High-dose thiopentone infusion is being used for refractory intracranial hypertension after traumatic brain injury. Titration of the infusion should be guided by achieving which finding on continuous EEG?

• A Generalised theta slowing with retained sleep spindles
• B Isoelectric silence sustained for more than 24 hours
• C Burst suppression pattern ✓
• D Periodic lateralised epileptiform discharges

Explanation

Barbiturate coma for intracranial hypertension is titrated to burst suppression, the EEG point at which cerebral metabolic rate for oxygen is maximally reduced, matching flow to demand without excessive dosing. A permanently flat EEG is neither required nor desirable and risks cardiovascular depression and prolonged coma. Theta slowing indicates light sedation only and does not confer maximal cerebral protection.

Reference: Miller's Anesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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