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Related Experiment Videos

Barbiturate coma in severe hemispheric stroke: useful or obsolete?

S Schwab1, M Spranger, S Schwarz

  • 1Department of Neurology, University of Heidelberg, Germany.

Neurology
|June 1, 1997
PubMed
Summary

High-dose barbiturate coma therapy effectively lowers intracranial pressure (ICP) in severe stroke patients. However, this treatment offers no neurological benefit and is associated with severe side effects and high mortality.

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Area of Science:

  • Neurology
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Elevated intracranial pressure (ICP) is a critical concern in severe brain injury.
  • Barbiturates are used to manage ICP, but their efficacy and safety are debated due to potential side effects.
  • Severe middle cerebral artery (MCA) or hemispheric infarction can lead to significant brain edema and increased ICP.

Purpose of the Study:

  • To investigate the effect of high-dose barbiturate therapy on ICP and patient outcomes.
  • To evaluate the efficacy and safety of barbiturate coma in patients with severe ischemic stroke and elevated ICP.
  • To determine if barbiturate therapy improves neurological outcomes in this patient population.

Main Methods:

  • Sixty patients with critically increased ICP due to large hemispheric or MCA territory infarction were treated with thiopental-induced barbiturate coma.

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  • ICP was monitored throughout the therapy.
  • Barbiturate coma was initiated after standard ICP management protocols failed, including osmotherapy and hyperventilation.

    • Main Results:

    • Barbiturate infusion lowered ICP in 50 of 60 patients, but control was not always sustained.
    • Cerebral perfusion pressure (CPP) decreased by a mean of 9 mm Hg.
    • The survival rate was only 8% (5 out of 60 patients), with most deaths resulting from transtentorial herniation.
    • Severe side effects, including arterial hypotension, occurred in 25% of patients.

    Conclusions:

    • Barbiturate coma can effectively reduce critically elevated ICP levels in severe ischemic hemispheric stroke.
    • Despite initial ICP reduction, barbiturate therapy does not appear to positively impact neurological outcomes.
    • The high mortality and severe side effects associated with barbiturate coma warrant careful consideration in managing ICP in these patients.