Long-term barbiturate infusion to reduce intracranial pressure

Area of Science:

• Pediatric Neurology
• Critical Care Medicine
• Neurosurgery

Background:

• Intracranial hypertension (ICH) poses a significant management challenge in pediatric neurosurgery.
• Conventional therapies often fail to adequately reduce elevated intracranial pressure following complex procedures or trauma.
• Alternative, aggressive treatment strategies are crucial for improving outcomes in severe ICH cases.

Observation:

• Two pediatric patients, aged 7 and 14 years, presented with severe intracranial hypertension.
• ICH occurred post-tumor resection in one case and following severe trauma in the other.
• Previous treatments for ICH had proven ineffective in both children.

Findings:

• Prolonged intravenous infusion of thiopental sodium (TS) was administered to both patients.
• TS was given at high doses (up to 7 mg/kg/h for 8 days and 12 mg/kg/h for 10 days).
• Both children regained consciousness and demonstrated substantial improvement in neurological function.

Implications:

• High-dose, prolonged thiopental sodium infusion can be a viable rescue therapy for refractory pediatric intracranial hypertension.
• Careful monitoring for side effects is essential during extended TS administration.
• This approach may offer a critical treatment option for pediatric neurocritical care patients with severe ICH.