Sodium Methohexital (Brevital) as an Anesthetic in the Wada Test

Abstract

Summary: Purposes:We report our experience with sodium methohexital (Brevital) as an anesthetic used in the Wada test for language and memory in 86 epilepsy surgery patients (173 procedures).Methods: The methods are compared with those of the more commonly used anesthetic sodium amobarbital (Amytal).Results: Despite differences between the methohexital and amobarbital test protocols, the behavioral and neurologic effects of the two anesthetics are similar. Because of the brief duration of methohexital, two successive injections are made on each side rather than one, to lengthen the time available for testing both language and memory. Behavioral and EEG indices return to baseline more quickly and more completely with methohexital than with amobarbital, allowing several repetitions of the procedure without incremental drowsiness, and the total time taken for the procedure is less with methohexital than with amobarbital.Conclusions: The results of language and memory testing in the Wada test are equivalent for amobarbital and methohexital, except that methohexital has a briefer duration of action and is associated with less sedation.

Provocative Test with Propofol: Experience in Patients with Cerebral Arteriovenous Malformations Who Underwent Neuroendovascular Procedures

“…12 Other barbiturates also used in Wada testing include pentobarbital 8 and methohexital. 7 Experience with these anesthetics in this setting has been promising but scarce. Etomidate 9,17 has also been suggested, yet association with increased risk of adrenal insufficiency has been reported.…”

“…Amobarbital has been the traditional drug of choice for pre-embolization testing, yet its availability has been affected by several shortages, including the present one. This has led many centers to consider the use of other drugs, such as methohexital, 7 pentobarbital, 8 etomidate, 9 and propofol, 10,11 reported primarily in Wada testing. Similar reports on the use of these or similar anesthetics in cerebral AVM pre-embolization provocative testing are absent or scarce.…”

The intracarotid etomidate Wada test: A 54-patient series

“…Methohexital use for the Wada test was associated with increased seizure risk [12,13]. One patient developed transient respiratory depression immediately after receiving pentobarbital [14].…”

Methods for determination of language dominance: The wada test and proposed noninvasive alternatives

“…This search was further fueled by an amobarbital shortage. Other anesthetic agents were explored to replace amobarbital [7][8][9]. The alternative anesthetics had a shorter half-life, in one case requiring infusion rather than injection.…”