Intraarterial use of sodium methohexital for provocative testing during brain embolotherapy

To assess its vascular effects and safety, we used sodium methohexital (Brevital)--an ultrashort-acting barbiturate--as the provocative intraarterial agent in a series of 30 patients with arteriovenous malformations at a 1% concentration and at doses of less than 5 mg per injection. Digital vascular imaging was performed just prior to and just after the injections.

No angiographic or clinical evidence of apparent vasospasm occurred in the trial population (66 vascular pedicle injections in 30 patients). When functional tissue was perfused with 1-6 mg of the 1% Brevital solution, evidence of altered neurologic status became immediately apparent, but cleared within 2 minutes in all cases. None of the patients experienced either prolongation of the induced clinical symptoms or seizures to suggest any adverse effects related to either crystallization of the Brevital or the effects of injecting an alkaline solution in the cerebral circulation.

Though the full effects of methohexital in the cerebral circulation remain to be elucidated, existing reports suggest it is a safe provocative agent for use prior to embolotherapy for brain arteriovenous malformations.