Related Experiment Videos
Pentobarbital sedation for patients in the pediatric intensive care unit
J D Tobias1, J K Deshpande, J B Pietsch
1Department of Anesthesiology, Vanderbilt University, Nashville, TN 37232.
Insights
Pentobarbital effectively sedated infants on mechanical ventilation when fentanyl and midazolam failed. This barbiturate offered adequate sedation, reducing the need for neuromuscular blockers and antihypertensives.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Anesthesiology
Background:
- Fentanyl and midazolam are first-line agents for sedation in infants requiring mechanical ventilation.
- Refractory cases may necessitate alternative sedative strategies.
Observation:
- Pentobarbital was administered to six infants (2-17 months) with inadequate sedation on fentanyl and midazolam.
- Patients received pentobarbital as a bolus followed by infusion (1-4 mg/kg/hr).
Findings:
- Adequate sedation was achieved in all six infants.
- Neuromuscular blocking agents were discontinued in four patients.
- Antihypertensive agents were discontinued in two patients on extracorporeal membrane oxygenation.
Implications:
- Pentobarbital serves as a viable alternative sedative when standard agents fail in critically ill infants.
- This approach may reduce the need for adjunctive therapies like neuromuscular blockers and antihypertensives.
- Further research into pentobarbital's role in pediatric sedation is warranted.
Abstract:
We present our experience with pentobarbital for sedation during mechanical ventilation in six infants when fentanyl and midazolam failed. The patients ranged in age from 2 to 17 months and in weight from 3.0 to 11.4 kg. Before the switch to pentobarbital, the maximum doses of fentanyl ranged from 7 to 13 micrograms/kg/hr and the midazolam infusions, from 0.2 to 0.4 mg/kg/hr. Pentobarbital was administered as a bolus dose followed by a continuous infusion. The hourly infusion rates ranged from 1 to 4 mg/kg. Adequate sedation was achieved in all six patients. In the four patients who required neuromuscular blocking agents, their use was discontinued after pentobarbital was given. The antihypertensive agents (diazoxide and nitroprusside) required by the two patients receiving extracorporeal membrane oxygenation were also discontinued after pentobarbital administration. Although we continue to use fentanyl and benzodiazepines as first-line drugs for sedation, pentobarbital may be an effective alternative when these agents fail.