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A pharmacological coma is a controlled coma into which the patient is introduced on purpose. It is a treatment method used in intensive care units. Its aim is to facilitate the treatment of physicians, for example, to conduct mechanical ventilation and to reduce the pain experienced by the patient. How and when is a patient put into a pharmacological coma? What does awakening from a pharmacological coma look like?

Pharmacological coma(medically induced coma) is a deliberate unconsciousness of the patient, which is carried out in intensive care units (ICU) by anaesthesiologists. In general, the word coma is associated with patients rather negatively - with a coma resulting from a head injury or with a diabetic coma. However, the pharmacological coma is completely different - it is absolutely not a pathological condition, as it is a planned element of the entire treatment process and the pharmacological coma is to support the patient's recovery.

Pharmacological coma has been used in medicine for decades, but in 2022 patients became more interested in it because of the coronavirus pandemic and the disease it causes, COVID-19. The microorganism can lead to very serious infections, which may result in pneumonia and circulatory and respiratory failure, resulting in the necessity to assist the patient's breathing with the use of a respirator - and this happens in patients who have just entered a pharmacological coma.

Pharmacological coma: target

The goal of a pharmacological coma - figuratively speaking - is to make the patient active only in those elements of the central nervous system which are essential for survival. During this type of coma, the nervous system stops responding to external stimuli. The effect of this situation is the reduction of the brain's demand for oxygen - thanks to this phenomenon, the risk of damage to the nervous tissue caused by reduced oxygen supply to it is eliminated.

Pharmacological coma is sometimes used in patients who are at risk of brain swelling - in their case, reduced blood supply to the brain causes blood vesselsthey contract and this alone can lead to a reduction in intracranial pressure.

The purpose of the pharmacological coma is to limit life processes as much as possible so that the body of a sick person can regenerate at a faster pace.

Pharmacological coma: medications used

Putting the patient into a pharmacological comaresembles general anesthesia - in both situations the same pharmaceuticals are used, but in those who are to be in a pharmacological coma, they are administered by definitely longer time.

In patients in pharmacological coma, drugs are administered as a continuous infusion with the use of an infusion pump and the basic measures in this case are anesthetics, such as, for example, propofol, thiopental or pentobarbital.

However, these are not the only drugs used in people in a pharmacological coma - due to the fact that most patients then breathe using a respirator, they are also given skeletal muscle relaxants. In the case of people who may experience severe pain - e.g. those who have experienced a serious injury - painkillers are also administered during a pharmacological coma.

Pharmacological coma: indications

Pharmacological coma is used in patients who are in a very serious condition. Among the problems that can be indications for introducing the patient into this state, the following can be mentioned:

  • extensive multi-organ injuries (resulting from e.g. a traffic accident)
  • significant, extensive burns
  • cardiorespiratory failure (which may result from a heart attack, severe pneumonia, pulmonary edema, or pulmonary embolism)
  • diseases with extremely severe pain (those that cannot be eliminated with the use of available painkillers)
  • conditions after overdosing on various pharmaceuticals
  • severe infections of the nervous system (e.g. meningitis)
  • long-term status epilepticus, not responding to drugs commonly used in this case
  • brain injuries
  • brain hemorrhage
  • state after extensive operations

Pharmacological coma: what does the patient feel?

Theoretically, a patient in a pharmacologically comatose state should not feel anything, but there are stories about experiencing rather unusual sensations during a coma. Some of the patients who were in a pharmacological coma recall that they experienced extensive, very muchrealistic dreams in which they found it difficult to believe untrue, even for a long time after awakening. In general, however, patients in a pharmacological coma should be completely unaware and not feel any stimuli, including pain stimuli.

Pharmacological coma: possible complications

Pharmacological coma can have many benefits, but it has some consequences. Complications of this procedure are uncommon, one of the possible causes is a significant drop in blood pressure (hypotension), which may result in ischemia of certain organs of the body.

Due to the inhibition of the cough reflex, patients become more prone to developing pneumonia, moreover, prolonged stay in the supine position poses a risk of pressure ulcers. To prevent such consequences of pharmacological coma, patients are constantly monitored, additionally they can rest on anti-bedsore mattresses and their body position may be slightly changed from time to time.

Pharmacological coma: waking up

As it has already been mentioned several times, pharmacological coma is controlled by doctors - when the patient's condition improves, it may be interrupted. The duration of its maintenance varies, some patients have a drug-induced coma for several days, others for a few, sometimes even several weeks. It is generally believed that the maximum,safe duration of a pharmacological coma is up to 6 months .

Then, when a decision is made to stop using a pharmacological coma, the patient's doses of drugs are gradually reduced, until their use is finally stopped, which results in the patient waking up after a short time.

The main difference between a pathological coma and a pharmacological coma is that in the latter, the awake person regains full consciousness, as if they woke up from sleep.

The fact that the patient wakes up from a pharmacological coma does not necessarily mean the end of treatment and full recovery. Further treatment depends on the reason for using this method and on how long the patient was kept in a coma - in those patients who required a long-term pharmacological coma, long-term rehabilitation may be necessary to regain full fitness.

About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. At work withpatients, focusing on always listening to them and devoting as much time to them as they need.

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Category:

Neurology