Methohexital for procedural sedation of cardioversions in the emergency department

Procedural sedation for electrical cardioversion is a common practice in the emergency department (ED). Ideal sedative properties for this procedure are a short half-life and minimal hemodynamic effects. There is limited literature examining methohexital for this use.

To compare the use of methohexital to propofol and etomidate for procedural sedation for electrical cardioversions in the ED.

This was a single-center, retrospective study of adult patients who underwent procedural sedation for electrical cardioversion in the ED between February 1, 2015 and July 31, 2020. Included patients received methohexital, propofol, or etomidate as an initial sedative agent in the ED. The primary outcome was time from initial dose of sedative to goal Aldrete score. The main secondary outcome was time from sedative agent to ED discharge. The safety outcome was the occurrence of a critical hemodynamic change requiring intervention. Outcomes were assessed using a single-factor ANOVA analysis.

One-hundred and fifty cardioversion encounters were included with 50 encounters per cohort. The median (IQR) time (minutes) to goal Aldrete score was 10.5 (7-18.5) for methohexital, 12.0 (9-16.8) for propofol, and 11.0 (8-15) for etomidate (p = 0.863). Mean (SD) time (minutes) to discharge from the ED (n = 105) was 90.4 ± 40.4 for methohexital, 89.0 ± 57.4 for propofol, and 94.0 ± 42.5 for etomidate (p = 0.897). No difference was seen between the groups regarding hemodynamic changes requiring intervention.

Methohexital was found to have a similar efficacy and safety profile when compared to propofol and etomidate when used as procedural sedation for cardioversions in the ED.