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Midazolam/thiopental-sodium Severe cardiac dysfunction: case report

A 2-year-old boy developed severe cardiac dysfunction (manifesting as decreased BP and left ventricular ejection fraction) during treatment with thiopental sodium and midazolam for generalised tonic seizures and acute encephalopathy with biphasic seizures. The boy presented to hospital with high fever, prolonged unconsciousness and generalised tonic seizures. On hospital day 2, he was diagnosed with acute encephalopathy with biphasic seizures. He received treatment with midazolam, along with diazepam for sub-clinical seizures. However, his seizures did not improve. Therefore, he was initiated on continuous thiopental sodium infusion [dosage not stated]. However, his BP and left ventricular ejection fraction (LVEF) gradually decreased [duration of treatment to reaction onset not stated]. Therefore, he was started on unspecified catecholamines for haemodynamic stability. However, his BP and LVEF decreased further. Despite treatment with epinephrine [adrenaline], dobutamine and dopamine, his BP and LVEF continued to decrease. The boy’s thiopental sodium was discontinued. On hospital day 15, he was started on venoarterial extracorporeal membrane oxygenation. Eventually, his serum thiopental level decreased, and cardiac function improved. On hospital day 28, his veno-arterial extracorporeal membrane oxygenation was weaned off. On hospital day 72, he was discharged with normal cardiac function. Uchida K, et al. Severe cardiac dysfunction induced by thiopental sodium. Pediatrics International 61: 1270-1272, No. 12, Dec 2019. Available from: URL: http:// doi.org/10.1111/ped.14031

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Reactions 25 Jan 2020 No. 1788