Although not used as frequently as in the past, occasionally patients in the ICU are placed in a “pentobarb coma”, most commonly in cases of hepatic encephalopathy secondary to liver failure awaiting transplantation and traumatic brain injury. Most critical care services have developed their own protocols, but the following is a representative sample:
1. Prior to induction, obtain continuous arterial pressure monitoring and central hemodynamic monitoring. This is via invasive monitoring such as radial arterial line and Swan Ganz (pulmonary artery) cannula or using a non-invasive system such as the Cheetah product for central monitoring.
2. Place BIS monitor
3. Bolus/loading dose of 5-10 mg/kg/hr is given via slow IV push to avoid the hypertension seen with rapid administration.
4. Vital signs should be recorded q 30 minutes until the patient is hemodynamically stable
5. Maintenance dose varies by generally is 1-5 mg/kg/hr titrated for burst suppression.
6. Lab monitoring of serum levels vary but generally the blood sample is placed in a green top tube.