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A novel step‐down infusion method of barbiturate therapy: Its safety and effectiveness for intracranial pressure control

Intracranial pressure (ICP) has to be maintained quite constant, because increased ICP caused by cerebrovascular disease and head trauma is fatal. Although controlling ICP is clinically critical, only few therapeutic methods are currently available. Barbiturates, a group of sedative‐hypnotic drugs,...

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Autores principales: Yamakawa, Yukako, Morioka, Motohiro, Negoto, Tetsuya, Orito, Kimihiko, Yoshitomi, Munetake, Nakamura, Yukihiko, Takeshige, Nobuyuki, Yamamoto, Masafumi, Takeuchi, Yasuharu, Oda, Kazutaka, Jono, Hirofumi, Saito, Hideyuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899213/
https://www.ncbi.nlm.nih.gov/pubmed/33617150
http://dx.doi.org/10.1002/prp2.719
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author Yamakawa, Yukako
Morioka, Motohiro
Negoto, Tetsuya
Orito, Kimihiko
Yoshitomi, Munetake
Nakamura, Yukihiko
Takeshige, Nobuyuki
Yamamoto, Masafumi
Takeuchi, Yasuharu
Oda, Kazutaka
Jono, Hirofumi
Saito, Hideyuki
author_facet Yamakawa, Yukako
Morioka, Motohiro
Negoto, Tetsuya
Orito, Kimihiko
Yoshitomi, Munetake
Nakamura, Yukihiko
Takeshige, Nobuyuki
Yamamoto, Masafumi
Takeuchi, Yasuharu
Oda, Kazutaka
Jono, Hirofumi
Saito, Hideyuki
author_sort Yamakawa, Yukako
collection PubMed
description Intracranial pressure (ICP) has to be maintained quite constant, because increased ICP caused by cerebrovascular disease and head trauma is fatal. Although controlling ICP is clinically critical, only few therapeutic methods are currently available. Barbiturates, a group of sedative‐hypnotic drugs, are recognized as secondary treatment for controlling ICP. We proposed a novel “step‐down infusion” method, administrating barbiturate (thiamylal) after different time point from the start of treatment under normothermia, at doses of 3.0 (0–24 h), 2.0 (24–48 h), 1.5 (48–72 h), and 1.0 mg/kg/h (72–96 h), and evaluated its safety and effectiveness in clinical. In 22 patients with severe traumatic brain injury or severe cerebrovascular disease (Glasgow coma scale ≤8), thiamylal concentrations and ICP were monitored. The step‐down infusion method under normothermia maintained stable thiamylal concentrations (<26.1 µg/ml) without any abnormal accumulation/elevation, and could successfully keep ICP <20 mmHg (targeted management value: ICP <20 mmHg) in all patients. Moreover the mean value of cerebral perfusion pressure (CPP) was also maintained over 65 mmHg during all time course (targeted management value: CPP >65 mmHg), and no threatening changes in serum potassium or any hemodynamic instability were observed. Our novel “step‐down infusion” method under normothermia enabled to maintain stable, safe thiamylal concentrations to ensure both ICP reduction and CPP maintenance without any serious side effects, may provide a novel and clinically effective treatment option for patients with increased ICP.
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spelling pubmed-78992132021-02-23 A novel step‐down infusion method of barbiturate therapy: Its safety and effectiveness for intracranial pressure control Yamakawa, Yukako Morioka, Motohiro Negoto, Tetsuya Orito, Kimihiko Yoshitomi, Munetake Nakamura, Yukihiko Takeshige, Nobuyuki Yamamoto, Masafumi Takeuchi, Yasuharu Oda, Kazutaka Jono, Hirofumi Saito, Hideyuki Pharmacol Res Perspect Original Articles Intracranial pressure (ICP) has to be maintained quite constant, because increased ICP caused by cerebrovascular disease and head trauma is fatal. Although controlling ICP is clinically critical, only few therapeutic methods are currently available. Barbiturates, a group of sedative‐hypnotic drugs, are recognized as secondary treatment for controlling ICP. We proposed a novel “step‐down infusion” method, administrating barbiturate (thiamylal) after different time point from the start of treatment under normothermia, at doses of 3.0 (0–24 h), 2.0 (24–48 h), 1.5 (48–72 h), and 1.0 mg/kg/h (72–96 h), and evaluated its safety and effectiveness in clinical. In 22 patients with severe traumatic brain injury or severe cerebrovascular disease (Glasgow coma scale ≤8), thiamylal concentrations and ICP were monitored. The step‐down infusion method under normothermia maintained stable thiamylal concentrations (<26.1 µg/ml) without any abnormal accumulation/elevation, and could successfully keep ICP <20 mmHg (targeted management value: ICP <20 mmHg) in all patients. Moreover the mean value of cerebral perfusion pressure (CPP) was also maintained over 65 mmHg during all time course (targeted management value: CPP >65 mmHg), and no threatening changes in serum potassium or any hemodynamic instability were observed. Our novel “step‐down infusion” method under normothermia enabled to maintain stable, safe thiamylal concentrations to ensure both ICP reduction and CPP maintenance without any serious side effects, may provide a novel and clinically effective treatment option for patients with increased ICP. John Wiley and Sons Inc. 2021-02-22 /pmc/articles/PMC7899213/ /pubmed/33617150 http://dx.doi.org/10.1002/prp2.719 Text en © 2021 The Authors. Pharmacology Research & Perspectives published by John Wiley & Sons Ltd, British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Yamakawa, Yukako
Morioka, Motohiro
Negoto, Tetsuya
Orito, Kimihiko
Yoshitomi, Munetake
Nakamura, Yukihiko
Takeshige, Nobuyuki
Yamamoto, Masafumi
Takeuchi, Yasuharu
Oda, Kazutaka
Jono, Hirofumi
Saito, Hideyuki
A novel step‐down infusion method of barbiturate therapy: Its safety and effectiveness for intracranial pressure control
title A novel step‐down infusion method of barbiturate therapy: Its safety and effectiveness for intracranial pressure control
title_full A novel step‐down infusion method of barbiturate therapy: Its safety and effectiveness for intracranial pressure control
title_fullStr A novel step‐down infusion method of barbiturate therapy: Its safety and effectiveness for intracranial pressure control
title_full_unstemmed A novel step‐down infusion method of barbiturate therapy: Its safety and effectiveness for intracranial pressure control
title_short A novel step‐down infusion method of barbiturate therapy: Its safety and effectiveness for intracranial pressure control
title_sort novel step‐down infusion method of barbiturate therapy: its safety and effectiveness for intracranial pressure control
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899213/
https://www.ncbi.nlm.nih.gov/pubmed/33617150
http://dx.doi.org/10.1002/prp2.719
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