title: Role of barbiturate coma in the management of focally induced, severe cerebral edema in children.
abstract: Barbiturates are widely used in the management of high intracranial pressure (ICP) caused by diffuse brain swelling. The cardiovascular, renal, and immunological side effects of these drugs limit them to last-line therapy. There are few published data regarding the role of barbiturates in focal brain lesions causing refractory elevated ICP and intraoperative brain swelling in the pediatric population. The authors here present 3 cases of nontraumatic, focally induced, refractory intracranial hypertension due to 2 tumors and 1 arteriovenous malformation, in which barbiturate therapy was used successfully to control elevated ICP. They focus on cardiovascular, renal, and immune function during the course of pentobarbital therapy. They also discuss the role of pentobarbital-induced hypothermia. From this short case series, they demonstrate that barbiturates in conjunction with standard medical therapy can be used to safely reduce postoperative refractory intracranial hypertension and intraoperative brain swelling in children with focal brain lesions.
authors: Section of Neurosurgery, University of Chicago, Illinois 60637, USA. nmonim@surgery.bsd.uchicago.edu
authors: Nassir
authors: N
authors: Mansour
authors: Ruth-Mary
authors: RM
authors: deSouza
authors: Christian
authors: C
authors: Sikorski
authors: Madelyn
authors: M
authors: Kahana
authors: David
authors: D
authors: Frim
mesh_terms: D001929:Brain Edema / Q000150:complications* / Q000209:etiology; D001932:Brain Neoplasms / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000139:chemically induced*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007036:Hypothermia, Induced / Q000379:methods; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D019586:Intracranial Hypertension / Q000188:drug therapy* / Q000209:etiology; D007427:Intracranial Pressure / Q000187:drug effects; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D010424:Pentobarbital / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D010424:Pentobarbital