Clinical Comparison between Barbiturate and Propofol Coma Therapy in the Patients with Severe Traumatic Brain Injury

Objective: Barbiturates have been demonstrated to reduce intracranial pressure (ICP), but adverse effects, which include hypotension and a long recovery time, make clinical applications difficult. Propofol is also known to have same effect. In the present study, we undertook coma therapy using propofol or barbiturate and compared clinical value in the practical point. Methods: From June 2004 to April 2007, 38 patients with severe traumatic brain injury underwent thiopental or propofol coma therapy for the 3 days following neurosurgery. Seventeen patients were treated with thiopental (group A) and 21 patients with propofol (group B). Results: Mean doses were 6.1 mg/kg/hr of thiopental and 4.4 mg/kg/hr of propofol. In group A, mean bispectral indexes were 29.4 on day 1, 27.4 on day 2, and 26.0 on day 3, and in group B, 31.4 on day 1, 29.9 on day 2, and 27.8 on day 3. Mean ICP was 16.8 cm on day 1, 24.4 cm on day 2 and 15.1 cm on day 3 in group A, and 18.3 cm on day 1, 25.4 cm on day 2 and 18.0 cm on day 3 in group B. To maintain systemic normotentsion, dopamine was infused continuously at mean doses of 10.2 μg/kg/min in group A and 4.4 μg/kg/min in group B. Mean times to stationary state were 32.9 hours in group A and 6.6 hours in group B. Conclusion: The present study suggest that propofol coma therapy has less systemic hypotension and shorter time to stationary state than thiopental therapy for achieving the same depth of anesthesia and ICP-reducing effect. (J Kor Neurotraumatol Soc 2008;4:24-30)