Pediatric Head Trauma Medication

Medical therapy is directed at controlling intracranial pressure (ICP) through the administration of sedatives and neuromuscular blockers, diuretics, lidocaine, and anticonvulsants.

Class Summary

Nondepolarizing neuromuscular blockers are used in combination with a sedative as part of the rapid-sequence intubation process or as a means of controlling ICP.

Vecuronium

Vecuronium is used to facilitate endotracheal intubation and provide neuromuscular relaxation during intubation and mechanical ventilation. It is given as an adjunct to a sedative or hypnotic agent.

Class Summary

Barbiturates are used as adjuncts for intubation in patients with head trauma and in the management of elevated ICP. They may also be used as anticonvulsants.

Thiopental

Thiopental is the drug of choice for endotracheal intubation of patients with head injury. It also decreases the ICP. Thiopental facilitates transmission of impulses from the thalamus to the cortex, resulting in an imbalance in central inhibitory and facilitative mechanisms.

Pentobarbital (Nembutal)

Pentobarbital is a short-acting barbiturate with sedative, hypnotic, and anticonvulsant properties. It may be used in high dosages to induce barbiturate coma for treatment of refractory increased ICP.

Phenobarbital

Phenobarbital is used for seizure control in patients with head trauma.

Class Summary

Benzodiazepines may be used to obtain immediate control of seizure activity or as adjuncts to narcotics and neuromuscular blockers for control of ICP. Prolonged use of these drugs may alter neurologic examination findings.

Midazolam

Midazolam is a short-acting benzodiazepine with a rapid onset of action. It is useful in treating increased ICP.

Lorazepam (Ativan)

Lorazepam is a long-acting benzodiazepine used as an anticonvulsant for the immediate control of seizure activity.

Class Summary

Diuretics may have a beneficial effect in lowering ICP by decreasing cerebrospinal fluid (CSF) production, preferentially excreting water over solute, and decreasing blood viscosity, with subsequent improvement of cerebral blood flow (CBF).

Furosemide (Lasix)

Furosemide is a loop diuretic that helps decrease ICP via 2 mechanisms. One mechanism influences CSF formation by affecting sodium-water movement across the blood-brain barrier; the other mechanism is the preferential excretion of water over solute in the distal tubule. This agent is mostly useful when used in combination with mannitol, especially when the latter is administered 15 minutes before furosemide.

Mannitol (Osmitrol)

Mannitol is an osmotic diuretic that lowers blood viscosity and produces cerebral vasoconstriction with normal CBF. A decrease in ICP occurs subsequent to a decrease in cerebral blood volume (CBV).

Class Summary

These agents may be used to blunt ICP elevation during endotracheal intubation process or during airway manipulation such as suctioning.

Lidocaine 1% (Xylocaine)

Lidocaine can be used with good results to control ICP in patients with head trauma.

Class Summary

Anticonvulsants are recommended as a prophylactic measure for patients at increased risk for seizure activity after head trauma. No proof exists of a beneficial effect in seizure prevention more than 1 week after head trauma. These agents are also used for immediate control of seizures.

Phenytoin (Dilantin, Phenytek)

Phenytoin may act in the motor cortex, where it may inhibit the spread of seizure activity. It may also inhibit the activity of the brainstem centers responsible for the tonic phase of grand mal seizures. Phenytoin is preferred to phenobarbital for controlling seizures because it does not cause as much central nervous system (CNS) depression.