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Created February 7, 2021, last updated almost 4 years ago.
Collection: 135, Score: 1032, Trend score: 0, Read count: 1425, Articles count: 2, Created: 2021-02-07 23:12:08 UTC. Updated: 2021-02-07 23:22:59 UTC.Notes
A barbiturate derivative (Brevital™, Brietal™) intravenous anaesthetic agent, no longer available in Australia although still used in other parts of the world.
Preferred for use in electroconvulsive therapy for its pro-seizure effects and comparatively short duration.
Compared to thiopentone
- Oxybarbiturate
- Made up in 50 mL to 1% solution
- 3x more potent
- 3x clearance (12 mL/kg/min)
- tß½ 3 h (STP 8h)
- Greater ionised proportion
- Less protein binding (65%)
- More rapid recovery: 2-3 min (smaller fat compartment, no active metabolites, ⇡ clearance)
- Higher incidence of pain on injection
- Pro-convulsant/epileptiform EEG (excitatory in 30%)
- PONV (30%)
- Less dec MAP, more inc HR than STP
- More pronounced resp depression
Daniel Jolley
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Collected Articles
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Anesthesia and analgesia · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialExcitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol.
Excitatory movements have been observed during induction of anesthesia with etomidate, thiopental, methohexital, and propofol. We studied the frequency of these excitatory effects and correlated movements with electroencephalographic (EEG) findings in 67 unpremedicated patients (mean age 66.1 yr, range 45-82 yr). Excitatory effects, including myoclonus, tremor, and dystonic posturing, occurred in 86.6% of patients receiving etomidate; 69.2% of the patient responses were myoclonic. ⋯ In most patients, the excitatory movements were coincident with the early slow phase of the EEG which corresponds to the beginning of deep anesthesia. We conclude that perhaps caution should be exercised when administering etomidate to patients with a history of seizures as the myoclonic activity is associated with seizure activity. The incidence of excitatory movements after administration of propofol is very low.
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Use of methohexital as an agent for moderate procedural sedation in the Emergency Department (ED) recently has increased. As a barbiturate, potential complications include respiratory and myocardial depression. We conducted a retrospective review of medical records and procedural flow charts for all use of methohexital in our ED during a 31-month period. ⋯ Complications occurred in 20.2% of patients and included oxygen desaturation, hypotension, hypoventilation, vomiting, tremor, and airway obstruction. All complications were transient and managed without sequelae. Use of concurrent parenteral opioid medications had no significant impact on success or complications.