Barb coma: EEG endpoint
Clinical - Neurologic
Current indications for pharmacologic burst suppression based on low level evidence include : Refractory Status Epilepticus (6), Refractory Intracranial Hypertension (such as in traumatic brain injury) (7), and Intraoperative Neuroprotection during cerebrovascular (such as carotid endarterectomy) surgery (8). Insufficient evidence exists to determine benefit or harm in the setting of prolonged cerebral ischemia due to cerebral aneurysm surgery (prolonged temporary clip application), cerebral bypass surgery with prolonged vascular clamping and cerebral ischemia, or cardiac/aortic surgery with cerebral blood flow disruption/ischemia.
In the operating room, barbiturate burst suppression with pentobarbital or thiopental results in delayed emergence from anesthesia that can take days. Propofol burst suppression can be shut off intraoperatively after full restoration of cerebral blood flow and may still allow for anesthetic emergence and even extubation by the end of the procedure.