Case-Based Modules > Case 5 > Stage 4

This is really a measure of last resort. It's controversial (and a long discussion about) whether pentobarbital should be pursued truly as a last-ditch effort, even after a decompressive craniectomy, or whether it should occur before a craniectomy. Pentobarbital is a challenge as it has such a long half-life and essentially commits patients to a longer time on the ventilator, causes profound vasoplegia, raises the risk of infection (it suppresses leukocyte function), and raises the risk of ileus, among other side effects. Regardless, there are other options with a less concerning risk profile that should be pursued first.

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