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Pronunciation |
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(meth
oh HEKS i
tal) |
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U.S. Brand
Names |
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Brevital®
Sodium |
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Generic
Available |
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No |
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Synonyms |
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Methohexital Sodium |
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Pharmacological Index |
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Barbiturate |
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Use |
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Induction and maintenance of general anesthesia for short procedures
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Restrictions |
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C-IV |
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Pregnancy Risk
Factor |
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C |
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Contraindications |
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Porphyria, hypersensitivity to methohexital or any
component |
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Warnings/Precautions |
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Use with extreme caution in patients with liver impairment, asthma,
cardiovascular instability |
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Adverse
Reactions |
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>10%: Local: Pain on I.M. injection
1% to 10%: Gastrointestinal: Cramping, diarrhea, rectal bleeding
<1%: Hypotension, peripheral vascular collapse, seizures, headache,
nausea, vomiting, hemolytic anemia, thrombophlebitis, tremor, twitching,
rigidity, involuntary muscle movement, radial nerve palsy, apnea, respiratory
depression, laryngospasm, coughing, hiccups |
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Overdosage/Toxicology |
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Symptoms of overdose include apnea, tachycardia, hypotension
Treatment is primarily supportive with mechanical ventilation if needed
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Drug
Interactions |
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CNS depressants worsen CNS depression |
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Stability |
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Do not dilute with solutions containing bacteriostatic agents; solutions are
alkaline (pH 9.5-11) and incompatible with acids (eg, atropine sulfate,
succinylcholine, silicone), also incompatible with phenol-containing
solutions and silicone |
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Mechanism of
Action |
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Ultra short-acting I.V. barbiturate anesthetic |
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Pharmacodynamics/Kinetics |
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Onset of effect: Immediately after I.V. injection
Duration: 10-20 minutes after a single dose |
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Usual Dosage |
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Doses must be titrated to effect
I.M.: Preop: 5-10 mg/kg/dose
I.V.: Induction: 1-2 mg/kg/dose
Rectal: Preop/induction: 20-35 mg/kg/dose; usual 25 mg/kg/dose; administer as
10% aqueous solution
Adults: I.V.: Induction: 50-120 mg to start; 20-40 mg every 4-7 minutes
Dosing adjustment/comments in hepatic impairment: Lower dosage and
monitor closely |
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Dietary
Considerations |
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Should not be given to patients with food in stomach because of danger of
vomiting during anesthesia |
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Administration |
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Dilute to a maximum concentration of 1% for I.V. use |
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Mental Health: Effects
on Mental Status |
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Drowsiness is common |
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Mental Health:
Effects on Psychiatric
Treatment |
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Used as induction anesthesia for electroconvulsive therapy (ECT); concurrent
use with psychotropics may produce additive CNS depression |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
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May cause drowsiness |
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Nursing
Implications |
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Avoid extravasation or intra-arterial administration |
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Dosage Forms |
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Injection, as sodium: 500 mg, 2.5 g, 5 g |
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References |
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Cote' CJ, "Sedation for the Pediatric Patient," Pediatr Clin North Am,
1994, 41(1):31-58.
Folkerts H,
"Spontaneous Seizure After Concurrent Use of Methohexital Anesthesia For Electroconvulsive Therapy and Paroxetine: A Case Report,"
J Nerv Ment Dis, 1995, 183(2):115-6.
Forbes RB, Murray DJ, Dillman JB, et al,
"Pharmacokinetics of Two Percent Rectal Methohexitone in Children," Can J
Anaesth, 1989, 36(2):160-4.
Wells D, Davies G, and Wagner D,
"Accidental Injection of Epidural Methohexital," Anesthesiology, 1987,
67(5):846-8. |
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