J Korean Soc Transplant.  2012 Jun;26(2):120-124.

Use of Continuous Venovenous Hemodiafiltration to Enhance the Elimination of Serum Pentobarbital before Diagnosis of Brain Death

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea. sicuab@hotmail.com
  • 2Department of Pharmaceutical Service, Ajou University Hospital, Suwon, Korea.
  • 3Department of Neurology, Ajou University School of Medicine, Suwon, Korea.
  • 4Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea.

Abstract

Continuous venovenous hemodiafiltration (CVVHDF) was used to eliminate pentobarbital from the blood of a 30-year-old potentially brain dead male patient with traumatic intracranial hemorrhage after a motorcycle accident. The Acute Physiology and Chronic Health Evaluation (APACHE) II score of hospital day 1 was 24, but by day 8 it was 36, when the patient was considered to be brain dead. To control seizures and reduce intracranial pressure, pentobarbital had been administered in a continuous flow (2,880 mg/day for 5 days). Coma can be induced by pentobarbital at a serum level of 1~5 mg/dL. However, drug intoxication should be excluded from a brain death evaluation; therefore, the patient was not given any drug for approximately 88 hrs after ceasing pentobarbital in order for serum level to dip below 0.5 mg/dL (which is the hypnotic level). At 48 hours from CVVHDF, the pentobarbital level was close to the hypnotic level (0.1~0.5 mg/dL). Before stopping, the serum level of pentobarbital was 3.89 mg/dL and between 48 and 72 hours from CVVHDF, 4 cycles of pentobarbital half-life elimination (0.24 mg/dL) could be measured. Therefore, we suggest that in case of potential brain dead patients who have been administered pentobarbital, CVVHDF can enhance the elimination of pentobarbital from the circulatory system and shorten the waiting time for a brain death evaluation.

Keyword

Brain death; Pentobarbital; Continuous renal replacement therapy; Continuous venovenous hemodiafiltration

MeSH Terms

Adult
APACHE
Brain
Brain Death
Coma
Half-Life
Hemodiafiltration
Humans
Intracranial Hemorrhage, Traumatic
Intracranial Pressure
Male
Motorcycles
Pentobarbital
Seizures
Pentobarbital

Figure

  • Fig. 1 This figure shows sequence of serum pentobarbital levels from during pentobarbital infusion, before CVVHDF, and after CVVHDF time sequences. After 48 hours CVVHDF start the serum pentobarbital levels were down to hypnotic levels (0.1~0.5 mg/dL). Abbreviation: CVVHDF, continuous venovenous hemodiafiltration.


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