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Continuous pentobarbital infusion in children is associated with high rates of complications

Ofer Yanay1, Thomas V Brogan, Lynn D Martin

  • 1Department of Pediatrics, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle 98105, USA.

Journal of Critical Care
|October 16, 2004
PubMed

Insights

Continuous pentobarbital (PB) infusion effectively sedates pediatric intensive care unit (PICU) patients when other sedatives fail. However, this barbiturate carries a high risk of significant complications, often necessitating drug discontinuation.

Area of Science:

  • Pediatric critical care medicine
  • Pharmacology
  • Neuroscience

Background:

  • Continuous intravenous pentobarbital (PB) infusion is utilized for sedation in pediatric intensive care units (PICUs).
  • PB is typically reserved as a second-line agent when standard sedatives prove insufficient.

Purpose of the Study:

  • To assess the frequency and severity of complications associated with continuous pentobarbital infusion for sedation in the PICU.
  • Evaluate the efficacy and safety of pentobarbital in pediatric patients requiring intensive care.

Main Methods:

  • Retrospective chart review of patients admitted to the PICU between January 1997 and June 1998.
  • Inclusion criteria: patients receiving continuous intravenous PB infusion for sedation (n=8).

Main Results:

  • Pentobarbital facilitated reduction or cessation of benzodiazepines/opioids and discontinuation of neuromuscular blocking agents in all patients.
  • A high incidence of complications (62.5%) was observed, including blood pressure instability, oversedation, drug reactions, and neurologic sequelae.
  • Drug discontinuation due to complications was required in 25% of cases.

Conclusions:

  • Continuous pentobarbital infusion is an effective sedative option for pediatric patients refractory to other agents.
  • Clinically significant complications are frequent, often mandating the cessation of pentobarbital therapy.
Abstract

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