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Clinical Neurophysiology Practice 2021The Wada test is used to evaluate language lateralization and memory performance after inactivation of an isolated cerebral hemisphere. Methohexital a short-acting...
OBJECTIVE
The Wada test is used to evaluate language lateralization and memory performance after inactivation of an isolated cerebral hemisphere. Methohexital a short-acting barbiturate has a history of use to induce interictal discharges during intraoperative corticography. We report a new finding of activation of lateralized periodic discharges (LPDs) after Methohexital injection.
METHODS
We retrospectively reviewed 174 consecutive adult patients who underwent Wada testing in preparation for epilepsy surgery (N = 129, 74%) or brain tumor resection (N = 45, 26%) at the University of Michigan to determine the frequency of induced periodic discharges by methohexital.
RESULTS
Four epilepsy patients (2.29%) had methohexital-induced LPDs within a median of 2 s (1-99 s) of the injection and lasting a median of 4 min (3-10 min) after a total of 7 injections. All LPDs occurred ipsilateral to the injection hemisphere in the known region of interictal epileptiform discharges. LPDs were not induced in brain tumor patients. In one patient, LPDs occurred during memory testing, and this patient's memory performance was below expectation based on pre-test neuropsychological testing.
CONCLUSIONS
Methohexital can induce LPDs in ipsilateral hemisphere and that can potentially affect memory performance.
SIGNIFICANCE
This observation indicates that concurrent EEG monitoring during the Wada test is important and that induced discharges should be considered when interpreting Wada test results.
PubMed: 34409239
DOI: 10.1016/j.cnp.2021.07.002 -
Forensic Science International Aug 2001Larvae of Sarcophaga (Curranea) tibialis (S. tibialis) were reared at constant temperature on chicken liver treated with a steroid or a barbiturate at concentrations... (Review)
Review
Preliminary observations on the effects of hydrocortisone and sodium methohexital on development of Sarcophaga (Curranea) tibialis Macquart (Diptera: Sarcophagidae), and implications for estimating post mortem interval.
Larvae of Sarcophaga (Curranea) tibialis (S. tibialis) were reared at constant temperature on chicken liver treated with a steroid or a barbiturate at concentrations that would be lethal, half-lethal and twice-lethal doses for humans. Trends to greater mortality at higher drug concentrations were not statistically significant. Larvae exposed to either drug took significantly longer to reach pupation compared to those in the control, while larvae exposed to sodium methohexital passed through pupation significantly faster than those in the control. No systematic relationship was found between drug concentration and development time of larvae or pupae. The total developmental period from hatching to eclosion did not differ between treatments, implying that estimates of post mortem intervals- (PMI) based on the emergence of adult flies will not be affected by the involvement of these drugs in a case. On the other hand, anomalous pupation spans may indicate the presence of barbiturates. These findings are compared with patterns found in another fly fed other contaminants.
Topics: Animals; Anti-Inflammatory Agents; Diptera; Forensic Medicine; Humans; Hydrocortisone; Life Cycle Stages; Methohexital; Postmortem Changes
PubMed: 11457607
DOI: 10.1016/s0379-0738(01)00415-7 -
The Journal of ECT Dec 2017This randomized controlled pilot study examines the differences in response to electroconvulsive therapy (ECT) as defined by an improvement of depressive symptoms... (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
This randomized controlled pilot study examines the differences in response to electroconvulsive therapy (ECT) as defined by an improvement of depressive symptoms between ketamine and methohexital as the primary anesthetic agent. Adverse effects and cognitive tolerability were also examined.
METHODS
Subjects undergoing ECT for unipolar or bipolar depression were randomized to receive ketamine or methohexital as the anesthetic agent. Primary outcome measure includes the Hamilton rating scale for depression (17-item). Secondary outcome measures included the mini-mental status examination and Beck depression inventory. All ratings were conducted masked to anesthetic agent. Because of multiple outcome measures obtained over time, mixed models were used to account for the correlations among the measurements within the subjects. Because outcomes were either normally distributed or approximately normally distributed, general linear mixed models were fit with a random intercept specified.
