Methohexital

Aka: Methohexital, Methohexital Sodium, Brevital

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II. Indications

  1. Procedural Sedation (esp. Electroconvulsive Therapy or ECT)

III. Contraindications

  1. Absolute Contraindications
    1. Acute Intermittent Porphyria
    2. Barbiturates Hypersensitivity
  2. Relative Contraindications
    1. Cardiovascular disease
    2. Hypotension
    3. Respiratory depression or uncontrolled respiratory disease

IV. Precautions: Standard Procedural Sedation precautions

  1. Close cardiopulmonary monitoring (e.g. Pulse Oximetry, Blood Pressure, End-Tidal CO2)
  2. Airway management (e.g. suction, LMA, Endotracheal Intubation)
  3. Breathing management (e.g. Supplemental Oxygen, Bag Valve Mask)

V. Mechanism

  1. See Barbiturate
  2. Rapid onset, short acting Barbiturate (barbituric acid derivative)
  3. Cerebral Cortex and cerebellar Sedative-Hypnotic

VI. Dosing

  1. Procedural Sedation
    1. Start: 1 mg/kg IV
    2. Next: 0.5 mg/kg every 2-5 minutes
  2. Induction
    1. See Rapid Sequence Intubation
    2. Adults: 50-120 mg (mean 70 mg) IV push given as 10 mg (1 ml of 1% solution) every 5 seconds until effect

VII. Pharmacokinetics

  1. Half-life: 3-6 hours
  2. Onset
    1. IV: Immediate
    2. IM: 2-10 minutes
    3. PR: 5-15 minutes
  3. Duration
    1. IV: 10-20 minutes
    2. PR: 45 minutes
  4. Metabolism
    1. Slow hepatic metabolism to inactive substances
  5. Excretion
    1. Primarily excreted in urine (minimal excretion in sweat and stool)

VIII. Adverse Effects

  1. See Barbiturates
  2. See Procedural Sedation
  3. Laryngospasm (rare)
    1. Administering additional Methohexital dose typically stops the laryngospasm
  4. Respiratory Depression or Apnea
  5. Hiccoughs
  6. Hypotension

IX. Resources

  1. Methohexital (Stat Pearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK544291/

X. References

  1. LoVecchio (2019) Crit Dec Emerg Med 33(7): 28

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Related Studies

Ontology: Methohexital (C0025668)

Definition (MSH) An intravenous anesthetic with a short duration of action that may be used for induction of anesthesia.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D008723
SnomedCT 373488009, 39124003
LNC LP18125-2, MTHU003436
English Methohexital, Methohexitone, Methohexital [Chemical/Ingredient], methohexitone, methohexital, Methohexital (product), Methohexital (substance), METHOHEXITAL
Swedish Metohexital
Czech methohexital
Finnish Metoheksitaali
Russian METOGEKSITAL, METOGEKSITON, ENALLINIMAL, МЕТОГЕКСИТАЛ, МЕТОГЕКСИТОН, ЭНАЛЛИНИМАЛ
Japanese メトヘキシタール, ブレビタール, メトヘキシタールナトリウム, ナトリウムメトヘキシタール, ブレビミタール, ブリエタール, ブリエタールナトリウム, ブレビタールナトリウム, メトヘキシトン
Italian Methohexitone, Metohexital
Polish Metoheksytal, Enallynymalum
Spanish metohexital (producto), metohexital (sustancia), metohexital, metohexitona, Metohexital, Metohexitona
French Méthohéxital
German Methohexital, Methohexiton
Portuguese Metoexital, Metoexitona
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Methohexital Sodium (C0304448)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D008723
SnomedCT 333856000, 91594002
English Methohexitone sodium, methohexital sodium, methohexital sodium (medication), Methohexital Sodium [Chemical/Ingredient], sodium methohexital, Methohexital, Monosodium Salt, Monosodium Salt Methohexital, Sodium, Methohexital, Methohexitone sodium (product), Methohexital sodium, Methohexital sodium (substance), Methohexitone sodium (substance), Methohexital Sodium, METHOHEXITAL SODIUM
Spanish metohexital sódico (producto), metohexital sódico (sustancia), metohexital sódico, metohexitona sódica (producto), metohexitona sódica
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Brevital (C0733444)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D008723
English brevital, Brevital, Jones Brand of Methohexital Sodium
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology

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