Detection of Brain Death in Barbiturate-Induced Coma: The Dilemma of an Intracranial Pulse

Introduction: Diagnosing brain death in barbiturate coma is tricky due to suppressed activity and persistent pulse signals. This study tests TCD reliability in eight TBI patients, finding 50% mismatch with clinical criteria, urging protocol revision. Methods: Eight TBI patients (18-65) in barbiturate coma (pentobarbital, 20-40 ?g/mL, ?48h) were studied (2024-2025). Brain death assessed via AAN guidelines and TCD (2-MHz, MCA flow). Exclusions: instability, incomplete data. Descriptive stats used. Results: All eight (5 male, mean age 42.3) met clinical brain death criteria. TCD showed pulsatile flow in 50%, others had brain death patterns (reverberating, n=3; absent, n=1). Two recovered, two confirmed dead post-weaning. Discussion: 50% TCD-clinical mismatch shows barbiturates mimic brain death, with pulsatile flow hinting at perfusion. Recovery risks premature calls; weaning clarifies. Multimodal testing needed. Conclusion: Barbiturates skew brain death diagnosis, with 50% TCD discordance. Revised guidelines with clearance or combined tests are key, pending bigger studies.