A high mortality rate has been accepted by many as inevitable in severe barbiturate poisoning. Analeptics such as pentylenetetrazole (metrazol®) and picrotoxin are usually given in heroic doses to arouse the victim. A recent monograph1 by Nilsson of Sweden challenges both these concepts.
He compares the severe depression of barbiturate overdosage to the similar state of profound surgical anesthesia. The gravest dangers in anesthesia are drug overdosage and lack of oxygen. Overdosage causes respiratory depression and hence suboxygenation. Overdosage of depressants also brings on hypoxia by a mechanism that is often neglected outside the operating room, namely, airway obstruction from the relaxed tongue and throat muscles. The loud stertor of any deeply unconscious patient is the measure of the obstruction that prevents the proper ingress of oxygen.
From the anesthesiologist's point of view, there is little to choose between deep anesthetic depression and that of barbiturate overdosage. In
RESPIRATORY PROBLEMS OF BARBITURATE POISONING. JAMA. 1951;147(9):874. doi:10.1001/jama.1951.03670260076018
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