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International Anesthesiology Clinics 1969
Topics: Anesthetics; Atropine; Chemical Phenomena; Chemistry; Humans; Injections, Intravenous; Methohexital; Premedication; Propanidid
PubMed: 5370809
DOI: 10.1097/00004311-196900710-00004 -
The Journal of Emergency Medicine Aug 2020Methohexital is a short-acting barbiturate used for procedural sedation in the emergency department (ED). As with other sedatives, adverse effects with methohexital...
BACKGROUND
Methohexital is a short-acting barbiturate used for procedural sedation in the emergency department (ED). As with other sedatives, adverse effects with methohexital include excess sedation and hypotension, but this agent can also lower the seizure threshold. We report a patient who developed a generalized seizure after administration of methohexital.
CASE REPORT
A 60-year-old man presented to the ED by ambulance with chest pain and shortness of breath. Paramedics had administered adenosine for supraventricular tachycardia without conversion before arrival to the ED. He had no history of seizures. His initial vital signs in the ED included heart rate of 189 beats/min with a supraventricular rhythm, blood pressure 137/108 mm Hg, respiration 22 breaths/min, and oxygen saturation of 98% on room air. It was decided to attempt synchronized electrical cardioversion, and methohexital 1 mg/kg (120 mg) was administered over 2 min for moderate sedation. Within 15 s of methohexital administration, the patient developed a generalized seizure that lasted for 90 s. After seizure termination, he was successfully cardioverted, returned to his previous baseline level of consciousness within 20 min, and discharged without further problems with a follow-up referral to neurology. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Methohexital is a short-acting barbiturate used for moderate sedation. Its adverse effects are unique in that it can lower the seizure threshold in some patients. Alternative agents for sedation should be considered in individuals with possible seizure disorders.
Topics: Anesthetics, Intravenous; Conscious Sedation; Humans; Hypnotics and Sedatives; Male; Methohexital; Middle Aged; Seizures
PubMed: 32565170
DOI: 10.1016/j.jemermed.2020.05.012 -
The Journal of ECT Sep 2003
Topics: Anesthesia, General; Anesthetics, Intravenous; Drug Industry; Electroconvulsive Therapy; Humans; Methohexital
PubMed: 12972979
DOI: 10.1097/00124509-200309000-00001 -
Anesthesia Progress 1991Methohexital is an ultrashort-acting barbiturate widely used in dentistry because of its rapid onset, predictable effects, and short duration of action. Like other... (Comparative Study)
Comparative Study Review
Methohexital is an ultrashort-acting barbiturate widely used in dentistry because of its rapid onset, predictable effects, and short duration of action. Like other barbiturates, methohexital exerts its effects through the gamma-aminobutyric acid (GABA) receptor complex. By binding to its own receptor on the complex, methohexital augments the inhibitory effect of GABA on neurons and additionally can exert a similar effect independent of GABA. After intravenous injection, maximal brain concentrations are achieved within 30 sec and then quickly fall as the drug is redistributed to other tissues, yielding a duration of action after a single dose of 4 to 7 min. Hepatic metabolism accounts for elimination of the drug. Methohexital at conventional doses in healthy individuals is a mild respiratory depressant with modest cardiovascular effects. Adverse effects, however, can include apnea, cardiovascular depression, laryngospasm, hiccough, and allergic-like reactions. Although more recently introduced drugs, such as midazolam, etomidate, and propofol, have specific advantages, methohexital remains a drug of choice for dental outpatient anesthesia because of its low cost, rapid onset, short duration, lack of secretory or emetic properties, and proven history.
