Methohexital

DEA Class;  Rx

Common Brand Names; Brevital

Known hypersensitivity to barbiturates

Patients in whom general anesthesia contraindicated

Patients with latent or manifest porphyria

Hiccups, coughing, muscle twitching & laryngospasm, which may impair pulmonary ventilation

Respiratory depression, apnea, dyspnea, cardiorespiratory arrest (which may occur in association with seizures), or hypotension may occur

Circulatory depression, peripheral vasculatory collapse, bronchospasm, postanesthetic shivering, salivation, skeletal muscle hyperactivity (twitching to convulsive-like movements), seizures, restlessness, anxiety (especially in the presence of postop pain), headache, nausea, vomiting, abd pain, & emergence delirium may also occur

Acute allergic reactions including erythema, pruritus, urticaria, rhinitis, hypotension, dyspnea, anxiety, restlessness, abdominal pain & peripheral vascular collapse have been reported

Thrombophlebitis, injection site pain, & injury to nerves adjacent to injection site

Extravasation may cause local irritation manifested as pain, swelling, ulceration, & necrosis

Caution in severe anemia, extreme obesity, debilitated patients

Rapid bolus doses will increase cardiorespiratory effects including laryngospasm, apnea, hypotension, myocardial depression, cardiovascular collapse

Mild sedation may persist 8-12 hr

Patients should be instructed on discharge not to drive or operate heavy machinery

All routes of administration are often associated with hiccups, coughing, and/or muscle twitching, which may also impair pulmonary ventilation; following induction, temporary hypotension and tachycardia may occur

Recovery from methohexital anesthesia is rapid and smooth; the incidence of postoperative nausea and vomiting is low if the drug is administered to fasting patients; postanesthetic shivering has occurred in a few instances

The usual precautions taken with any barbiturate anesthetic should be observed with this drug; the drug should be used with caution in patients with asthma, obstructive pulmonary disease, severe hypertension or hypotension, myocardial disease, congestive heart failure, severe anemia, or extreme obesity

Use with extreme caution in patients in status asthmatics; caution should be exercised in debilitated patients or in those with impaired function of respiratory, circulatory, renal, hepatic, or endocrine systems

This drug should be used only in hospital or ambulatory care settings that provide for continuous monitoring of respiratory (eg. Pulse oximetry) and cardiac function; immediate availability of resuscitative drugs and age- and size-appropriate equipment for bag/valve/mask ventilation and intubation and personnel trained in their use and skilled in airway management should be assured

There are no adequate and well-controlled studies in pregnant women; published studies in pregnant primates demonstrate that administration of anesthetic and sedation drugs that block NMDA receptors and/or potentiate GABA activity during the period of peak brain development increases neuronal apoptosis in the developing brain of the offspring when used for longer than 3 hours

Excreted in breast milk; use by nursing mothers should be evaluated carefully