The effects of the falling therapeutic and subtherapeutic barbiturate blood levels on electrocerebral silence in clinically brain-dead children.

In a retrospective study at a large children's hospital, we identified 92 children who had received barbiturates that were simultaneously discontinued at the time they were being evaluated for brain death in the presence of electrocerebral silence and clinical brain death by physical exam. Of these 92 children, 67 had barbiturate levels that were monitored from initial therapeutic or subtherapeutic levels. Repeat EEGs were obtained in 76 patients, and in all electrocerebral silence and clinical brain death (by exam) persisted despite the lower barbiturate levels. The study suggests that therapeutic and subtherapeutic barbiturate levels have no effect on the outcome of children who fulfill the criteria for brain death.