In turn, the significant risk of causing hypotension-a factor known to be a harbinger of poor neurologic outcomes in patients with severe TBI-would offset any beneficial effect seen with ICP reduction. A meta-analysis by the Cochrane group noted that barbiturate infusion was associated with a fall in blood pressure in 25% of patients. 177Ī key side effect to consider prior to barbiturate administration is the potential to precipitate systemic hypotension. Maximal reductions in CBF and cerebral metabolism are seen when electrographic burst suppression of cerebral activity is achieved. 176 illustrated that in the setting of intractable intracranial hypertension, patients whose ICPs were responsive to barbiturate therapy had a significantly reduced mortality.īarbiturates such as pentobarbital are administered concomitant with continuous electroencephalogram monitoring in severe TBI patients with medically refractory intracranial hypertension. Although prophylactic use of barbiturates has no clinical benefit, 137, 175 Eisenberg et al. Studies investigating clinical outcomes in patients who received barbiturate therapy have been inconclusive. 172 The mechanism by which this reduction in ICP occurs is not entirely understood but likely involves mediating cerebral vasoconstriction, 173 reversibly reducing CMRO 2, 174 and preventing the onset of numerous excitatory neurotoxic cascades. The ability of barbiturates to lower ICP has been known since the 1930s. Alfredo Quiñones-Hinojosa MD, in Schmidek and Sweet: Operative Neurosurgical Techniques, 2022 Barbiturate-Induced Burst Suppression
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
January 2023
Categories |