Phenobarbital as Anticonvulsant Prophylaxis in Patients With Traumatic Brain Injury at Risk for Alcohol Withdrawal...

Area of Science:

• Neuroscience
• Pharmacology
• Critical Care Medicine

Background:

• Anticonvulsant prophylaxis (ACP) is standard for preventing early post-traumatic seizures (PTS) in traumatic brain injury (TBI) patients.
• Phenobarbital (PB) is utilized for alcohol withdrawal syndrome (AWS) prevention, presenting an opportunity for dual-purpose pharmacotherapy in TBI patients.

Purpose of the Study:

• To assess the incidence of early PTS in TBI patients at risk for AWS when treated with PB as primary ACP.
• To evaluate the rates of over sedation and endotracheal intubation associated with PB use in this population.

Main Methods:

• Patients received intravenous PB loading doses (15-20 mg/kg) followed by maintenance doses (1 mg/kg q12h) for seven days.
• Therapeutic drug monitoring aimed for PB levels of 15-20 mcg/mL.
• Data collected included medication details, seizure occurrences, and instances of over sedation and intubation.

Main Results:

• Of 39 analyzed patients, only one (2.6%) experienced electrographic evidence of early PTS.
• Phenobarbital was discontinued in 10.3% of patients due to concerns about over sedation.
• One patient required endotracheal intubation following rapid PB administration.

Conclusions:

• Phenobarbital demonstrated a low frequency of early PTS when used as primary ACP in TBI patients at risk for AWS.
• Over sedation emerged as a significant adverse effect, necessitating careful clinical judgment.
• The study could not establish the efficacy of PB in preventing AWS.