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The University of Toronto Head Injury Treatment Study: A Prospective, Randomized Comparison of Pentobarbital and Mannitol

Published online by Cambridge University Press:  18 September 2015

Michael L. Schwartz ,
Charles H. Tator ,
David W. Rowed ,
S. Ross Reid ,
Kotoo Meguro  and
David F. Andrews
Michael L. Schwartz*
Affiliation:
the Division of Neurosurgery, Department of Surgery and the Department of Anesthesia, Sunnybrook Medical Centre, Toronto, and the Department of Preventive Medicine and Biostatistics, University of Toronto
Charles H. Tator
Affiliation:
the Division of Neurosurgery, Department of Surgery and the Department of Anesthesia, Sunnybrook Medical Centre, Toronto, and the Department of Preventive Medicine and Biostatistics, University of Toronto
David W. Rowed
Affiliation:
the Division of Neurosurgery, Department of Surgery and the Department of Anesthesia, Sunnybrook Medical Centre, Toronto, and the Department of Preventive Medicine and Biostatistics, University of Toronto
S. Ross Reid
Affiliation:
the Division of Neurosurgery, Department of Surgery and the Department of Anesthesia, Sunnybrook Medical Centre, Toronto, and the Department of Preventive Medicine and Biostatistics, University of Toronto
Kotoo Meguro
Affiliation:
the Division of Neurosurgery, Department of Surgery and the Department of Anesthesia, Sunnybrook Medical Centre, Toronto, and the Department of Preventive Medicine and Biostatistics, University of Toronto
David F. Andrews
Affiliation:
the Division of Neurosurgery, Department of Surgery and the Department of Anesthesia, Sunnybrook Medical Centre, Toronto, and the Department of Preventive Medicine and Biostatistics, University of Toronto
*
Sunnybrook Medical Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5
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Abstract

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Fifty-nine patients were treated in a prospective, randomized comparison of pentobarbital and mannitol for the control of intracranial hypertension resulting from head injury. Patients with elevated intracranial pressure (ICP) after evacuation of intracranial hematomas were randomized to one of two treatment groups; mannitol initially or pentobarbital initially, followed by the second drug as required by further elevation of ICP. Similarly, patients with raised ICP but without hematomas requiring evacuation were randomly assigned to two treatment groups in an identical paradigm.

Those with ICP elevation and no hematoma treated with pentobarbital as initial therapy had a 77% mortality compared to a 41% mortality for those with mannitol as initial treatment. Patients with evacuated hematomas had mortalities of 40% and 43% (no significant difference) for pentobarbital and mannitol respectively. In both no-hematoma and hematoma streams pentobarbital was less effective than mannitol for control of raised ICP.

Multivariate statistical analysis indicates that pentobarbital coma is not better than mannitol for the treatment of intracranial hypertension and may be harmful in no-hematoma patients with intracranial hypertension after head injury.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 11 , Issue 4 , November 1984 , pp. 434 - 440
Copyright
Copyright © Canadian Neurological Sciences Federation 1984

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