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A prospective study of rectal methohexital: efficacy and side effects in 648 cases
S M Audenaert1, C L Montgomery, D E Thompson
1Department of Anesthesiology, Kosair Children's Hospital, Louisville, KY 40202, USA.
Abstract:
Rectal methohexital has been used for nearly 30 yr in pediatric anesthesia. Despite this long and increasingly varied use, no large prospective series has been published detailing safety and efficacy. This study prospectively evaluated the efficacy, safety, and side effects of this medication in a series of 648 cases. On 553 of 648 occasions (85%), the child fell asleep after a single 30-mg/kg dose of 10% methohexital. Sleep was less likely in patients with myelomeningocele or who were receiving oral phenobarbital or phenytoin. When sleep occurred, the average time to onset of sleep was 6 min. Most patients who remained awake 15 min after drug were sedated. Defecation (10%) and hiccups (13%) were common but benign side effects. Partial airway obstruction and/or desaturation to Spo2 < or = 93% occurred in 26 patients (4%), but was resolved with blow-by oxygen and/or jaw-thrust in all but two cases. These two patients (0.3% of total) required aggressive airway intervention by the supervising anesthesiologist. Apnea did not occur in any patient. Methohexital has a high efficacy rate for sleep (85%) or sedation (96%), and has a relatively rapid onset. Significant respiratory side effects occur infrequently, but can be life threatening if not properly managed.
Insights
Rectal methohexital effectively induces sleep or sedation in 96% of pediatric patients. While generally safe, careful airway management is crucial due to rare but serious respiratory side effects.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
Background:
- Rectal methohexital is a long-established anesthetic agent in pediatric care.
- Limited prospective data exists on its safety and efficacy in children.
Purpose of the Study:
- To prospectively evaluate the efficacy and safety of rectal methohexital in pediatric anesthesia.
- To document common side effects and adverse events.
Main Methods:
- A prospective study of 648 pediatric cases using rectal methohexital.
- Dose: 30 mg/kg of 10% methohexital.
- Data collected on sleep onset, efficacy, side effects, and airway events.
Main Results:
- 85% achieved sleep with a single dose; 96% achieved sedation.
- Average onset of sleep was 6 minutes.
- Common side effects included defecation (10%) and hiccups (13%).
- 4% experienced partial airway obstruction or desaturation, with 0.3% requiring significant intervention.
- No apnea occurred.
Conclusions:
- Rectal methohexital demonstrates high efficacy for inducing sleep or sedation in pediatric patients.
- While generally safe, vigilance for respiratory side effects is essential.
- Specific patient populations (myelomeningocele, on phenobarbital/phenytoin) may have reduced efficacy.
