From the Guidelines
Methohexital is a suitable anesthetic agent for use in electroconvulsive therapy (ECT) and procedural sedation, with a rapid onset of action and short duration, as supported by studies such as 1 and 1. The typical adult dose for induction of anesthesia is 1-1.5 mg/kg IV, with a total dose usually not exceeding 100 mg. For procedural sedation, smaller doses of 0.5-1 mg/kg may be used. Some key points to consider when using methohexital include:
- Rapid onset of action (within 30-60 seconds) and short duration (5-7 minutes), making it suitable for brief procedures
- Enhances the inhibitory effects of GABA in the central nervous system, resulting in sedation, hypnosis, and anticonvulsant effects
- Side effects include respiratory depression, hypotension, and pain at the injection site
- Should be used with caution in patients with porphyria, cardiovascular disease, or respiratory compromise
- Adequate monitoring equipment and personnel trained in airway management must be present when administering methohexital due to its potential for causing respiratory depression
- Contraindicated in patients with known hypersensitivity to barbiturates As noted in 1, methohexital has demonstrated efficacy in providing procedural sedation in children, with success rates ranging from 92% to 100% in various studies. However, it is essential to consult with an anesthesiologist and other specialists as needed, as recommended in 1, to ensure safe and effective use of methohexital. In terms of administration, methohexital can be given via intravenous, intramuscular, or rectal routes, with the choice of route depending on the specific procedure and patient needs. Overall, methohexital is a valuable option for anesthesia and sedation in various medical procedures, including ECT and procedural sedation, when used judiciously and with appropriate caution.
From the FDA Drug Label
Methohexital sodium is a rapid, ultrashort-acting barbiturate anesthetic. BREVITAL is a Schedule IV drug. BREVITAL may be habit-forming.
The main points about Methohexitol are:
- It is a rapid, ultrashort-acting barbiturate anesthetic 2
- It is a Schedule IV drug and may be habit-forming 2
From the Research
Methohexitol Overview
- Methohexitol is a barbiturate used for procedural sedation and anesthesia 3, 4, 5, 6
- It has a short half-life and minimal hemodynamic effects, making it suitable for procedures like cardioversion 5, 6
Comparison with Other Agents
- Methohexitol has been compared to propofol, ketamine, and midazolam in various studies 3, 4, 5
- A study found that methohexitol had a higher number of complications compared to propofol and benzodiazepine/narcotics 3
- However, another study found that methohexitol was a safe and effective option for procedural sedation in musculoskeletal procedures, with no incidence of respiratory depression 4
- Methohexitol has also been compared to propofol and etomidate for procedural sedation in cardioversions, with similar efficacy and safety profiles 6
Pharmacological Properties
- Methohexitol is a potent anesthetic agent that acts on the central nervous system 5
- It has a rapid onset and recovery time, making it suitable for short procedures 5
- The duration of action of methohexitol is dependent on the duration of administration 7
Clinical Use
- Methohexitol is used for procedural sedation and anesthesia in various settings, including oral and maxillofacial surgery and emergency departments 3, 4, 6
- It is often used in combination with other agents, such as benzodiazepines and opioids 7
- Methohexitol has been found to be a safe and effective option for procedural sedation in various studies, with minimal hemodynamic effects and a low risk of adverse events 4, 6