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Medically Induced Coma performed on an 11-year-old boy from Midnapore by Dr Agni Shekhar Saha at Fortis Hospitals, Anandapur

A skiing accident led F1 legend Michael Schumacher into a vegetative state with induced coma while the world prayed for his recovery. It took him 6 months to recover from that condition.

A similar case of induced coma was performed at Fortis Hospitals, Anandapur, on a eleven year-old boy, from a remote village of Tehatta, Nadia,, who suffered from encephalitis and thus had to endure a suffocating array of convulsions, lasting literally for days.

 

In order to rid him from the turmoil, a method of treatment was used, which is rarely utilized in patients of traumatic brain injuries – a medically induced coma, like it was used in the case of the seven-time Formula One World Champion Michael Schumacher and the Israeli Prime Minister Ariel Sharon. It’s a last-ditch measure taken when the doctors feel like they are at the end of the game.

The procedure, called Thiopentone coma, slows brain activity almost to a stop by pumping huge doses of barbiturates, a group of sedatives, into the patient. The goal is to give the injured brain a rest in the hope that it will heal itself.

In usual cases, a drug called Midazolam does the trick. It is usually utilised in pediatric patients for sedation and amnesia prior to diagnostic, therapeutic or endoscopic procedures. Midazolam was used thrice, once with the highest possible dose. However, in Ashraful’s case, the convulsion responded when Midazolam was infused, only to come back as soon as it was stopped. This is in spite of Ashraful being on a cocktail of four different anti-convulsion medications on top of the Midazolam. Options were running out fast for Ashraful. Extreme measure had to be taken by inducing a Thiopental coma, which is a form of Barbiturate coma therapy. Thiopentone is essentially a strong anaesthetic agent which is usually applied as a single injection to induce Anaesthesia. However, in Ashraful’s case, Thiopental was infused continuously in his veins to induce a come so deep that almost every function of the brain stops. He was kept in that condition for four days. Dr. Agni Sekhar Saha who treated Ashraful explains “We were doing serial EEGs to measure the amount of suppression that we achieved. We continued until we got ‘burst suppression’ – which is the deepest possible state of coma. In this state, even the very basic brain stem reflexes are also suppressed. Absence of brain stem reflex is the hallmark of brain death. So, in effect, we stopped all useful activities of the brain. It is almost like hitting a reset button on the brain so that it rests and heals itself. It is very similar to the use of defibrillators when the hearts rhythms go hay-wire and the defib stops everything and lets the heart get a jumpstart like an engine.”  

Using this method on a pediatric patient is a dangerous task and can lead to fatality if something goes wrong. He was of course monitored very closely. Ashraful’s blood pressure did drop during this phase but stabilized later.

Dr. Saha continues in what sound almost like a medical thriller.  “The most important point in the therapy came when Thiopentone was stopped and Ashraful was allowed to gradually ‘wake up’ to see whether the convulsion recurs – which would mean that he had no further option left for cure. It would also reveal what sort of brain functioning was left. Ashraful needed nearly four days just to come out of the effect of Thiopentone! Thankfully, the ugly convulsions did not come back. And as he woke up, he gradually started showing progressive signs of brain function like breathing on his own, coughing, blinking of eyes and subsequently moving his limbs. Finally, he was taken off the ventilator after being on it for 25 days. Everyone of the medical team were thrilled and his parents were in tears when he first uttered ‘Paani dao’ in a muffled voice, 3 days after being off the ventilator.”

 He was subsequently transferred to the Institute of Child Health for a steady recovery. He was finally discharged after being in hospital for nearly two months. 

After coming back to life, initially everything was confusing for little Ashraful. Although he always remembered his parents, he had lost some of his old memories and could not recognize some family members. But now he is creating new memories and re-acquainting himself with the close ones. He had to re-learn all motor skills like using his hands and walking. Ashraful was a bright boy and his academic performance had always been excellent. Now, Ashraful has started reading and writing with the same interest that he was always known for! There are no psychological or anatomical repercussions and the boy is living a normal life now like the other kids of his age.

 

“I have just seen him today in the clinic. At one point of time we thought Ashraful may have to live the rest of his life in a vegetative state. But from there, the amount of recovery that the boy made is absolutely fantastic!” Dr. Saha exclaims with a broad grin. 

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