WARNING
Brevital should be used only in hospital or ambulatory care settings that provide for continuous monitoring of respiratory (e.g. 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. For deeply sedated patients, a designated individual other than the practitioner performing the procedure should be present to continuously monitor the patient. (See WARNINGS)
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BREVITAL SUMMARY
Brevital® Sodium (Methohexital Sodium for Injection, USP) is 2,4,6 (1 H, 3 H, 5 H)-Pyrimidinetrione, 1-methyl-5-(1-methyl-2-pentynyl)-5-(2-propenyl)-, (±)-, monosodium salt and has the empirical formula C14H17N2NaO3.
BREVITAL (methohexital) is indicated for the following:
Brevital Sodium can be used in adults as follows:
- For intravenous induction of anesthesia prior to the use of other general anesthetic agents.
- For intravenous induction of anesthesia and as an adjunct to subpotent inhalational anesthetic agents (such as nitrous oxide in oxygen) for short surgical procedures; Brevital Sodium may be given by infusion or intermittent injection.
- For use along with other parenteral agents, usually narcotic analgesics, to supplement subpotent inhalational anesthetic agents (such as nitrous oxide in oxygen) for longer surgical procedures.
- As intravenous anesthesia for short surgical, diagnostic, or therapeutic procedures associated with minimal painful stimuli (see
WARNINGS).
- As an agent for inducing a hypnotic state.
Brevital Sodium can be used in pediatric patients older than 1 month as follows:
- For rectal or intramuscular induction of anesthesia prior to the use of other general anesthetic agents.
- For rectal or intramuscular induction of anesthesia and as an adjunct to subpotent inhalational anesthetic agents for short surgical procedures.
- As rectal or intramuscular anesthesia for short surgical, diagnostic, or therapeutic procedures associated with minimal painful stimuli.
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NEWS HIGHLIGHTS
Published Studies Related to Brevital (Methohexital)
The comparative hemodynamic effects of methohexital and remifentanil in electroconvulsive therapy. [2005.03]
Remifentanil is a short acting opioid frequently used to supplement general anesthesia for brief procedures. Narcotic agents are known for their ability to blunt autonomic responses to stimuli such as laryngoscopy and intubation and do not alter seizure threshold...
The comparative effects of sevoflurane and methohexital for electroconvulsive therapy. [2003.12]
The standard anesthetic agent for electroconvulsive therapy (ECT) has been methohexital... We conclude that, when indicated, sevoflurane could provide a suitable alternative treatment option to methohexital, but some limitations, including shortened seizure duration and potential side effects, should be kept in mind.
Seizure duration with remifentanil/methohexital vs. methohexital alone in middle-aged patients undergoing electroconvulsive therapy. [2003.10]
CONCLUSION: Substituting part of the methohexital dose with remifentanil is a useful anesthetic technique to prolong seizure duration in middle-aged patients requiring a 1.5-fold higher induction dose of methohexital than elderly patients, the only population studied to date for the combined use of methohexital and remifentanil in ECT.
A randomized comparison of propofol and methohexital as general anesthetics for vacuum abortion. [2003.09]
The objective of this study was to determine whether propofol and methohexital differ in their efficacy, acceptability, cost and side effects when used as the single anesthetic agent for inducing general anesthesia in first-trimester vacuum abortion... In our population of midwestern patients in a major urban area, propofol use had modest advantages over methohexital when used as single agents as judged by first recovery charge nurses, but patients found them equally acceptable.
Randomized clinical trial of propofol versus methohexital for procedural sedation during fracture and dislocation reduction in the emergency department. [2003.09]
Although methohexital has been well studied for use in emergency department (ED) procedural sedation (PS), propofol has been evaluated less extensively for ED use. OBJECTIVE: The authors hypothesized that there is no difference in the depth of sedation and the rate of respiratory depression (RD) between propofol and methohexital in PS during the reduction of fractures and dislocations in the ED... CONCLUSIONS: The authors were unable to detect a significant difference in the level of subclinical RD or the level of sedation by BIS between the two agents. The use of either agent seems to be safe in the ED.
Clinical Trials Related to Brevital (Methohexital)
Ketamine Anesthesia in Electroconvulsive Therapy [Completed]
Does the use of ketamine as the anesthetic medication in electroconvulsive therapy (ECT)
accelerate the antidepressant effect of ECT?
The study hypothesis was that depressed subjects receiving ECT with ketamine as the
anesthetic agent would demonstrate a faster rate of improvement, defined as lower depression
ratings after the second ECT than depressed patients receiving ECT with the usual anesthetic
agent.
Use of Ketamine vs Methohexital for Electroconvulsive Therapy (ECT) on Patient Recovery and Re-orientation Time [Completed]
Ketamine as an Augmentation Strategy for Electroconvulsive Therapy (ECT) in Depression [Recruiting]
The study aims to compare outcomes of Electroconvulsive Therapy (ECT) using ketamine versus
methohexital anesthesia in depressed patients. The investigators hypothesize that patients
who receive ketamine anesthesia during ECT will achieve remission status faster than those
receiving methohexital anesthesia. Also, at the end of the ECT course subjects will display
fewer cognitive side effects compared to those treated with methohexital anesthesia.
Enhancing the Effectiveness of Electroconvulsive Therapy in Severe Depression [Active, not recruiting]
Electroconvulsive therapy (ECT) is the most powerful antidepressant treatment available and
is often life-saving. There are concerns, however, that standard bitemporal ECT (the most
commonly used form of ECT worldwide) causes persisting retrograde amnesia. However, clinical
trials have indicated that high-dose unilateral ECT may be as effective as bitemporal ECT
but have much less cognitive side-effects.
The trial aims to test the primary experimental hypothesis: High-dose (6 x ST) right
unilateral ECT is as effective as (i. e. not inferior to) standard (1. 5 x ST) bitemporal ECT
for severe depression in terms of Hamilton Depression Rating Score (HDRS) at the end of the
treatment course.
Use of Ketamine to Enhance Electroconvulsive Therapy (ECT) in Depression [Terminated]
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Page last updated: 2006-01-31
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