Michael Schumacher in critical condition

Rasmus said:
What I did find, though, were (older) comments that Schumacher was put in an artificial coma -implying that his unconsciousness is intentional.
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To be clear, the use of pentobarbital to create an "artificial coma" does not mean that he wouldn't remain in that coma if that medication was discontinued. What pentobarbital does is essential create a "flat line" EEG and reduce cerebral oxygen requirements to the most minimal possible. This is thought to help reduce secondary injury and ameliorate brain swelling.

His prognosis, based on the fact that they opted for this extreme measure, is quite poor.

http://www.mirror.co.uk/news/uk-news/michael-schumacher-news-may-remain-3058072

(Sorry for the source.)

~Dr. Imago
 
Dr. Imago said:
To be clear, the use of pentobarbital to create an "artificial coma" does not mean that he wouldn't remain in that coma if that medication was discontinued.
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True.

I am wondering if the Munich doctors and/or management/family would have made some sort of announcement had they tried and failed to reverse the induced coma: such an event would certainly be medically very noteworthy, and consequently very newsworthy, but the management and family appear to have initiated a near-total news blackout in any event, so I guess it's entirely possible that something along these lines did happen.

From what I know of induced coma (and their usual maximum lengths - which have increased significantly over the past couple of decades, owing to better medications and better monitoring equipment/procedures), three weeks is nowadays pretty much the upper limit, if one expects the coma to be reversible and for the patient to make a significant recovery. So, either way, unless Schumacher actually has come out of his coma by now (and for some reason the family have refused to release this news), then I'm afraid I think we now have to start to assume a pretty bad prognosis.



What pentobarbital does is essential create a "flat line" EEG and reduce cerebral oxygen requirements to the most minimal possible. This is thought to help reduce secondary injury and ameliorate brain swelling.

His prognosis, based on the fact that they opted for this extreme measure, is quite poor.

http://www.mirror.co.uk/news/uk-news/michael-schumacher-news-may-remain-3058072

(Sorry for the source.)

~Dr. Imago
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Yep. However, I think (but am not certain) that propofol is now a more preferred anaesthetic (hypnotic) for inducing a coma. It has many advantages over barbiturates, including a better and more predictable recovery, the ability to use alongside many analgesic drugs without any adverse interactions, and its fast response time (meaning that instant-result very fine control of the amount of the infused drug is possible).

Did the hospital or mgmt/family say that pentobarbital was the anaesthetic used in this case?
 
LondonJohn said:
It has many advantages over barbiturates, including a better and more predictable recovery, the ability to use alongside many analgesic drugs without any adverse interactions, and its fast response time (meaning that instant-result very fine control of the amount of the infused drug is possible).

Did the hospital or mgmt/family say that pentobarbital was the anaesthetic used in this case?
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Propofol is associated with propofol infusion syndrome (PrIS) in this population and is generally avoided in doses that will produce a flat-line EEG, which is paramount in protecting whatever surviving brain remains.

~Dr. Imago
 
Skwinty said:
Michael Schumacher being woken up from artificial coma, according to French reports - Telegraph
http://www.telegraph.co.uk/sport/mo...ificial-coma-according-to-French-reports.html
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Or maybe not:

Sabine Kehm, Mr Schumacher's manager, did not deny the L'Equipe report, but urged fans to ignore anything other than official comments on his health.
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"I am stressing again any statement regarding Michael's health not coming from the doctors treating him, or from his management, must be considered as speculation," she said. "I repeat, we will not comment on any speculation."
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Ah! So even though she has said she will not comment on the reports, she hasn't denied them!

Sabine Kehm told the BBC the seven-time world champion remained in a "stable" condition at a clinic in Grenoble.

She has rejected as "speculation" a French media report saying Schumacher was being woken from his coma.
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BBC

What are the grounds for even taking the reports seriously? According to that Telegraph article:

Professor Jean-Luc Truelle, the former head of the neurology department of the Foch hospital in Suresnes, told L'Equipe that a month is "the maximum period before entering into this phase" of coming out of an artificial coma.

He said the process would begin with a sedation phase, then the patient opens his eyes followed by the "re-establishment of some kind of communication, which we verify through simple commands," such as "open your eyes, shut your eyes, squeeze your hand".

"Schumacher appears to show this type of re-awakening," wrote L'Equipe.
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Where did they get this bit of information from? What kind of source is L'Equipe?*


* I don't know. Though Wikipedia gives it a very unsavoury history.
 
Skwinty said:
Michael Schumacher being woken up from artificial coma, according to French reports - Telegraph
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And Wednesday, Kehm reportedly discounted a story in the French newspaper L'Equipe that doctors were prepared to gradually awaken Schumacher from his coma.

"I am stressing again that any statement regarding Michael's health not coming from the doctors treating him or from his management must be considered as speculation," Kehm said in a statement, according to Britain's Sky.com.
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http://www.latimes.com/sports/sport...update-20140129,0,5769491.story#axzz2rqGmC5pk

~Dr. Imago
 
Now there's a written statement from Kehm that confirms that they are reducing his medication to initiate a wake-up process "that can take very long".

And L'Equipe is again a step ahead and claims that he has "blinked".

Both according to the FOCUS news-ticker.
 
Childlike Empress said:
Now there's a written statement from Kehm that confirms that they are reducing his medication to initiate a wake-up process "that can take very long".

And L'Equipe is again a step ahead and claims that he has "blinked".

Both according to the FOCUS news-ticker.
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Well, I'll be...

So, is L'Equipe trustworthy?

By the way, how the Hell am I supposed to understand that feed?

This could mean anything!!!

Ihr Statement im Wortlaut: "Die Familie von Michael Schumacher bittet erneut um Respekt für ihre Privatsphäre"
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ABC news reported that they are trying to wake him up:

http://abcnews.go.com/Sports/michael-schumacher-leaving-coma/story?id=22295050

This is clearly a credible news source.

I think they will have to wait and see. It will take time. Blinking, in and of itself, means little at this point. My assumption is that the treating team feels that he has achieved maximum benefit from the medically-induced coma and it is, essentially, time to fish or cut bait.

I would also assume that once his serum levels of whichever medication they used, which is likely pentobarbital, are down to the point that he should be conscious, they will re-assess his mental faculties and make a determination to the initial extent of the damage done. Of course, brain injury is a strange beast and it make take months (or years) to see what damage has been done.

I would also assume that they have already done a tracheostomy and placed a permanent feeding tube (i.e., PEG tube). Part of the long term success of his treatment will be predicated on the successful removal of these devices.

My best hopes and wishes for a meaningful recovery go out to him and his family.

~Dr. Imago
 
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