martes, 12 de enero de 2016

Coma barbitúrico en neurocirugia / Barbiturate-induced coma in neurosurgery

Enero 12, 2016. No. 2204


 



Uso del coma barbitúrico inducido durante procedimientos neuroquirúrgicos cerebrovasculares. Un revisión de la literatura
The use of barbiturate-induced coma during cerebrovascular neurosurgery procedures: A review of the literature.
Ellens NR, Figueroa BE, Clark JC.
Brain Circ [serial online] 2015 [cited 2015 Dec 31];1:140-5. Available from: http://www.braincirculation.org/text.asp?2015/1/2/140/172887
Barbiturates are indicated for use during vascular neurosurgery procedures such as carotid surgery, arteriovenous malformation (AVM) surgery, cerebral aneurysm surgery, extracranial-intracranial bypass, and following significant bleeding due to AVMs or subarachnoid hemorrhage (SAH). These drugs are commonly used for their neuroprotective effects during focal cerebral ischemia and for their ability to treat intractable intracranial hypertension. Currently, thiopental and pentobarbital are the most frequently used barbiturates for these purposes, although methohexital and phenobarbital have been studied as well. Depending on the drug used and the desired effect, the dose administered may vary. Additionally, barbiturates are known to cause significant, severe side effects including depression of cardiac output, increased liver enzymes, increased risk of cardiac arrhythmia, lowered immune threshold, adversely affected brain temperature, systemic hypotension, and dyskalemia. For these reasons, these drugs should be monitored carefully and only used in circumstances of clear benefit. Finally, in order to evaluate barbiturates use during these procedures, information was gathered via an extensive PubMed literature review in addition to reviewing the resources of previous reviews on this topic or similar, relevant topics.
Keywords: Cerebroprotection, focal ischemia, intractable intracranial hypertension, neuroprotection, pentobarbital, thiopental
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