah Kadry, Patrick M McQuillan, Sonia J Vaida, Dmitri S Bezinover
In this report, we describe a case of posterior reversible encephalopathy syndrome in a female patient after deceased donor liver transplantation. She developed posterior reversible encephalopathy syndrome on postoperative day 3 and did not improve despite adjustments in immunosuppressive therapy. The patient had symptoms of severe brain edema requiring maximal therapy, which included cooling, mannitol, 3% saline, and a pentobarbital infusion. Attempts to lighten the level of sedation failed because of recurring intractable seizure activity...
December 1, 2014: A & A Case Reports
Amar B Bhatt, Alexandra Popescu, Elizabeth J Waterhouse, Bassel W Abou-Khalil
Pentobarbital and propofol are used for the treatment of refractory status epilepticus or elevated intracranial pressure, typically with continuous EEG monitoring. We report a series of patients who developed generalized periodic discharges related to anesthetic withdrawal (GRAWs), different from previous seizure activity. At times, this pattern was misinterpreted as recurrent seizure activity, leading to reinstitution of drug-induced coma, but resolved spontaneously without additional treatment.We identified five patients who developed GRAWs during pentobarbital or propofol withdrawal...
June 2014: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Nassir Mansour, Ruth-Mary deSouza, Christian Sikorski, Madelyn Kahana, David Frim
Barbiturates are widely used in the management of high intracranial pressure (ICP) caused by diffuse brain swelling. The cardiovascular, renal, and immunological side effects of these drugs limit them to last-line therapy. There are few published data regarding the role of barbiturates in focal brain lesions causing refractory elevated ICP and intraoperative brain swelling in the pediatric population. The authors here present 3 cases of nontraumatic, focally induced, refractory intracranial hypertension due to 2 tumors and 1 arteriovenous malformation, in which barbiturate therapy was used successfully to control elevated ICP...
July 2013: Journal of Neurosurgery. Pediatrics
Robert G Kowalski, Wendy C Ziai, Richard N Rees, J Kent Werner, Grace Kim, Haley Goodwin, Romergryko G Geocadin
OBJECTIVES: To characterize associations between antiepileptic drugs with sedating or anesthetic effects (third-line antiepileptic drugs) vs. other antiepileptic agents, and short-term outcomes, in status epilepticus. Furthermore, to evaluate the role of adverse hemodynamic and respiratory effects of these agents in status epilepticus treatment. DESIGN: Retrospective comparative analysis. SETTING: Tertiary academic medical center with two emergency departments and two neurologic intensive care units...
September 2012: Critical Care Medicine
Ömer Bektas, Arzu Yılmaz, Tanıl Kendirli, Zeynep Sıklar, Gülhis Deda
Hashimoto encephalopathy is a rare, clinically heterogenous condition. Its treatment is based on corticosteroids. A previously normal 12-year-old boy was admitted to our pediatric emergency department with status epilepticus. He experienced a recurrence of status epilepticus after pentobarbital withdrawal, and required repeated resumptions of drug-induced coma. He manifested acute personality changes. His limbic encephalitis markers were normal, but his level of anti-thyroid peroxidase antibody was high. A diagnosis of Hashimoto encephalopathy was considered...
February 2012: Pediatric Neurology
Karin Skoglund, Per Enblad, Lars Hillered, Niklas Marklund
OBJECTIVES: The "neurological wake-up test" is needed to evaluate the level of consciousness in patients with severe traumatic brain injury. However, the neurological wake-up test requires interruption of continuous sedation and may induce a stress response and its use in neurocritical care is controversial. We hypothesized that the neurological wake-up test induces an additional biochemical stress response in patients with severe traumatic brain injury. PATIENTS: Twenty-four patients who received continuous propofol sedation and mechanical ventilation after moderate to severe traumatic brain injury (Glasgow Coma Scale score ≤ 8; patient age 18-71 yrs old) were analyzed...
January 2012: Critical Care Medicine
H Isaac Chen, Neil R Malhotra, Mauro Oddo, Gregory G Heuer, Joshua M Levine, Peter D LeRoux
OBJECTIVE: Barbiturate-induced coma can be used in patients to treat intractable intracranial hypertension when other therapies, such as osmotic therapy and sedation, have failed. Despite control of intracranial pressure, cerebral infarction may still occur in some patients, and the effect of barbiturates on outcome remains uncertain. In this study, we examined the relationship between barbiturate infusion and brain tissue oxygen (PbtO2). METHODS: Ten volume-resuscitated brain-injured patients who were treated with pentobarbital infusion for intracranial hypertension and underwent PbtO2 monitoring were studied in a neurosurgical intensive care unit at a university-based Level I trauma center...
