Artificial coma

term "induced coma" is not entirely correct, it is better to use the term "artificial sedation."In this condition, the patient is unconscious, he has a reaction to stimuli, including pain, the tendon reflexes are preserved. For the introduction of artificial coma, as a rule, drugs from the barbiturate group - phenobarbital, sodium oxybutyrate, sodium thiopental are used. Why enter into an artificial coma? To protect the brain with neurosurgical interventions, with severe trauma to the skull, with epileptic status( not copied in other ways).

The mechanism of development of barbiturate-induced artificial coma

How to inject into artificial coma? Intravenously injected funds from the barbiturate group. Barbiturates have a protective effect on neurons: they reduce the metabolic activity of the brain, significantly reduce its need for oxygen, glucose, reduce edema-swelling( by reducing blood flow), reduce intracranial pressure. As a result, the probability of development of ischemia and necrosis of the parenchyma of the brain is significantly reduced, which allows the patient to avoid( or at least reduce the probability of their occurrence) paresis, paralysis after trauma, brain surgery.

Medicinal substances( barbiturates) interact with benzodiazepine receptors-berbituratnymi( portion of barbiturate), significantly improving the sensitivity of receptors to neurotransmitters( gamma-aminobutyric acid, GABA).As a result, the excitability of the cell membrane decreases, the transfer of impulses between neurons is inhibited - there is a state of sedation, sleep, coma( depending on the dose and interaction with other drugs).The course of cerebral coma: characteristic features.

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Control of vital signs with "artificial coma»

basic patient vital signs to be monitored when administered into an artificial coma( after surgery, after trauma, etc...):

1. Blood pressure( requires constant monitoring of blood pressure - in patients who areOn infusions of dopamine - hourly, at others - three times a day( at least). Critical decrease in blood pressure - a sign of deep coma, extremely unfavorable condition.
2. Respiratory rateix NPV may be due to hypercapnia), respiratory disorders indicates that that coma becomes deeper suffering brain stem is also necessary to pay attention to the presence of pathological types of breathing( eg, Cheyne-Stokes -.. it's also a sign of unfavorable course of an artificial coma, destruction of brain
3. The level of oxygenation of the blood( a decrease in the oxygen saturation of the blood - an indicator of insufficiency of independent breathing and a direct indication for the transfer to mechanical ventilation).The level of carbon dioxide( hypercapnia - a sign of inefficiency of respiration) is also monitored.
4. Control over depth coma( do not allow the development of deep, and furthermore, the terminal coma) - must constantly monitor the patient's response to stimulation( pain, etc.), Reflexes from the tendons, corneal, pupillary etc. For suspected gain depth..Coma, an adjustment of the dose of the drug is necessary, since the effects of an artificial coma( with loss of control over depth) can be fatal( brain death, vegetative state).
5. EEG monitoring( determination of the degree of inhibition of brain electrical activity).
6. Blood counts( general and biochemical analysis), if necessary - toxicological studies.
7. If necessary, you can do the CT scan( or MRI) of the head to exclude( confirmation) of organic disease of the brain( as well as the changes that occurred in a patient as a result of the introduction of an artificial coma.

Indications for removal from the artificial coma

The duration of an artificial coma is usually due either to the timing of neurosurgical intervention, or the timing of recovery from trauma. With the normalization of the patient's condition, brain activity( based on EEG data), it is possible to carry out activities aimed at removing from the coma. This process is lengthy, gradual. So, the dosage of medicines decreases( with constant control over the level of consciousness and brain activity) until their complete cancellation. In this case, the following outcomes are possible:

1. Patient exit from an artificial coma with complete restoration of brain functions.
2. Exit from a coma with partial restoration of brain functions( with preservation of focal symptomatology, impaired movement, sensitivity).
3. No exit from the coma with increasing( or decreasing or without it) its depth.
4. Transition to the vegetative state, brain death.

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Results of

An artificial coma is a neuroprotective technique that is used in emergency cases when it is necessary to protect the brain, is performed in a hospital( intensive care unit) in the constant readiness of ventilators, under conditions of monitoring the basic indicators of the patient's vital activity. When using the technique, one can not be reliably sure that the patient will leave the artificial coma with the stored functions of the brain( and whether it will ever be released).However, in cases of severe trauma, extensive brain operations, etc. - this may be the only chance for him.