methohexital


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methohexital

 [meth″o-hek´sĭ-tal]
an ultrashort-acting barbiturate; its sodium salt is used as a general anesthetic, a general and local anesthesia adjunct, and a sedative for certain diagnostic procedures in children.

methohexital

(meth-o-hex-i-tal) ,

Brevital

(trade name),

Brietal

(trade name)

Classification

Therapeutic: general anesthetics
Pharmacologic: barbiturates
Pregnancy Category: C

Indications

Induction of general anesthesia.Sole anesthesia in short (<15 min), minimally painful procedures.Supplement to other anesthetic agents.To produce unconsciousness during balanced anesthesia.

Action

Produces anesthesia by depressing the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.

Therapeutic effects

Unconsciousness and general anesthesia.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Accumulates and may be slowly re-released from lipoid tissues; rapidly crosses the blood-brain barrier. Crosses the placenta.
Metabolism and Excretion: Mostly metabolized by the liver; some metabolism in kidneys and brain.
Half-life: 1.5–5 hr (increased in geriatric patients).

Time/action profile (anesthesia)

ROUTEONSETPEAKDURATION
IVwithin 60 secunknown5–7 min
IM†2–10 minunknownunknown
†In pediatric patients

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Intra-arterial injection; Porphyria; Lactation: Lactation.
Use Cautiously in: Addison’s disease; Severe anemia; Severe CV or hepatic disease; Myxedema; Shock or hypotension; Pulmonary disease; Debilitated patients; Geriatric: Appears on Beers list. Geriatric patients are at increased risk for side effects (dose reduction recommended); Obstetric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • seizures (life-threatening)
  • anxiety
  • emergence delirium
  • headache
  • restlessness

Ear, Eye, Nose, Throat

  • rhinitis

Respiratory

  • apnea (life-threatening)
  • laryngospasm (life-threatening)
  • bronchospasm
  • coughing
  • dyspnea
  • respiratory depression

Cardiovascular

  • cardiorespiratory arrest (life-threatening)
  • hypotension

Gastrointestinal

  • abdominal pain
  • hiccups
  • nausea
  • salivation
  • vomiting

Dermatologic

  • erythema
  • pruritus
  • urticaria

Local

  • pain at IM site
  • phlebitis at IV site

Musculoskeletal

  • muscle twitching

Miscellaneous

  • shivering (most frequent)
  • allergic reactions

Interactions

Drug-Drug interaction

Additive CNS depression with alcohol, antihistamines, opioid analgesics, and sedative/hypnotics.See sedative interactions.St. John's wort may affect methohexital levels and effectiveness; avoid use.Concomitant use of kava, valerian, skullcap, chamomile, or hops can increase CNS depression.

Route/Dosage

All doses must be individualized
Intravenous (Adults) Induction—1–1.5 mg/kg. Maintenance—20–40 mg q 4–7 min as intermittent doses or 3 mL of a 0.2% solution/min.
Intramuscular (Children >1 mo) Induction—6.6–10 mg/kg of a 5% solution.
Rectal (Children >1 mo) Induction—25 mg/kg using a 1% solution.

Availability (generic available)

Powder for injection: 500 mg, 2.5 g, 5 g

Nursing implications

Nursing assessment

  • Assess BP, ECG, heart rate, and respiratory status continuously throughout methohexital therapy. Methohexital should be used only by individuals qualified to administer anesthesia and experienced in endotracheal intubation. Equipment for this procedure should be immediately available. Apnea may occur immediately after IV injection, especially in the presence of opioid premedication.
  • Monitor IV site carefully. Extravasation may cause pain, swelling, ulceration, and necrosis. Intra-arterial injection may cause arteritis, vasospasm, edema, thrombosis, and gangrene of the extremity.
  • Overdose may occur from rapid injection (drop in BP, possibly to shock levels) or excessive or repeated injections (respiratory distress, laryngospasm, apnea).

Potential Nursing Diagnoses

Ineffective breathing pattern (Side Effects)
Risk for injury (Side Effects)

