A prospective evaluation of the safety and efficacy of methohexital in the emergency department

Lerman, Benjamin J; Yoshida, Douglas; Levitt, M. Andrew

doi:10.1016/s0735-6757(96)90047-9

Cited by 25 publications

(7 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This compares favorably with the use of intramuscular ketamine in nonpremedicated pediatric patients, as well as with other regimens used for procedural sedation and analgesia in adult ED patients. 7,8,10,[17][18][19]31 While there were no cases of emergence hallucinations, delirium, or other severe emergence reactions, 18 patients recalled dreaming while sedated. Of these, five patients described their dreams as being unpleasant (two unpleasant, three both pleasant and unpleasant).…”

Section: Discussionmentioning

confidence: 94%

“…[3][4][5][6][7][8][9][10] Unfortunately, all of these agents may cause respiratory depression, particularly when given in combination, in large doses, or to patients with underlying respiratory diseases. 3,[5][6][7][8][9][10][11][12][13][14] Ketamine hydrochloride is a phencyclidine derivative that causes dissociation between the cortical and limbic systems, preventing the higher centers from perceiving visual, auditory, or painful stimuli. It possesses a rapid onset and short duration of action and produces profound sedation and analgesia.…”

mentioning

confidence: 99%

See 1 more Smart Citation

A Combination of Midazolam and Ketamine for Procedural Sedation and Analgesia in Adult Emergency Department Patients

Chudnofsky

Weber

Stoyanoff

et al. 2000

Academic Emergency Medicine

120

View full text Add to dashboard Cite

Abstract. Objective:To describe the clinical characteristics of a combination of midazolam and ketamine for procedural sedation and analgesia in adult emergency department (ED) patients. Methods: This was a prospective, observational trial, conducted in the ED of an urban level II trauma center. Patients Ն 18 years of age requiring procedural sedation and analgesia were eligible, and enrolled patients received 0.07 mg/kg of intravenous midazolam followed by 2 mg/kg of intravenous ketamine. Vital signs were recorded at regular intervals. The adequacy of sedation, adverse effects, patient satisfaction, and time to reach discharge alertness were determined. Descriptive statistics were calculated using statistical analysis software. Results: Seventy-seven patients were enrolled. Three were excluded due to protocol violations, three due to lack of documentation, and one due to subcutaneous infiltration of ketamine, leaving 70 patients for analysis. The average age was 31 years, and 41 (59%) were female. Indications for procedural sedation and analgesia included abscess incision and drainage (66%), fracture/joint reduction (26%), and other (8%). The mean dose of midazolam was 5.6 Ϯ 1.4 mg and the mean dose of ketamine was 159 Ϯ 42 mg. The mean time to achieve discharge criteria was 64 Ϯ 24 minutes. Five patients experienced mild emergence reactions, but there were no episodes of hallucinations, delirium, or other serious emergence reactions. Eighteen (25%) patients recalled dreaming while sedated; twelve (17%) were described as pleasant, two (3%) unpleasant, three (4%) both pleasant and unpleasant, and one (1%) neither pleasant nor unpleasant. There were four (6%) cases of respiratory compromise, two (3%) episodes of emesis, and one (1%) case of myoclonia. All of these were transient and did not result in a change in the patient's disposition. Only one (1%) patient indicated that she was not satisfied with the sedation regimen. Conclusions: The combination of midazolam and ketamine provides effective procedural sedation and analgesia in adult ED patients, and appears to be safe.

show abstract

Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

A Combination of Midazolam and Ketamine for Procedural Sedation and Analgesia in Adult Emergency Department Patients

Chudnofsky

Weber

Stoyanoff

et al. 2000

Academic Emergency Medicine

120

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5][6] These rates are high compared to the 0.1-0.2% incidence of awareness after general anaesthesia. 7 In none of the ED studies was recall the primary outcome measure.…”

