title: Pentobarbital sedation for patients in the pediatric intensive care unit.
abstract: We present our experience with pentobarbital for sedation during mechanical ventilation in six infants when fentanyl and midazolam failed. The patients ranged in age from 2 to 17 months and in weight from 3.0 to 11.4 kg. Before the switch to pentobarbital, the maximum doses of fentanyl ranged from 7 to 13 micrograms/kg/hr and the midazolam infusions, from 0.2 to 0.4 mg/kg/hr. Pentobarbital was administered as a bolus dose followed by a continuous infusion. The hourly infusion rates ranged from 1 to 4 mg/kg. Adequate sedation was achieved in all six patients. In the four patients who required neuromuscular blocking agents, their use was discontinued after pentobarbital was given. The antihypertensive agents (diazoxide and nitroprusside) required by the two patients receiving extracorporeal membrane oxygenation were also discontinued after pentobarbital administration. Although we continue to use fentanyl and benzodiazepines as first-line drugs for sedation, pentobarbital may be an effective alternative when these agents fail.
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, TN 37232.
authors.forename: J D
authors.initials: JD
authors.lastname: Tobias
authors.forename: J K
authors.initials: JK
authors.lastname: Deshpande
authors.forename: J B
authors.initials: JB
authors.lastname: Pietsch
authors.forename: T J
authors.initials: TJ
authors.lastname: Wheeler
authors.forename: D F
authors.initials: DF
authors.lastname: Gregory
mesh_terms: D000284:Administration, Oral; D016292:Procedural Sedation / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D004334:Drug Administration Schedule; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D015278:Intensive Care Units, Pediatric; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D010424:Pentobarbital / Q000008:administration & dosage / Q000627:therapeutic use*; D012121:Respiration, Artificial; D017211:Treatment Failure
chemical_list: D010424:Pentobarbital; D008874:Midazolam; D005283:Fentanyl