Implementation

  • Do not confuse Brevital (methohexital) with Brevibloc (esmolol).
    • Dose is individualized according to depth of anesthesia desired; concurrent use of other medications and/or nitrous oxide; patient’s condition, age, weight, and sex.
    • Geriatric: Geriatric patients may require smaller doses than young patients. Tolerance may develop with repeated use, such as for burns. Individuals tolerant to alcohol or barbiturates may require higher doses.
  • Intravenous Administration
  • Intravenous: Repeated doses or continuous infusion of methohexital may cause prolonged somnolence and respiratory and circulatory depression. If the patient requires a second anesthetic in the same day, reduction in the dose of methohexital may be required.
    • Methohexital may be given in doses sufficient to produce deep surgical anesthesia, but such doses may cause dangerous respiratory and circulatory depression.
    • Premedication with anticholinergics (atropine, glycopyrrolate) may be used to decrease mucous secretions. Opioid analgesics may be administered preoperatively to enhance the poor analgesic effects of methohexital. Preoperative medications should be given so that peak effect is attained shortly before induction of anesthesia. Muscle relaxants, if required, should be administered separately.
  • Diluent: Do not use diluents containing bacteriostats. Dilute 500 mg vial with 50 mL of sterile water for injection (preferred), D5W, or 0.9% NaCl. Concentration: 10 mg/mL (1% solution). Solution should be freshly prepared and used within 24 hr of reconstitution. Refrigerate and keep sealed. Do not administer solution containing a precipitate.
  • Rate: Induction dose is administered at a rate not to exceed 1 mL (10 mg) over 5 sec.
  • Continuous Infusion: Diluent: To prepare a 1% (10 mg/mL) solution, reconstitute each 2.5-g vial with 15 mL or each 5-g vial with 30 mL of sterile water for injection (preferred), D5W, or 0.9% NaCl. Initial solution will be yellow. Further dilute the 2.5-g vial in 250 mL or the 5-g vial in 500 mL. Concentration: 10 mg/mL (1% solution). Solution should be used only if clear and colorless.
    • Diluent: To prepare a 0.2% solution, dilute 500 mg in 250 mL of D5W or 0.9% NaCl. To avoid hypotonicity, do not dilute with sterile water. Concentration: 0.2% solution.
    • Solution is stable for 24 hr.
  • Rate: Anesthesia is maintained by intermittent injections every 4–7 min or by continuous infusion.
  • Syringe Compatibility: propofol.
  • Syringe Incompatibility: glycopyrrolate
  • Y-Site Compatibility: acyclovir, aminocaproic acid, atenolol, bivalirudin, bleomycin, carboplatin, cisplatin, cyclophosphomide, cytarabine, dactinomycin, dexmedetomidine, doxacurium, etoposide, fludarabine, fluorouracil, hydromorphone, ifosfamide, methotrexate, milrinone, mitoxantrone, nesiritide, octreotide, paclitaxel, pancuronium, pantoprazole, tigecycline, tirofiban, vasopressin, vincristine, voriconazole
  • Y-Site Incompatibility: doxorubicin, epirubicin, eptifibitide, etoposide phosphate, fenoldopam, gemtuzumab, idarubicin, irinotecan, mechlorethamine, ondanestron, oxytocin, rocuronium, vecuronium, vinorelbine

Patient/Family Teaching

  • Methohexital may cause psychomotor impairment for 24 hr after administration. Caution patient to avoid driving or other activities requiring alertness for 24 hr.
  • Advise patient to avoid use of alcohol or other CNS depressants for 24 hr after anesthesia, unless directed by health care professional.

Evaluation/Desired Outcomes

  • Loss of consciousness.
  • Maintenance of desired level of anesthesia without complications.

methohexital

/meth·o·hex·i·tal/ (meth″o-hek´sit-al) an ultrashort-acting barbiturate; its sodium salt is used as a general anesthetic, a general and local anesthesia adjunct, and a sedative for certain diagnostic procedures in children.

methohexital, methohexitone

an ultra-short-acting barbiturate.
References in periodicals archive ?
lack of responding during cocaine maintenance sessions, observed swelling, unusual difficulty or ease of injection during presession flush), patency was tested using an acute dose of methohexital (0.
Propofol as compared to methohexital has shown improved cognitive performance after anesthesia but statistical significance has been observed in only two cognitive trials.
A comparison of propofol, midazolam and methohexital for sedation during retrobulbar and peribulbar block.
24) By 2013, propofol had replaced the short-acting barbiturates, thiopental, and methohexital, as the preferred induction agent for general anesthesia in over 80% of U.
IV pentobarbital, rectal methohexital and thiopental are the barbiturates that have been studied for procedural sedation.
The FDA is adding its warning to the labels of 11 general anesthetics and sedatives, including desflurane, halothane, ketamine, lorazepam injection, methohexital, pentobarbital, and propofol.
Though IgE-mediated hypersensitivity reactions to thiopental, a thiobarbiturate, have been described, no reports of IgE-mediated hypersensitivity reactions to methohexital, an oxybarbiturate, have been described [11].
General Anesthesia Drugs Market by Molecule (Propofol, Benzodiazepines, ketamine(s(+) ketamine HCl), Methohexital Sodium), route of administration (Intravenous, Inhalational), Supply Chain (GPOs, Distributors), Competitive - Analysis Forecast to 2020
Acute detoxification of opioid-addicted patients with naloxone during propofol or methohexital anesthesia: a comparison of withdrawal symptoms, neuroendocrine, metabolic, and cardiovascular patterns.
Avramov MN, Husain MM, White PE The comparative effects of methohexital, propofol, and etomidate for electroconvulsive therapy.
14) Etomidate can be used in patients with contraindications to methohexital (15); however, this medication can lengthen ictal duration.
Brief unconscious sedation for painful pediatric oncology procedures: intravenous methohexital with appropriate monitoring is safe and effective.