Barbiturates in Critical Care

[Vance]

I understand that barbiturates are neuroprotective in CNS/brain injury. Why don't I see their use, particularly when sedation is warranted? Instead, it's seems propofol and/or a benzodiazapine are used, without further consideration. Have barbiturates been retired from use in critical care? Thank you for your reply.

[mwbeah]

Caveat,

When reading articles (whole 'nother topic) and taking information from people, I would hope that everyone is like I am:

"Let me do some research on my own and see if what they said is true..."

Never take anything at face value, you will become a better practitioner if you "verify" that what your doing is the standard.

:) Mike

[hrtprncss]

Thank you, another HYPOTHETICAL situation....let's say you're in CT or for arguments sake let's just say MRI a place where the ICP has been elevated may it be from moving the patient and irritating the patient for some reason. Then your patient exhibits signs of herniations(this might be an extreme example) and the ICP shoots up and it won't come down. When medications are not readily available at hand, and you decide to manually bag the patient to decrease the ICP. Then do you recommend that when the patient goes back to the unit, to place that patient on a higher rate on the ventilator? as oppose to the original RR before you went down? Please keep in mind this is hypothetical and sometimes and not always, things are not within reach such as medications...

[mwbeah]

Thank you, another HYPOTHETICAL situation....let's say you're in CT or for arguments sake let's just say MRI a place where the ICP has been elevated may it be from moving the patient and irritating the patient for some reason. Then your patient exhibits signs of herniations(this might be an extreme example) and the ICP shoots up and it won't come down. When medications are not readily available at hand, and you decide to manually bag the patient to decrease the ICP. Then do you recommend that when the patient goes back to the unit, to place that patient on a higher rate on the ventilator? as oppose to the original RR before you went down? Please keep in mind this is hypothetical and sometimes and not always, things are not within reach such as medications...

Short term, hyperventilation has its place. I certainly would use it if I had nothing else (in the short term). But, I wouldn't take the CO2 too low (maybe 20-25).

Mike

[hrtprncss]

Thank you, thanks for the info and in regards to taking it face value, i was basically curious to know if there was deviations as to what the literature says compared to what's done in real settings as handled by other neuro RN's.

[Elenaster]

Are you implying...........?

Lets see, I work with propofol daily. When the BP drops, I believe that you turn the infusion down.....correct me if I am wrong..........

I am a Doctoral Neuroscience student.........I should know the formula..... (JK) :)

(One question, how can Right atrial pressure affect ICP?)

The CPP number which has been evidenced based is 70mmHg or above with injury:

Chan K H, Miller J D, Dearden N M, Andrews P J D & Midgley S. "The effects of changes in cerebral perfusion pressure upon middle cerebral artery blood flow velocity and jugular bulb venous oxygen saturation after severe brain trauma." J.Neurosurgery 1992; 77: 55- 61.

:)

I wasn't implying anything and my post certainly wasn't directed towards you. Just trying to add my perspective as an experienced neurosurgery nurse and educate those that are new or unfamiliar with that particular scenario.

Additionally, the propofol drip can be turned down, but if you're titrating to sedation and the sedative effects are not therapeutic when the MAP rises sufficiently to support ideal CPP, then it may be necessary to try an alternative drug for sedation.

Good luck with your Doctorate.

[gwenith, BSN, RN]

Thank-you everyone and we do have to remember that not everyone is posting from America or even a first world country. There are times when we will get questions from people who do not have access to "the latest and the best" but who are interested in what is being done elsewhere.

[SFRN]

Um, I am not a doctoral neuroscience student but if you had elevated Right atrial pressure--thus leading to JVD and back up of blood would it be implausible to assume a possibility of increased ICP?

Thoughts?

Are you implying...........?

Lets see, I work with propofol daily. When the BP drops, I believe that you turn the infusion down.....correct me if I am wrong..........

I am a Doctoral Neuroscience student.........I should know the formula..... (JK) :)

(One question, how can Right atrial pressure affect ICP?)

The CPP number which has been evidenced based is 70mmHg or above with injury:

Chan K H, Miller J D, Dearden N M, Andrews P J D & Midgley S. "The effects of changes in cerebral perfusion pressure upon middle cerebral artery blood flow velocity and jugular bulb venous oxygen saturation after severe brain trauma." J.Neurosurgery 1992; 77: 55- 61.

:)