Abstract
The effects and indications of barbiturate therapy for reduction of posttraumatic intracranial hypertension were investigated using an ultrashort acting barbiturate, thiamylal, in 48 severely head-injured patients, who showed initial intracranial pressure (ICP) of over 15 mmHg and could be monitored for at least 72 hours after admission. Two different kinds of barbiturate schedules and doses were used; mild barbiturate therapy (MBT) and advanced barbiturate therapy (ABT). In both schedules, the goal was to keep ICPs under 30 mmHg, as a rule. In 16 patients given MBT and in 13 given ABT, the ICPs were kept under 30 mmHg, but this level could not be achieved in 19. The mean initial ICPs for these three groups were 21 mmHg for MBT, 33 mmHg for ABT, and 52 mmHg for those who were not controlled. Although their initial ICP levels were widely scattered, there were no cases with initial ICPs of over 40 mmHg in which intracranial hypertension was controlled by either schedule. There were five unusual cases in the series. Three cases showed brain death, although their ICPs were kept under 30 mmHg. Two cases whose ICPs could not be controlled also showed brain death, even though their initial ICPs were comparatively low (under 30 mmHg). The main lesion in the former three cases was in the brain stem, and the latter two cases had an ischemic accident after trauma.
It is concluded that barbiturate therapy may provide a satisfactory effect reduction in posttraumatic intracranial hypertension for patients whose initial ICPs are under 40 mmHg and whose main lesion is neither a primary global ischemic lesion nor a brain-stem injury.
