Efficacy of low dose barbiturate coma therapy for the patients with intractable intracranial hypertension using the bispectral index monitoring.
OBJECTIVE
Barbiturate coma therapy (BCT) is a useful method to control increased intracranial pressure (IICP) patients. However, the complications such as hypotension and hypokalemia have caused conditions that stopped BCT early. The complications of low dose BCT with Bispectral index (BIS) monitoring and those of high dose BCT without BIS monitoring have been compared to evaluate the efficacy of low dose BCT with BIS monitoring.


METHODS
We analyzed 39 patients with high dose BCT group (21 patients) and low dose BCT group (18 patients). Because BIS value of 40-60 is general anesthesia score, we have adjusted the target dose of thiopental to maintain the BIS score of 40-60. Therefore, dose of thiopental was kept 1.3 to 2.6 mg/kg/hour during low dose BCT. However, high dose BCT consisted of 5 mg/kg/hour without BIS monitoing.


RESULTS
The protocol of BCT was successful in 72.2% and 38.1% of low dose and high dose BCT groups, respectively. The complications such as QT prolongation, hypotension and cardiac arrest have caused conditions that stopped BCT early. Hypokalemia showed the highest incidence rate in complications of both BCT. The descent in potassium level were 0.63 +/- 0.26 in low dose group, and 1.31 +/- 0.48 in high dose group. The treatment durations were 4.89 +/- 1.68 days and 3.38 +/- 1.24 days in low dose BCT and high dose BCT, respectively.


CONCLUSIONS
It was proved that low dose BCT showed less severe complications than high dose BCT. Low dose BCT with BIS monitoring provided enough duration of BCT possible to control ICP.
An
Hung-Shik
HS
Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Cho
Byung-Moon
BM
Kang
Jeong-Han
JH
Kim
Moon-Kyu
MK
Oh
Sae-Moon
SM
Park
Se-Hyuck
SH
Can J Neurol Sci. 1984 Nov;11(4):434-40
6440704
Crit Care. 2007;11(5):R108
17897479
J Physiol. 2007 May 15;581(Pt 1):277-89
17331992
Neurol Clin. 2008 May;26(2):521-41, x
18514825
Resuscitation. 2001 Jan;48(1):77-90
11162885
J Neurosurg. 1988 Jul;69(1):15-23
3288723
AANA J. 2001 Dec;69(6):477-83
11837151
Pediatr Crit Care Med. 2003 Jul;4(3 Suppl):S49-52
12847349
J Neurosurg. 1985 Mar;62(3):383-8
3882899
Acta Anaesthesiol Scand Suppl. 1975;57:1-17
128981
J Crit Care. 2004 Sep;19(3):174-8
15484178
J Korean Neurosurg Soc. 2008 Sep;44(3):141-5
19096664
J Neurosurg. 1979 Jan;50(1):26-30
758375
Anesthesiology. 1999 Dec;91(6):1853-60
10598630
Ther Drug Monit. 2009 Apr;31(2):153-69
19177032
Int Arch Med. 2009 Jul 31;2(1):23
19646241