Weaning a patient from barbiturate-induced coma is a very complex medical procedure. An induced coma acts to protect the brain from further stress and damage caused by major neurosurgery or from status epilectus seizures that have been unresponsive to other treatments. The theory maintains that the barbiturates will decrease the flow of blood to the brain which will relieve the pressure and reduce the swelling thus allowing the brain to heal. Once the patient shows improvement in their condition, they are gradually weaned off the barbiturates and out of the medically induced coma.
- Skill level:
Familiarise yourself with the institution's medically induced coma protocol.
Review the medical history of the patient including the reason for which he was placed under a medically induced coma.
Note the amount and type or combination of medications used to induce and maintain the medically induced coma.
Consider the number of days or weeks the patient has been in the medically induced coma.
Review and compare the standard 24-lead electroencephalogram (EEG) results recorded throughout the patient's induced coma.
Review the patient's blood work to determine the current amount of barbiturates needed to keep the patient in a medically induced coma. Note that there is no standard therapeutic amount of barbiturates determined to maintain such a coma. Monitoring the patient's blood work works to avoid barbiturate toxicity.
Review the institution's protocol on weaning the patient out of a medically induced coma. Most patients are weaned out of a medically induced coma within weeks or months from the time it was induced. You can determine this by the patient's improvement in condition or if she shows signs of any adverse reactions.
Evaluate the patient for weaning readiness if you are the physician (only he may make this decision). Weaning the patient out of the medically induced coma means tapering the amount of barbiturates down slowly. A quick withdrawal of this kind of medication could have deadly consequences. Frequent blood tests will determine the amount of medication required, as per the institution's protocol.
Monitor the patient during the withdrawal period with frequent EEG's.
Return the patient to the medically induced coma if the acute signs such as intracranial pressure or seizure activity resume during the weaning period.
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