mentioning

confidence: 93%

Recall after procedural sedation in the emergency department

Swann

Williams

Fatovich

2007

Emergency Medicine Journal

View full text Add to dashboard Cite

Background: Procedural sedation (PS) is common in the emergency department (ED) and ideally patients should have no recall of the procedure. Aim: To determine the incidence of recall. Methods: A prospective observational study in an university ED of all patients undergoing PS. Data were collected on a pre-formatted data sheet. Levels of satisfaction with the sedation by the treating physician and nurse were recorded on a 10 cm visual analogue scale. On recovery, the patient was asked a validated questionnaire to determine the rate of immediate recall and at telephone follow-up for delayed recall. Results: 125 patients (88 male, 70%) were enrolled and 110 had completed follow-up. Mean (range) age was 51.6 (13-91) years. Procedures included 84 (67%) orthopaedic reductions and 41 (33%) cardioversions. A wide range of drug combinations were used, including fentanyl/propofol 32 (25.6%), fentanyl/midazolam 30 (24%), fentanyl/midazolam/propofol 16 (12.8%), propofol 13 (10.4%). 87.2% of procedures were successful. A grimace/groan was observed in 61 of 125 (49%). Immediate recall occurred in 9 of 121 (7.4%; 95% CI 3.7 to 14.0) and delayed recall in 5 of 110 (4.5%; 95% CI 1.7 to 10.8). No drug combination was correlated with recall (Spearman's rho = 0.149), nor the presence of a grimace/groan (r = 20.039). Median sedation satisfaction scores were physician 9.0, nurse 10, patient 10. Correlation of delayed recall with patient satisfaction was -0.471 (p,0.001). Conclusions: Recall following PS in ED is uncommon. There is no association of recall with drugs used or the presence of a grimace/groan. There is high patient satisfaction with PS in the ED.

show abstract

“…16,17,22 Additionally, methohexital is safe, effective, and associated with low cost for outpatient procedural sedation and for general anesthesia. 23 Although reports have described the use of this agent for intubation, ours is the first study that includes patients with underlying hemodynamic compromise and high www.ajcconline.org (8) 7 (30) 4 (17) 6 (26) 2 (9) 4 (17) 12 (48) 22 (7) 10 (43) 46 (17) 2 (9) 6 (26) 55 (13) 13 (57) 30 (9) 6 (26) 3 (13) 7 (30) 4 (17) 3 (13) 13 (57) 23 (7) 8 (35) 41 (13) 3 (13) 9 (39) Although barbiturates may decrease systemic vascular resistance in preload-dependent patients and reduce cardiac output through negative inotropic effects, 14 the incidence of hypotension associated with the use of methohexital has previously been reported to be low.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16] Brief reports suggest that methohexital can be used safely with minimal hemodynamic effects in patients who require endotracheal intubation in the emergency department 17,18 ; however, its use in the ICU has not been studied.…”

mentioning

confidence: 99%

A Comparison of Methohexital Versus Etomidate for Endotracheal Intubation of Critically Ill Patients

Diaz-Guzman

Mireles-Cabodevila²,

Heresi³

et al. 2010

American Journal of Critical Care

View full text Add to dashboard Cite

Background Methohexital has been used for procedural sedation in the emergency department, but its use for endotracheal intubation in intensive care units has not been studied. Objective To compare methohexital with etomidate with respect to their effectiveness and safety of use for endotracheal intubation in the intensive care unit. Methods Retrospective, observational, single-center cohort study of consecutive patients admitted between December 2006 and August 2007 to a medical intensive care unit in a tertiary-care hospital. Results Twenty-three patients who received methohexital and 23 who received etomidate for endotracheal intubation were included. The 2 groups differed in age (mean [SD], 55[13] vs 64 [13] years, P = .03) but not in baseline demographics or illness severity scores. Mean (SD) doses given were 1 (0.2) mg/kg for methohexital and 0.2 (0.1) mg/kg for etomidate. Use of midazolam, fentanyl, and succinylcholine was similar between the groups. Rates of successful intubation after 1 attempt (78% vs 83%), time to successful intubation (mean, 5.9 vs 4 minutes), and number of intubation attempts (mean, 1.5 vs 1.2) also were similar. Change in hemodynamics (delta systolic blood pressure), vasopressor requirements, and amount of fluid resuscitation (normal saline) did not differ significantly between the groups. Conclusions Rates of successful intubation are similar with etomidate and methohexital. Methohexital provides adequate sedation and could be an alternative to etomidate, although both agents were often associated with development of hypotension. Prospective studies are needed to establish the safety of methohexital use in intensive care patients.

show abstract

A prospective evaluation of the safety and efficacy of methohexital in the emergency department

Cited by 25 publications

References 11 publications

A Combination of Midazolam and Ketamine for Procedural Sedation and Analgesia in Adult Emergency Department Patients

A Combination of Midazolam and Ketamine for Procedural Sedation and Analgesia in Adult Emergency Department Patients

Recall after procedural sedation in the emergency department

A Comparison of Methohexital Versus Etomidate for Endotracheal Intubation of Critically Ill Patients

Contact Info

Product

Resources

About