Propofol as a substitute for amobarbital in Wada testing

Area of Science:

• Neurology
• Neurosurgery
• Anesthesiology

Background:

• The Wada test is the gold standard for preoperative language lateralization.
• Functional MRI (fMRI) is typically accurate but can yield equivocal findings.
• Amobarbital, the traditional agent, faces availability and regulatory challenges.

Observation:

• A patient with non-diagnostic fMRI results underwent a propofol-based Wada test.
• Literature review on propofol use for Wada testing was conducted.
• This study reports the first Australian experience with the propofol Wada test.

Findings:

• Propofol serves as a feasible alternative to amobarbital for Wada testing.
• The propofol Wada test can provide crucial preoperative lateralization data when fMRI is inconclusive.
• A suggested protocol for propofol Wada testing is presented.

Implications:

• Facilitates definitive preoperative planning when fMRI is equivocal.
• Addresses the growing difficulty in obtaining amobarbital.
• Potentially improves patient outcomes by enabling timely surgical management.