Continuous pentobarbital infusion in children is associated with high rates of complications.
OBJECTIVE
To evaluate the incidence and severity of complications related to continuous pentobarbital (PB) infusion for sedation in the Pediatric Intensive Care Unit (PICU).


METHODS
We conducted a retrospective, chart review study. All patients admitted to the PICU from January 1997 through June 1998 who received continuous IV PB infusion for sedation (n = 8) were included.


RESULTS
All patients were intubated and mechanically ventilated prior to PB infusion. PB was used only as a second line sedative after a combination of an opioid and benzodiazepine failed to achieve adequate sedation. After initiation of PB, we were able to decrease or discontinue benzodiazepines and/or opioid doses and discontinue neuromuscular blocking drugs in all patients. We observed a high incidence of complications (62.5%) related to PB or the phenobarbital treatment used for barbiturate weaning, including blood pressure instability (25%), oversedation (12.5%), drug reaction (12.5%) and neurologic sequelae (12.5%). Discontinuation of the drug was required in 25% of the cases.


CONCLUSIONS
We found continuous PB infusion to be an effective sedative for children when other drugs fail. However, we observed a high rate of clinically significant complications requiring discontinuation of the drug.
Yanay
Ofer
O
Department of Pediatrics, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle 98105, USA.
Brogan
Thomas V
TV
Martin
Lynn D
LD
D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007223:Infant; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D010424:Pentobarbital / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies
D006993:Hypnotics and Sedatives; D010424:Pentobarbital