Methohexitone

Intravenous techniques in ambulatory anesthesia

The growing importance of ambulatory surgery during the past decade has led to the development of efficient anesthetic techniques in terms of quality and safety of anesthesia and recovery. In these challenging objectives, intravenous techniques have played an important role, as they provide safe, efficient, and cost-effective anesthesia in the ambulatory setting. Among the numerous intravenous drugs, propofol, with its fast and smooth onset of action, short duration of action, and low incidence of postoperative side effects appears to be the anesthetic of choice in this situation. The recent development of new techniques of administration (such as TCI, monitored anesthesia care, or patient-controlled sedation) and monitoring (such as the BIS and the availability of "hit and run" drugs such as remifentanil) will optimize intraoperative conditions and recovery, thus allowing faster home readiness in the ambulatory setting.

The cost-effectiveness of methohexital versus propofol for sedation during monitored anesthesia care

We designed this study to test the hypothesis that methohexital is a cost-effective alternative to propofol for sedation during local anesthesia. Sixty consenting women undergoing breast biopsy procedures under local anesthesia were randomly assigned to receive an infusion of either propofol (50 microg x kg(-1) x min(-1)) or methohexital (40 microg x kg(-1) x min(-1)). The sedative infusion rate was titrated to maintain an observer's assessment of alertness/sedation (OAA/S) score of 3 (with 1 = awake/alert to 5 = asleep). Fentanyl 25 microg i.v. was administered as a "rescue" analgesic during the operation. We assessed the level of sedation (OAA/S score), vital signs, time to achieve an OAA/S score of 3 at the onset and a score of 1 after discontinuing the infusion, discharge times, perioperative side effects, and patient satisfaction. The direct cost of methohexital was lower than that of propofol, based on the milligram dosage infused during the operation. The sedative onset (to achieve an OAA/S score of 3) and the recovery (to return to an OAA/S score of 1) times, as well as discharge times, did not differ between the two groups. Patients receiving methohexital had a significantly lower incidence of pain on initial injection compared with those receiving propofol (10% vs 23%). Because the use of methohexital (29.4 +/- 2.7 microg x kg(-1) x min(-1)) for sedation during breast biopsy procedures has a similar efficacy and recovery profile to that of propofol (36.8 +/- 15.9 microg x kg(-1) x min(-1)) and is less costly based on the amount infused, it seems to be a cost-effective alternative to propofol for sedation during local anesthesia. However, when the cost of the drug infused and drug wasted was calculated, there was no difference in the overall drug cost.

IMPLICATIONS

When administered to maintain a stable level of sedation during local anesthesia, methohexital is an acceptable alternative to propofol. However, the overall drug costs were similar with the two drugs.

Airway management and sedation for pediatric transport

Appropriate airway management is essential for the successful transport of sick children. Airway management begins with a thorough history and physical examination and may proceed to invasive therapeutic interventions. Successful care of the pediatric airway can be achieved only with a thorough knowledge of airway management technique and equipment. In addition, familiarity and understanding of the pharmacologic adjuvants to airway management and sedation will help to achieve the primary objective of any transport team, namely a safe and smooth transport of the critically ill child.

Comparative evaluation of propofol or methohexitone as the sole anaesthetic agent for microlaryngeal surgery

Propofol or methohexitone was given to the same twenty patients on two separate occasions during total intravenous anaesthesia for microlaryngeal surgery. With propofol the quality of induction was superior. Fewer patients required supplementation. Heart rate and blood pressure were well controlled at levels of 110-120% baseline. There were fewer side-effects during maintenance and recovery. Patients were able to return home earlier. However, apnoea and pain on injection occurred frequently, the latter when injection was made into the dorsum of the hand. With methohexitone, apnoea, abnormal movement, nausea, vomiting, headache, restlessness and confusion were common. Cardiovascular variables were poorly maintained at levels of 170-180% baseline. The results suggest that propofol is suitable as the sole anaesthetic agent in patients undergoing microlaryngeal surgery.

