thiopental and Near-Drowning

Six children who remained in deep coma after immersion accidents in fresh water received therapy to maintain normal intracranial pressure (ICP). This involved controlled ventilation to ensure hypocapnia and hyperoxaemia, maintenance of low normothermia, fluid restriction, dexamethasone (1-1.5 mg/kg initially, 1-1.5 mg/kg/day as maintenance) and barbiturates (phenobarbitone and thiopentone). The latter were given in a wide range of dosage. Increased ICP was common to all patients, but could always be kept at acceptable levels. All patients suffered from pulmonary oedema; three developed broncho-pneumonia and two developed adult respiratory distress syndrome. All children survived with good recovery, two needed active rehabilitation for several months.

Topics: Accidents; Child; Child, Preschool; Coma; Critical Care; Female; Fresh Water; Humans; Hypothermia, Induced; Immersion; Infant; Intracranial Pressure; Male; Monitoring, Physiologic; Near Drowning; Phenobarbital; Pulmonary Edema; Resuscitation; Thiopental

A case is presented of an infant who may have been immersed in water for 15 minutes, presenting apparently dead by instant assessment criteria, who was resuscitated and rehabilitated to make an excellent recovery.

Topics: Child, Preschool; Dexamethasone; Drug Therapy, Combination; Humans; Hypoxia, Brain; Immersion; Infusions, Parenteral; Male; Meperidine; Near Drowning; Oxygen Inhalation Therapy; Phenobarbital; Resuscitation; Thiopental; Time Factors