{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T04:10:06Z","timestamp":1777435806139,"version":"3.51.4"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2013,7]]},"abstract":"<jats:p>Barbiturates are widely used in the management of high intracranial pressure (ICP) caused by diffuse brain swelling. The cardiovascular, renal, and immunological side effects of these drugs limit them to last-line therapy. There are few published data regarding the role of barbiturates in focal brain lesions causing refractory elevated ICP and intraoperative brain swelling in the pediatric population. The authors here present 3 cases of nontraumatic, focally induced, refractory intracranial hypertension due to 2 tumors and 1 arteriovenous malformation, in which barbiturate therapy was used successfully to control elevated ICP. They focus on cardiovascular, renal, and immune function during the course of pentobarbital therapy. They also discuss the role of pentobarbital-induced hypothermia. From this short case series, they demonstrate that barbiturates in conjunction with standard medical therapy can be used to safely reduce postoperative refractory intracranial hypertension and intraoperative brain swelling in children with focal brain lesions.<\/jats:p>","DOI":"10.3171\/2013.3.peds12196","type":"journal-article","created":{"date-parts":[[2013,5,3]],"date-time":"2013-05-03T14:23:52Z","timestamp":1367591032000},"page":"37-43","source":"Crossref","is-referenced-by-count":6,"title":["Role of barbiturate coma in the management of focally induced, severe cerebral edema in children"],"prefix":"10.3171","volume":"12","author":[{"given":"Nassir","family":"Mansour","sequence":"first","affiliation":[{"name":"Section of Neurosurgery, University of Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth-Mary","family":"deSouza","sequence":"additional","affiliation":[{"name":"King's College Hospital, London, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Sikorski","sequence":"additional","affiliation":[{"name":"Lake Michigan Neurological Surgery, Saint Joseph, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madelyn","family":"Kahana","sequence":"additional","affiliation":[{"name":"Pediatrics Department, Stanford University, Palo Alto, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Frim","sequence":"additional","affiliation":[{"name":"Section of Neurosurgery, University of Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-peds12196","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1227\/01.NEU.0000156471.50726.26","article-title":"Phase II clinical trial of moderate hypothermia after severe traumatic brain injury in children","volume":"56","author":"Adelson","year":"2005"},{"key":"b2-peds12196","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1227\/00006123-198505000-00013","article-title":"Arteriovenous malformation in the territory of the occluded middle cerebral artery with massive intraoperative brain swelling: case report","volume":"16","author":"Aoki","year":"1985"},{"key":"b3-peds12196","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1227\/01.NEU.0000327882.10629.06","article-title":"Barbiturate infusion for intractable intracranial hypertension and its effect on brain oxygenation","volume":"63","author":"Chen","year":"2008"},{"key":"b4-peds12196","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1089\/neu.1999.16.927","article-title":"Cerebral hemodynamic effects of pentobarbital coma in head-injured patients","volume":"16","author":"Cormio","year":"1999"},{"key":"b5-peds12196","series-title":"Acta Physiol Scand Suppl","first-page":"91","article-title":"The free radical pathology and the microcirculation in the major central nervous system disorders","volume":"492","author":"Demopoulos","year":"1980"},{"key":"b6-peds12196","series-title":"Infection","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1007\/BF01704886","article-title":"Dose-dependent rate of nosocomial pulmonary infection in mechanically ventilated patients with brain oedema receiving barbiturates: a prospective case study","volume":"20","author":"Eberhardt","year":"1992"},{"key":"b7-peds12196","series-title":"J Pediatr","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1016\/S0022-3476(82)80782-8","article-title":"Outcome in severe Reye syndrome with early pentobarbital coma and hypothermia","volume":"100","author":"Frewen","year":"1982"},{"key":"b8-peds12196","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1080\/01616412.2000.11740726","article-title":"Extensive subdural empyema treated with drainage and barbiturate therapy under intracranial pressure monitoring: case report","volume":"22","author":"Kageyama","year":"2000"},{"key":"b9-peds12196","series-title":"Anesthesiology","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1097\/00000542-198910000-00016","article-title":"A comparison of the effects of halothane, isoflurane, and pentobarbital anesthesia on intracranial pressure and cerebral edema formation following brain injury in rabbits","volume":"71","author":"Kaieda","year":"1989"},{"key":"b10-peds12196","series-title":"Pediatr Neurosci","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1159\/000120397","article-title":"Aggressive physiologic monitoring of pediatric head trauma patients with elevated intracranial pressure","volume":"14","author":"Kasoff","year":"1988"},{"key":"b11-peds12196","series-title":"Curr Opin Pediatr","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1097\/MOP.0b013e3283460584","article-title":"Protecting the future: neuroprotective strategies in the pediatric intensive care unit","volume":"23","author":"Koch","year":"2011"},{"key":"b12-peds12196","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1056\/NEJM199702203360803","article-title":"Treatment of traumatic brain injury with moderate hypothermia","volume":"336","author":"Marion","year":"1997"},{"key":"b13-peds12196","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1227\/00006123-198310000-00011","article-title":"Treatment of massive intraoperative brain swelling","volume":"13","author":"Marshall","year":"1983"},{"key":"b14-peds12196","series-title":"Crit Care Med","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00003246-197801000-00001","article-title":"Pentobarbital therapy for intracranial hypertension in metabolic coma. 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