Topics: Anesthesia, Dental; Etomidate; Humans; Methohexital; Midazolam; Propofol
PubMed: 1842156
DOI: No ID Found -
Journal of Oral and Maxillofacial... Jul 1995
Comparative Study Review
Topics: Affect; Ambulatory Surgical Procedures; Anesthesia Recovery Period; Anesthesia, Dental; Drug Costs; Humans; Methohexital; Patient Satisfaction; Propofol
PubMed: 7595797
DOI: 10.1016/0278-2391(95)90340-2 -
Anesthesia and Analgesia 1962
Topics: Analgesia; Anesthesia; Anesthesia and Analgesia; Barbiturates; Methohexital; Pain Management
PubMed: 14040162
DOI: No ID Found -
Chirality Aug 2001The narcotic drug methohexital 1 contains two asymmetric carbon atoms and, thus, consists of four isomers, two diastereomeric pairs of enantiomers. The commercial drug... (Review)
Review
The narcotic drug methohexital 1 contains two asymmetric carbon atoms and, thus, consists of four isomers, two diastereomeric pairs of enantiomers. The commercial drug is the so-called alpha-racemate, one pair of diastereomers only. A method was developed to prepare differently enriched mixtures of methohexital isomers without resorting to lengthy and expensive optical resolutions. A model reaction for the synthesis of methohexital is the palladium-catalyzed allylation of 1,5-dimethyl-barbituric acid 3, which is optimized and checked by molecular modeling. Catalysts with the best ligands are used in the allylation of the methohexital precursor 7, which contains the C(6) sidechain at the tetrahedral center of the barbiturate skeleton. The product stereochemistry was determined by the contribution of the enantioselective Pd catalysts and by the fact that the allylation is a kinetic resolution. The methohexital isomer mixtures obtained were evaluated with the corneal stimulus test of rats. Methohexital compositions were found, which are superior to the commercially used alpha-racemate (Brevimytal).
Topics: Anesthetics, Intravenous; Animals; Catalysis; Methohexital; Models, Molecular; Molecular Conformation; Narcotics; Rats; Stereoisomerism
PubMed: 11466761
DOI: 10.1002/chir.1054 -
Journal of Clinical Neuroscience :... May 2019Pharmacologic provocative testing (PT) and intraoperative neurophysiologic monitoring (IONM) both mitigate and predict risks associated with endovascular embolization...
Pharmacologic provocative testing (PT) and intraoperative neurophysiologic monitoring (IONM) both mitigate and predict risks associated with endovascular embolization procedures. We present a series of patients undergoing endovascular intracranial embolization predominantly for AVMs both under general anesthesia and awake with the use of IONM. We reviewed our database to identify all patients undergoing endovascular procedures between January 1, 2014 and January 1, 2016. Awake patients were tested with SSEP, EEG and real time neurologic examination while TcMEPs were performed in all anesthetized patients. BAEPs were performed in anesthetized patients if indicated. Methohexital was administered as an injection at a dose of 5 mg or 10 mg and repeat testing was performed if needed.Sixty-three endovascular procedures that met criteria were performed in 32 patients. 54 procedures in 28 patients were performed under general anesthesia, 9 procedures in 4 patients were performed in wakefulness. PT was negative in 61 procedures and subsequently completed embolizations without neurological sequelae. In two cases, the testing was positive and the procedure was terminated without embolization in one patient. The other patient underwent embolization at an alternative site without repeat PT. There were no new postoperative neurologic deficits after any of these procedures. Specificity of PT was 100% as none of the patients with a negative provocative test developed a new postoperative neurologic deficit after embolization. To our knowledge, this is the first review of PT with the use of neurophysiologic IONM techniques under general anesthesia. These data suggest a high specificity comparable to awake testing.
Topics: Adult; Anesthetics, Intravenous; Embolization, Therapeutic; Female; Humans; Intracranial Arteriovenous Malformations; Intraoperative Neurophysiological Monitoring; Male; Methohexital; Middle Aged; Postoperative Complications
PubMed: 30772199
DOI: 10.1016/j.jocn.2019.01.051 -
Journal of Oral and Maxillofacial... Jul 1995
Comparative Study Review
Topics: Akathisia, Drug-Induced; Ambulatory Surgical Procedures; Anesthesia, Dental; Apnea; Drug Costs; Endothelium, Vascular; Hiccup; Humans; Laryngismus; Methohexital; Propofol
PubMed: 7595796
DOI: 10.1016/0278-2391(95)90339-9 -
International Anesthesiology Clinics 1974
Topics: Adult; Anesthesia, Intravenous; Animals; Bile; Biotransformation; Carbon Radioisotopes; Chromatography, Gas; Chromatography, Thin Layer; Dogs; Feces; Female; Humans; Lipids; Methohexital; Methylation; Rats; Time Factors
PubMed: 4846714
DOI: 10.1097/00004311-197412020-00016