RESULTS
A total of 21 subjects were enrolled, and 16 were randomized (methohexital, n = 8; ketamine, n = 8). The 2 treatment groups did not differ statistically in any demographic characteristic. No statistical difference was found between the ketamine and methohexital groups for an improvement in depressive symptoms (P = 0.6); however, subjects in both groups showed significant improvement in depression over time (ketamine, P < 0.0001; methohexital, P < 0.0001). Mini-mental status examination results did not differ between groups, and fatigue was reported more in subjects receiving ketamine (P = 0.03).
CONCLUSIONS
The results of this pilot study are inconclusive because they lack power to support an advantage of ketamine anesthesia compared with methohexital in ameliorating depressive symptoms for electroconvulsive therapy.
Topics: Adult; Aged; Anesthesia; Anesthesia, Intravenous; Anesthetics, Dissociative; Anesthetics, Intravenous; Bipolar Disorder; Depressive Disorder; Electroconvulsive Therapy; Fatigue; Female; Humans; Ketamine; Male; Methohexital; Middle Aged; Pilot Projects; Psychiatric Status Rating Scales; Treatment Outcome
PubMed: 28422805
DOI: 10.1097/YCT.0000000000000413 -
Anesthesiology Aug 1971
Comparative Study Review
Topics: Anesthesia, Intravenous; Anesthetics; Barbiturates; Diazepam; Eugenol; Kinetics; Methohexital; Neuroleptanalgesia; Preanesthetic Medication; Thiopental
PubMed: 4936119
DOI: 10.1097/00000542-197108000-00009 -
Epilepsia Sep 2002We report our experience with sodium methohexital (Brevital) as an anesthetic used in the Wada test for language and memory in 86 epilepsy surgery patients (173... (Comparative Study)
Comparative Study
PURPOSES
We report our experience with sodium methohexital (Brevital) as an anesthetic used in the Wada test for language and memory in 86 epilepsy surgery patients (173 procedures).
METHODS
The methods are compared with those of the more commonly used anesthetic sodium amobarbital (Amytal).
RESULTS
Despite differences between the methohexital and amobarbital test protocols, the behavioral and neurologic effects of the two anesthetics are similar. Because of the brief duration of methohexital, two successive injections are made on each side rather than one, to lengthen the time available for testing both language and memory. Behavioral and EEG indices return to baseline more quickly and more completely with methohexital than with amobarbital, allowing several repetitions of the procedure without incremental drowsiness, and the total time taken for the procedure is less with methohexital than with amobarbital.
CONCLUSIONS
The results of language and memory testing in the Wada test are equivalent for amobarbital and methohexital, except that methohexital has a briefer duration of action and is associated with less sedation.
Topics: Adolescent; Adult; Amobarbital; Anesthetics, Intravenous; Brain; Carotid Artery, Internal; Child; Epilepsy; Female; Functional Laterality; Humans; Hypnotics and Sedatives; Injections, Intra-Arterial; Male; Memory; Methohexital; Middle Aged; Neuropsychological Tests
PubMed: 12199731
DOI: 10.1046/j.1528-1157.2002.00902.x -
Pharmacopsychiatry Jul 2023The effectiveness of ECT relies on the induction of a generalized cerebral seizure. Among others, seizure quality (SQ) is potentially influenced by the anesthetic drug...
INTRODUCTION
The effectiveness of ECT relies on the induction of a generalized cerebral seizure. Among others, seizure quality (SQ) is potentially influenced by the anesthetic drug used. Commonly used anesthetics comprise barbiturates, etomidate, propofol, and esketamine, with different characteristics and impacts on seizure parameters. So far, no studies have compared the influence of methohexital vs. a combination of propofol/esketamine on established SQ parameters.
METHODS
This retrospective longitudinal study compared eight established SQ parameters (PSI, ASEI, MSC, midictal amplitude, motor and electroencephalography (EEG) seizure duration, concordance, PHR) before and after the change from propofol/esketamine to methohexital in 34 patients under maintenance ECT. Each patient contributed four measurements, two before and two after the anesthesia change. Anesthesia dose, stimulus dose, electrode placement, and concomitant medication remained unchanged throughout the analyzed treatments.
