J Korean Neurotraumatol Soc.  2008 Jun;4(1):24-30. 10.13004/jknts.2008.4.1.24.

Clinical Comparison between Barbiturate and Propofol Coma Therapy in the Patients with Severe Traumatic Brain Injury

• Lee JI
• Kim YZ
• Kim JS
• Choi YC
• Kim KH

• KMID: 1814439
• DOI: http://doi.org/10.13004/jknts.2008.4.1.24

Abstract

OBJECTIVE
Barbiturates have been demonstrated to reduce intracranial pressure (ICP), but adverse effects, which include hypotension and a long recovery time, make clinical applications difficult. Propofol is also known to have same effect. In the present study, we undertook coma therapy using propofol or barbiturate and compared clinical value in the practical point.
METHODS
From June 2004 to April 2007, 38 patients with severe traumatic brain injury underwent thiopental or propofol coma therapy for the 3 days following neurosurgery. Seventeen patients were treated with thiopental (group A) and 21 patients with propofol (group B).
RESULTS
Mean doses were 6.1 mg/kg/hr of thiopental and 4.4 mg/kg/hr of propofol. In group A, mean bispectral indexes were 29.4 on day 1, 27.4 on day 2, and 26.0 on day 3, and in group B, 31.4 on day 1, 29.9 on day 2, and 27.8 on day 3. Mean ICP was 16.8 cm on day 1, 24.4 cm on day 2 and 15.1 cm on day 3 in group A, and 18.3 cm on day 1, 25.4 cm on day 2 and 18.0 cm on day 3 in group B. To maintain systemic normotentsion, dopamine was infused continuously at mean doses of 10.2 microg/kg/min in group A and 4.4 microg/kg/min in group B. Mean times to stationary state were 32.9 hours in group A and 6.6 hours in group B.
CONCLUSION
The present study suggest that propofol coma therapy has less systemic hypotension and shorter time to stationary state than thiopental therapy for achieving the same depth of anesthesia and ICP-reducing effect.

Keyword

Propofol; Barbiturate; Coma therapy; Bispectral index; Traumatic brain injury

MeSH Terms

Anesthesia
Barbiturates
Brain Injuries
Coma
Dopamine
Humans
Hypotension
Intracranial Pressure
Neurosurgery
Propofol
Thiopental
Barbiturates
Dopamine
Propofol
Thiopental

Figure

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  FIGURE 1 A 64-year-old woman visited emergency care unit with acute altered mentality after head trauma. A: At admission, precontrast computed tomographic (CT) image showed crescent-formed, high-density lesion on the left fronto-temporal area and midline shift to right side. B: After craniectomy and removal of hemorrhage, there was aggravated midline shift on the immediate postoperative CT scan. C: In order to titrate propofol dosage, burst-suppression pattern was confirmed by use of the portable EEG monitoring. D: BIS leads were placed on her forehead. E: BIS monitoring was started after titration of propofol dose. EEG: electroencephalography, BIS: bispectral index.

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