The induction of general anaesthesia for electroconvulsive therapy (ECT) often includes intravenous agents, such as propofol, methohexitone and thiopentone (1).
While short-acting intravenous agents, such as propofol, methohexitone and thiopentone, are used in general anaesthesia for ECT, a short-acting opioid can also be added to these agents to prolong seizure duration, increase seizure quality and reduce haemodynamic responses to ECT (1-7).
Comparison of methohexitone and propofol for electroconvulsive therapy: effects on hemodynamic responses and seizure duration.
Comparison of patient-controlled sedation with either methohexitone
Weksler N, Stav A, Ovadia L, et al: Lidocaine pretreatment effectively decreases the incidence of hiccups during methohexitone
administration for dilatation and curettage.
Krystal et al (3) retrospectively investigated cases in which ECTs with methohexitone produced seizures lasting shorter than 25 seconds, despite maximal stimulation, and reported that the addition of ketamine at a mean dose of 1.
However, some investigators have reported that multiple-lead EEGs recorded during ketamine seizures revealed greater ictal power, suggesting that there might be qualitative differences in the seizure between ketamine and methohexitone (17).
They found no difference between ketamine and methohexitone in relation to peak HR and SBP, whereas DBP was found to be higher among patients receiving ketamine.
Methohexitone, initially proposed by the American Psychiatric Association as the anaesthetic agent of choice for induction of anaesthesia in patients undergoing ECT (6), is no longer available in Malaysia and many parts of the world.
Historically, because of its short duration of action and minimal effect on seizure threshold, methohexitone is the most popular intravenous anaesthetic for ECT (32).
Key Words: unapproved medicines, medicines regulations, Medicines Act 1981 Section 29, anaesthesia, metaraminol, halothane, thiopentone, etomidate, methohexitone
Products used specifically by anaesthetists were co-phenylcaine nasal spray, etomidate, halothane, metaraminol, methohexitone and thiopentone.