Influence of antemortem medication on the determination of brain death

Post-mortem concentration of pentobarbital in the blood and brain of two deceased neurosurgical patients was determined by gas chromatography/mass spectrometry. Patients treated with barbiturate for elevated intracranial pressure after head injury may incur brain death. In the present two cases of brain death a large amount of barbiturate remained in the brain, even when the blood concentration was not detectable, possibly because the blood flow was stagnant in the brain. It is suggested that a patient under barbiturate coma should be given serious consideration as to the determination of brain death, even if barbiturate is negative in the blood.