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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.

Southern Medical Journal
|March 1, 1995
PubMed

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.

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