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. 2016:2016:1765165.
doi: 10.1155/2016/1765165. Epub 2016 Jul 26.

Pentobarbital-Induced Myocardial Stunning in Status Epilepticus Requiring Extracorporeal Membrane Oxygenation: A Case Report and Literature Review

Tapan Kavi  1 , Donna Molaie  1 , Michael Nurok  1 , Axel Rosengart  1 , Shouri Lahiri  1
Affiliations

Pentobarbital-Induced Myocardial Stunning in Status Epilepticus Requiring Extracorporeal Membrane Oxygenation: A Case Report and Literature Review

Tapan Kavi et al. Case Rep Crit Care. 2016.

Abstract

Introduction. Mild hypotension is a well-recognized complication of intravenous pentobarbital; however fulminant cardiopulmonary failure has not been previously reported. Case Report. A 28-year-old woman developed pentobarbital-induced cardiopulmonary failure that was successfully treated with maximal medical management including arteriovenous extracorporeal membrane oxygenation. She made an excellent cardiopulmonary and neurological recovery. Discussion and Conclusion. Pentobarbital is underrecognized as a potential cause of myocardial stunning. The mechanism involves direct myocardial depression and inhibition of autonomic neuroanatomical structures including the medulla and hypothalamus. Early recognition and implementation of aggressive cardiopulmonary support are essential to optimize the likelihood of a favorable outcome.

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Figures

Figure 1
Figure 1
Transesophageal echocardiogram while on pentobarbital infusion, left ventricle ejection fraction of 20%: (a) end diastole; (b) end systole.
Figure 2
Figure 2
Transesophageal echocardiogram while off pentobarbital infusion, left ventricle ejection fraction of 50%: (a) end diastole; (b) end systole.
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