A Fatal Adverse Effect of Barbiturate Coma Therapy: Dyskalemia

Kwon, Hyun Mook; Baek, Jin Wook; Lee, Sang Pyung; Cho, Jae Ik

doi:10.13004/kjnt.2016.12.2.156

Cited by 7 publications

(2 citation statements)

References 8 publications

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“…Other studies have shown that PCT causes serious side effects such as hepatic and renal dysfunction, systemic hypotension, immunosuppressive hypokalemia, and rebound hyperkalemia 5) . RCT in 1985 by Ward et al showed hypotension was observed in 54% patients with PCT, which was higher than that in the control group (7%, p < 0.001) 6) .…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Complications of Pentothal Coma Therapy and Targeted Temperature Management in Traumatic Brain Injury Patients

Lee

Kim

Park

2022

J Neurointensive Care

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BackgroundPentothal coma therapy (PCT) and targeted temperature management (TTM) are considered the most aggressive medical care for patients with severe traumatic brain injury (TBI). However, there is very little comparison between these two options. We compared the survival rates and complications between the two treatments.MethodsNineteen patients who received treatment for PCT or TTM after severe TBI between March 2018 and April 2022 were retrospectively enrolled. Medical records were reviewed, including general information, neurologic status, treatment courses, survival rate, and complications. Patients were divided into two groups according to the treatment modalities (PCT vs. TTM), and comparison analyses were conducted.ResultsThe survival rate in the TTM group was 33.3% (3/9), which was higher than that in the PCT group (1/10, 10%). However, this difference was not significant (p = 0.213). In terms of complications, there were no statistically significant differences in hemodynamic instability, cardiovascular disability, hepatic dysfunction, renal dysfunction, pneumonia, urinary tract infection, hyperkalemia, hypokalemia, coagulopathy, or hyperglycemia. Commonly observed complications included hypokalemia in the TTM group (100% in the TTM group vs 70% in the PCT group; p = 0.073) and hyperkalemia in the PCT group (50% in the PCT group vs 11.1% in the TTM group; p = 0.069).ConclusionSevere TBI patients treated with TTM has non-significantly lower mortality than them with PCT (66.7% vs. 90%); however, complications of hypokalemia can be frequently observed (100%). Further study was necessary to evaluate the efficacy and safety of TTM.

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Section: Discussionmentioning

confidence: 99%

Comparison Between Complications of Pentothal Coma Therapy and Targeted Temperature Management in Traumatic Brain Injury Patients

Lee

Kim

Park

2022

J Neurointensive Care

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“…Complications of BCT include hypotension, hepatic or renal dysfunction, respiratory depression, and rarely, severe refractory hypokalemia with a subsequent hyperkalemia after stopping BCT. The loss of neurologic examination entails relying on ICP, hemodynamic readings, and electroencephalography (EEG) monitoring to guide therapy [26,27].…”

Section: Pressure (Cpp) By the Cerebrovascular Resistance (Cvr) As Pe...mentioning

confidence: 99%

Intracranial emergencies in neurosurgical oncology: pathophysiology and clinical management

Faraj

Snyder²,

McCutcheon³

2022

Emerg Cancer Care

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Intracranial tumors pose a challenge in neurosurgery, especially when patients present emergently or require emergency surgery. Tackling an acute change in the patient’s mental status is the primary reason for seeking an emergency surgery in the setting of an intracranial tumor. In addressing tumor-related complications, the aim of surgery is to relieve elevated intracranial pressure (ICP), confirm a diagnosis, improve or stabilize function, and extend the patient’s life by preventing herniation.Tumors and peritumoral edema form a space-occupying lesion that causes mass effect on nearby structures and elevates ICP. Surgical management involves (1) external ventricular drain (EVD) placement to monitor ICP, lower the volume of cerebrospinal fluid (CSF), and temporarily treat intracranial hypertension, (2) resection of the space-occupying mass responsible for the rise in ICP, and (3) in some patients, decompressive craniectomy (DC). Patients with brain tumors may also present with hydrocephalus due to the tumor’s obstructing CSF flow or disrupting CSF absorption. Tumors also cause tumor-associated epilepsy (TAE) and status epilepticus (TASE). TASE is a life-threatening condition characterized by an abnormally prolonged generalized seizure (or a chain of multiple seizures) without recovery of consciousness to baseline. Time is of the essence when managing TAE and TASE, and surgical resection of the tumor-associated epileptogenic focus can be curative. Brain tumors and their treatment can also provoke ischemic stroke, intratumoral hemorrhage, and cerebral venous sinus thrombosis depending on their location. Hemorrhagic infarction of pituitary adenomas leading to rapid expansion of the sellar region and acute pituitary gland dysfunction is known as pituitary apoplexy. Here, optimizing the patient’s hemodynamic status and treating adrenal insufficiency are crucial upon presentation. Emergency surgical resection plays an important role in saving nearby neurovascular entities when conservative treatment proves inadequate. Finally, infections of the central nervous system (CNS) occur as a result of immunologic compromise caused by the tumor itself or by its treatment.In conclusion, in severe and rapidly progressing cases in which the patient presents with altered mental status and neurologic deficits, an emergency neurosurgical procedure is indicated for removal of the cause(s) of the excess ICP, protection of brain function, and monitoring of ICP.

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