Pentobarbital is a medication used to manage and treat several medical conditions, including seizures, intracranial pressure control, insomnia, and as a pre-anesthetic in the operating room. This activity reviews the indications, mechanism of action, administration, adverse effects, and contraindications of pentobarbital therapy in the clinical setting. It is intended to relate the essential points needed by members of an interprofessional team managing the care of patients undergoing treatment with pentobarbital and its related conditions and sequelae.

Objectives:

• Identify the mechanism of action of pentobarbital.
• Describe the potential adverse effects of pentobarbital.
• Review the appropriate monitoring for the toxicity of pentobarbital.
• Explain interprofessional team strategies for improving care coordination and communication to advance the use of pentobarbital and improve outcomes.

Indications

Pentobarbital is a drug within the barbiturate class that works primarily on the central nervous system. At low doses, indications include short-term sedatives to treat insomnia and as a pre-anesthetic for surgery.[1] At higher doses, pentobarbital serves as an anticonvulsant for emergent seizure control and medically induced comas. Pentobarbital is often subject to comparison with phenobarbital, another barbiturate, in the use of refractory status epilepticus. Studies have found that pentobarbital is superior in that it has faster brain penetration and a shorter half-life, making it the treatment of choice.

Common off-label uses are for control of intracranial pressure in patients with severe brain injuries, cerebral ischemia, and those receiving treatment for Reye syndrome.

Mechanism of Action

Pentobarbital works in the central nervous system by binding to gamma-aminobutyric acid (GABA) A subtype receptors. This action induces a change in the chloride transport receptor, leading to an increase in the duration that the chloride channels remain open, hence potentiating GABA effects. GABA is responsible for producing CNS depression and thus prolonging the time the channels remain open and intensifying the depressant effects on the CNS.

Administration

Pentobarbital administration can be through three routes: intramuscular, intravenous, or oral. For intramuscular administration, it is advised to inject no more than 5 ml and only into a large muscle to avoid tissue irritation or necrosis. Intravenous administration is not to exceed 50 mg/minute and should only be given by slow IV injection in the undiluted form