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Comparison of methohexital and pentobarbital for premedication in children
P A Christensen1, T Balslev, L Hasselstrøm
1Department of Anaesthesiology, Randers Central Sygehus, Denmark.
Insights
Methohexital significantly reduced awakening and recovery room times in pediatric patients compared to pentobarbital. Both anesthetic premedications resulted in similar recovery quality, with no significant differences in agitation or confusion.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
Background:
- Premedication is crucial for managing pediatric anxiety and facilitating anesthesia induction.
- Rectal administration offers a non-invasive route for pediatric premedication.
Purpose of the Study:
- To compare the efficacy of rectal methohexital versus pentobarbital for pediatric premedication.
- To evaluate the impact of these premedications on postoperative recovery times and quality.
Main Methods:
- A randomized trial involving 30 children undergoing elective orchiopexy or herniotomy.
- Patients received either rectal methohexital or pentobarbital prior to anesthesia induction with halothane and nitrous oxide.
- Postoperative recovery was assessed using wake-up time, recovery room duration, and the Aldrete score.
Main Results:
- Children receiving methohexital demonstrated significantly shorter wake-up times and recovery room stays compared to the pentobarbital group.
- No significant differences were observed in the quality of recovery, including the absence of confusion or agitation, between the two groups.
- The study noted potential links between pentobarbital premedication and emergence delirium or agitation.
Conclusions:
- Rectal methohexital provides a faster recovery profile in pediatric surgical patients compared to pentobarbital.
- Both agents ensure a generally smooth recovery, but methohexital may be preferred for its quicker resolution.
- Further investigation into pentobarbital's association with emergence phenomena is warranted.
Abstract:
Thirty children scheduled for elective orchiopexy or herniotomy were consecutively assigned at random to premedication with methohexital 80 mg/ml, 20 mg/kg rectally, 15 min before transportation to the operating room, or pentobarbital 28 mg/ml, 7 mg/kg rectally, 45 min before transportation. The quality of premedication was recorded at induction with halothane 1-2% and 60% N2O in O2 by mask. All patients received a caudal injection of bupivacaine 1.9 mg/ml, 1.25 ml/kg before surgery. Following completion of anaesthesia, the postoperative wake-up time and the duration of stay in the post-operative recovery room were recorded. The degree and quality of recovery were assessed using the Aldrete score every 30 min until discharge from the recovery room. The group of children receiving methohexital showed a highly significantly shorter awakening time, and a highly significantly shorter stay in the recovery room compared to the pentobarbital group. The children in both groups had a quiet, easy recovery without significant signs of confusion or agitation, and no difference in quality of recovery could be shown. Emergence delirium or agitation in connection with pentobarbital premedication and a possible relation to postoperative pain is discussed.