November 2008: Neurosurgery
Nicholas S Abend, Dennis J Dlugos
Refractory status epilepticus describes continuing seizures despite adequate initial pharmacologic treatment. This situation is common in children, but few data are available to guide management. We review the literature related to the pharmacologic treatment and overall management of refractory status epilepticus, including midazolam, pentobarbital, phenobarbital, propofol, inhaled anesthetics, ketamine, valproic acid, topiramate, levetiracetam, pyridoxine, corticosteroids, the ketogenic diet, and electroconvulsive therapy...
June 2008: Pediatric Neurology
Alison M Stevens, Janine E Then, Karen M Frock, Bruce A Crookes, Christopher Commichau, Brian T Marden, Bonnie J Beynnon, Jill A Rebuck
BACKGROUND: There is considerable debate regarding the appropriateness of feeding patients by the enteral route in conjunction with pentobarbital coma therapy. OBJECTIVE: To determine the incidence of feeding intolerance (FI) in patients receiving pentobarbital in conjunction with enteral nutrition (EN). METHODS: A retrospective, observational evaluation of patients (>14 y of age) who received a therapeutic pentobarbital coma in combination with EN was conducted...
April 2008: Annals of Pharmacotherapy
Alexander Y Zubkov, Alejandro A Rabinstein, Edward M Manno, Eelco F M Wijdicks
BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is an extremely rare cause of status epilepticus. Review of literature demonstrated only four cases of brief status epilepticus (SE) associated with TTP. CASE: We describe a young woman with yet incomplete neurological recovery after prolonged refractory status epilepticus. Management required pentobarbital-induced coma for 60 days. Five months after onset, she was conversant and oriented with continued neuromuscular deficits...
2008: Neurocritical Care
J Scott Cline, Karen Roos
OBJECTIVE: To describe a case in which electroconvulsive therapy (ECT) was used successfully to treat refractory status epilepticus (SE) after all pharmacological therapies were exhausted. METHODS: A 39-year-old man with no seizure history presented in SE secondary to presumed viral encephalitis. His seizures remained refractory to medical management, and he was placed in a pentobarbital-induced coma. Multiple attempts to wean pentobarbital over the next several months failed due to SE relapses...
March 2007: Journal of ECT
I Sukhotinsky, V Zalkind, J Lu, D A Hopkins, C B Saper, M Devor
Anesthesia, slow-wave sleep, syncope, concussion and reversible coma are behavioral states characterized by loss of consciousness, slow-wave cortical electroencephalogram, and motor and sensory suppression. We identified a focal area in the rat brainstem, the mesopontine tegmental anesthesia area (MPTA), at which microinjection of pentobarbital and other GABA(A) receptor (GABA(A)-R) agonists reversibly induced an anesthesia-like state. This effect was attenuated by local pre-treatment with the GABA(A)-R antagonist bicuculline...
March 2007: European Journal of Neuroscience
J M K Murthy
Refractory status epilepticus (RSE) is a common problem in intensive care units and emergency departments. The important risk factor predisposing patients with SE to RSE is delay in receiving treatment. Self-sustaining SE is associated with progressive, time-dependent development of pharmacoresistance. Early termination of convulsive SE by aggressive treatment is the best way to prevent RSE. RSE once develop, requires more aggressive treatment as it is associated with higher mortality and morbidity. To date, no randomized controlled trials have been done for RSE...
December 2006: Neurology India
Mary Kay Bader, Richard Arbour, Sylvain Palmer
Patients with severe traumatic brain injury resulting in increased intracranial pressure refractory to first-tier interventions challenge the critical care team. After exhausting these initial interventions, critical care practitioners may utilize barbiturate-induced coma in an attempt to reduce the intracranial pressure. Titrating appropriate levels of barbiturate is imperative. Underdosing the drug may fail to control the intracranial pressure, whereas overdosing may lead to untoward effects such as hypotension and cardiac compromise...
October 2005: AACN Clinical Issues
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