Pentobarbital Treatment Guidelines for Severe Traumatic Brain Injury

This article discusses the use of pentobarbital in the management of severe traumatic brain injury. Pentobarbital is an anesthetic used to induce coma in patients with severe TBI. It should be used in conjunction with therapeutic hypothermia if ICP is above 25 mmHg. The primary endpoints of the study were mortality and a good outcome score (GOS), a measure of recovery. Secondary endpoints included length of hospitalization, need for vasopressors, and decompressive surgery.

Acute toxicity of Pentobarbital requires supportive care. If not administered properly, it may lead to respiratory failure, cardiovascular collapse, and coma. In severe cases, intubation and hemodynamic support are required. Activated charcoal is sometimes used to relieve the symptoms of pentobarbital toxicity. In milder cases, alkaline diuresis may be added. Patients with renal impairment may need special care while taking pentobarbital.

The initial dose of pentobarbital is administered in the ICU before connecting the patient's EEG. The patient is then placed in therapeutic hypothermia with an Artic Sun cooling blanket. This blanket reduces the temperature to 33 degrees Celsius (degC) for 24 hours. In this setting, blood cultures and a complete metabolic panel were collected every six hours. Once the pentobarbital-induced coma is completed, the patient's temperature should be returned to normal.

In adults, toxic doses of pentobarbital are approximately 1 gram. A toxic dose can cause death. The therapeutic dose for pentobarbital varies. Therapeutic values range from 1 to 5 mcg/mL to 30 to 40 mcg/mL. Adults typically require three to six days to reach steady-state. Monitoring parameters include electroencephalogram, complete blood count, and liver function tests.

Continuous treatment is also assessed by measuring the ratio of blood urea nitrogen to creatinine.

The duration of a barbiturate-induced coma is unknown, but the recommended duration ranges from four to 72 hours. In general, patients should be on two other anticonvulsants before withdrawal of pentobarbital. The optimal duration for the withdrawal of pentobarbital should be determined based on the patient's ICP after eight hours of therapy. This is a standard protocol, but there are some exceptions.

Although there is no standard dose for pentobarbital sodium injection, many physicians use the NEMBUTAL Sodium Solution (Nembutal) intravenously to induce sedation. NEMBUTAL Sodium Solution is available in two forms: intravenous and oral. The NEMBUTAL Sodium Solution is soluble in water but insoluble in alcohol and benzene. Injections of pentobarbital sodium are often given in increments of two to six mg per kilogram.

In an attempt to decrease the risk of recurrent seizures, pentobarbital is used as a pre-anesthetic in the operating room. It lowers intracranial pressure, reduces cerebral blood flow, and inhibits neuroexcitotoxicity. Prophylactic pentobarbital use is not recommended, as it has been associated with severe hypotension. This drug should not be used without the consent of a physician.