Open AccessA novel step‐down infusion method of barbiturate therapy: Its safety and effectiveness for intracranial pressure control
Author(s) -
Yamakawa Yukako,
Morioka Motohiro,
Negoto Tetsuya,
Orito Kimihiko,
Yoshitomi Munetake,
Nakamura Yukihiko,
Takeshige Nobuyuki,
Yamamoto Masafumi,
Takeuchi Yasuharu,
Oda Kazutaka,
Jono Hirofumi,
Saito Hideyuki
Publication year - 2021
Publication title -
pharmacology research and perspectives
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.975
H-Index - 27
ISSN - 2052-1707
DOI - 10.1002/prp2.719
Subject(s) - thiamylal , medicine , intracranial pressure , anesthesia , glasgow coma scale , cerebral perfusion pressure , blood pressure , traumatic brain injury , cerebral blood flow , psychiatry
Intracranial pressure (ICP) has to be maintained quite constant, because increased ICP caused by cerebrovascular disease and head trauma is fatal. Although controlling ICP is clinically critical, only few therapeutic methods are currently available. Barbiturates, a group of sedative‐hypnotic drugs, are recognized as secondary treatment for controlling ICP. We proposed a novel “step‐down infusion” method, administrating barbiturate (thiamylal) after different time point from the start of treatment under normothermia, at doses of 3.0 (0–24 h), 2.0 (24–48 h), 1.5 (48–72 h), and 1.0 mg/kg/h (72–96 h), and evaluated its safety and effectiveness in clinical. In 22 patients with severe traumatic brain injury or severe cerebrovascular disease (Glasgow coma scale ≤8), thiamylal concentrations and ICP were monitored. The step‐down infusion method under normothermia maintained stable thiamylal concentrations (<26.1 µg/ml) without any abnormal accumulation/elevation, and could successfully keep ICP <20 mmHg (targeted management value: ICP <20 mmHg) in all patients. Moreover the mean value of cerebral perfusion pressure (CPP) was also maintained over 65 mmHg during all time course (targeted management value: CPP >65 mmHg), and no threatening changes in serum potassium or any hemodynamic instability were observed. Our novel “step‐down infusion” method under normothermia enabled to maintain stable, safe thiamylal concentrations to ensure both ICP reduction and CPP maintenance without any serious side effects, may provide a novel and clinically effective treatment option for patients with increased ICP.