Abstract
The effect of pentobarbital therapy was studied prospectively in 31 nearly-drowned, severely comatose children in a flaccid state of coma who were randomized into two treatment groups. Group A: 16 children who received hypothermia (H) and i.v. pentobarbital (P) achieving serum levels 25 mcg/cc within 48 hours from admission. Group B: 15 children who received hypothermia but pentobarbital was completely excluded. All patients received “conventional therapy” (i.e., PaCO 20-25 torr, PaO 100 torr, fluid restriction pancuronium bromide, furosemide or mannitol). Analysis of variance failed to detect difference for age, estimated time of submersion, arterial pH, core temperature (T°), cerebral perfusion pressure (CPP) and mean intracranial pressure (ICP) among the patients prior to entering pentobarbital therapy.
In Group A, 6 patients (37%) had complete recovery (CR) and were neurologically intact, 6 patients (37%) had severe brain damage (BD) and 4 (25%) expired. In Group B, 6 children (40%) had CR, 6 (40%) survived with BD and 3 (20%) expired. Mortality rate, survival with BD and CR were not statistically different between the two groups (P > 0.05 by Chi square analysis).
The resull.s of this study support our previous claim that neurological outcome in nearly-drowned, flaccid comatose children is not influenced by pentobarbital therapy, and therefore, current practice of barbiturate therapy in this group of patients may not be justified. In addition, better outcome reported in the literature with pentobarbital combined with hypothermia regimen, may be attributed to the effect of hypothermia alone.
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Carlos, M., Eliezer, N. & Houchang, M. EFFECT OF PENTOBARBITAL THERAPY IN OUTCOME OF NEARLY DROWNED, FLACCID COMATOSE CHILDREN. Pediatr Res 21 (Suppl 4), 203 (1987). https://doi.org/10.1203/00006450-198704010-00222
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DOI: https://doi.org/10.1203/00006450-198704010-00222