The prevention of pain on injection. A study of the effect of intravenous lignocaine before methohexitone

The effect of pre-injection of lignocaine 10 mg or physiological saline was assessed in a double blind trial on 100 unpremedicated day cases having a methohexitone induction. The incidence of pain was reduced from 64% to 22% using lignocaine.

The effect of diazepam on methohexitone short anaesthesia: a clinical double-blind investigation

A double-blind investigation was performed on 113 adult females, hospitalized for short gynaecological procedures, in order to establish the suitability of methohexitone for short procedures and whether or not the quality of methohexitone anaesthesia could be improved with a diazepam supplement. All patients were anaesthetized with methohexitone (2.0 mg/kg): 57 of the patients received a 10 mg diazepam intravenous supplement and 56 received intravenous placebo (solvent of diazepam only). Diazepam injected after induction with methohexitone clearly improved the quality of methohexitone anaesthesia (p less than 0.1 more than 0.05) and reduced the need for supplementary doses of methohexitone (p less than 0.1 more than 0.05). The incidences of both nausea and vomiting were minimized (p less than 0.01 more than 0.001). Patient acceptance was equally good in both groups. It is commented that patients may seem fully awake and oriented, notwithstanding the fact that the body still contains significant amounts of the anaesthetic agent. Ambulatory patients should never be allowed to leave the hospital unescorted, as they recover their 'street-orientation' only after 12 to 24 hours. Furthermore, the patients or their escorts should be given definite and written instructions to avoid absolutely the use of alcohol or hypnotics which could, even in small amounts, potentiate the effect of methohexitone still in the body, for at least 12 hours. It is recommended that patients should avoid driving a motor vehicle or using dangerous tools or machines for 12 to 24 hours following recovery from methohexitone anaesthesia.

ICI 35868 (Diprivan): a new intravenous induction agent. A comparison with methohexitone

ICI 35868 (Diprivan) has been used as an induction agent in patients undergoing minor gynaecological surgery and as the sole anaesthetic agent during bronchoscopy, and its effects were compared with those of methohexitone. The new agent proved to be satisfactory, although induction of anaesthesia was significantly longer than following methohexitone. complications were similar with both drugs. ICI 35868 deserves full investigation as an intravenous anaesthetic agent.

Methohexitone or etomidate for induction of dental anaesthesia

Ninety-two patients who presented for outpatient dental extractions received methohexitone (1.5 mg . kg-1, 46 patients) or etomidate (0.3 mg . kg-1, 23 patients and 0.2 mg . kg-1, 23 patients). The induction characteristics of both drugs such as pain on injection, involuntary muscle movements and respiratory difficulties were comparable and the theoretical disadvantages of etomidate for dental anaesthetics did not prove troublesome in practice. Muscle movements did not interfere with the dentists' manipulations and pain on injection into veins of the antecubital fossa did not occur. The duration of operation for up to four extractions was three minutes and, following induction, anaesthesia was maintained with nitrous oxide, oxygen and halothane. Recovery was assessed by grading consciousness, airway control and motor activity. All the patients could maintain their airways one minute after the end of operation. The incidence of nausea and vomiting was significantly greater in the etomidate group.

Rectal methohexitone for induction of anaesthesia in children

Rectal induction of anaesthesia using ten per cent methohexitone is a safe and effective method for young children. It is particularly applicable to the child three months to four years of age. Twenty-five mg.kg-1 of methohexitone should be given and the child should be observed continuously by the anaesthetist until he falls asleep. Equipment to establish an artificial airway and to ventilate the lungs should be immediately at hand. The use of rectal methohexitone does not significantly delay immediate or late recovery after short (30-minute) surgical procedures.

Etomidate and methohexitone. A comparative clinical study in out-patient anaesthesia

Etomidate compares favourably with methohexitone as an intravenous induction agent in out-patient anaesthesia excluding the incidence of involuntary muscle movement. The use of propylene glycol as a solvent for etomidate does not alter the previously claimed advantageous features of this agent.