RESULTS
Under methohexital (=88.97 mg), ASEI (=0.039 to 0.013) and midictal amplitude (=0.022 to<0.001) were significantly lower, whereas seizure duration (motor and EEG) was significantly longer when compared to propofol/esketamine (M=64.26 mg/51.18 mg; =0.012 to<0.001). PSI, MSC, seizure concordance, and PHR were not affected by the anesthetic used.
DISCUSSION
Although to what extent these parameters correlate with the therapeutic effectiveness remains ambiguous, a decision for or against a particular anesthetic could be considered if a specific SQ parameter needs optimization. However, no general superiority for one specific substance or combination was found in this study. In the next step, anesthetic effects on treatment response and tolerability should be focused on.
Topics: Humans; Propofol; Methohexital; Anesthetics, Intravenous; Retrospective Studies; Longitudinal Studies; Electroconvulsive Therapy; Seizures; Electroencephalography; Anesthesia
PubMed: 37116539
DOI: 10.1055/a-2058-9010 -
Anesthesiology Feb 1995The use of anesthetics can lead to changes of the permeability of the blood-brain barrier (BBB). To eliminate those factors, such as varying hemodynamic effects that are...
BACKGROUND
The use of anesthetics can lead to changes of the permeability of the blood-brain barrier (BBB). To eliminate those factors, such as varying hemodynamic effects that are associated with anesthesia, an in vitro model of the BBB consisting of brain microvascular endothelial cells (BMEC) was used to study the direct effects of the opiate, fentanyl, and the barbiturates methohexital and thiopental, which are widely used in the clinical setting, on the permeability of confluent monolayers.
METHODS
BMEC isolated from porcine brains were grown to confluence on collagen-coated polycarbonate membranes, which were placed into 24 well dishes, thus forming a two-compartment chamber. The permeability of the BMEC monolayer to ions--determined by measurements of the transendothelial resistance (TER)--the passage of sucrose, Evans Blue albumin (EBA), and alpha-aminoisobutyric acid (AIB) across the BMEC monolayer were assessed in the presence and absence of fentanyl (25-100 ng/ml), methohexital (10-50 micrograms/ml), and thiopental (25-100 micrograms/ml).
RESULTS
The permeability of cultured BMEC to the tracers used increased significantly after exposure of the monolayer to arabinose and after removal of calcium ions. Fentanyl, methohexital, and thiopental did not change the permeability of the cell monolayer to ions, sucrose, albumin, and AIB. Only thiopental at the concentration of 100 micrograms/ml increased the flux of AIB.
CONCLUSIONS
At the concentrations tested, there is little evidence of changes in the permeability of the in vitro BBB caused by fentanyl, methohexital, and thiopental regarding the para- and transcellular route of ions, sucrose, and albumin. Only thiopental at a concentration of 100 micrograms/ml increased the passage of AIB across the BMEC monolayer.
Topics: Albumins; Aminoisobutyric Acids; Animals; Blood-Brain Barrier; Cells, Cultured; Dose-Response Relationship, Drug; Electrophysiology; Endothelium; Fentanyl; In Vitro Techniques; Methohexital; Sucrose; Swine; Thiopental; Time Factors
PubMed: 7856903
DOI: 10.1097/00000542-199502000-00015 -
British Journal of Anaesthesia Jul 1976
Review
Topics: Alfaxalone Alfadolone Mixture; Anesthesia, Intravenous; Humans; Ketamine; Methohexital; Propanidid
PubMed: 797395
DOI: 10.1093/bja/48.7.617 -
British Journal of Anaesthesia Mar 1970
Review
Topics: Anesthesia, Dental; Blood Pressure; Epilepsy; Heart Rate; Humans; Injections, Intra-Arterial; Injections, Intravenous; Methohexital; Muscles; Thrombophlebitis
PubMed: 4909790
DOI: 10.1093/bja/42.3.255 -
Proceedings of the Royal Society of... May 1963
Topics: Anesthesia; Anesthesia, Dental; Anesthesiology; Humans; Methohexital; Minor Surgical Procedures
PubMed: 13950113
DOI: No ID Found