High-dose barbiturates for intracranial pressure control

Approximately 10% of severely head-injured patients will manifest elevated intracranial pressure uncontrollable by any currently known medical or surgical treatments, with a resulting mortality of > 90%. High-dose barbiturate therapy used in this setting has been shown to control intracranial pressure and reduce mortality in a small but definite number of patients. The pharmacologic, physiologic, and systemic effects of high-dose barbiturates must be fully appreciated, and appropriate clinical safeguards must be established when this therapy is implemented after severe head injury.