Abstract
The barbiturate-induced coma has been studied experimentally and used clinically to protect the brain from the various damages. In the present clinical study, barbiturate was used in five patients with severe head injury and eleven patients with severe cerebro vascular diseases.
The therapy was started with intravenous infusion of 500-1000mg (15mg/kg) of thiamylal, then the continuous intravenous administration of 5mg/kg/hr thiamylal was carried out. Depth of induced coma was maintained at the level of burst and suppression pattern on EEG. High-dose barbiturate therapy was continued in all patients for at least 72 hours, and mannitol and steroids were continued in patients under controlled respiration and circulatory monitoring. Four of the five patients with severe head injury returned to a productive life and one remained moderately disabled. Two of the six patients with ruptured aneurysm, who fell under the clinical grade of IV or V by Hunt and Kosnik, returned to a productive life, one was severely disabled and three died. One of the two patients with arteriovenous malformation became excellent and the other died. One of the two patients with cerebellar hematoma and a patient with pontine hemorrhage returned to a productive life.
Barbiturates were useful in the treatment of uncontrolled intracranial hypertension and severely brain-injured patients, but dosage, indication and duration of administration were clinically not clear. The use of high-dose barbiturate was suggested as an indication for patients who were unresponsive to other forms of therapy
