Rectal methohexital for sedation of children during imaging procedures

Brevital (methohexital), administered as a solution per rectum, provides safe, rapid, and effective sedation for induction of surgical anesthesia. This study was undertaken to evaluate rectal Brevital as a sedative for children undergoing imaging procedures.

In a review of patients' records, we found that, during a 1-year period, 190 children from 1 month to 14 years old were sedated for CT or MR imaging. Sedation was required for 94 CT and 96 MR imaging studies. Rectal Brevital was used in 102 patients (mean age, 25 +/- 2 months), and oral chloral hydrate was used in 88 (mean age, 28 +/- 3 months).

Sleep was achieved in 81% of patients who received Brevital and in 80% of those who received chloral hydrate. Induction time was shorter (p = .0001) with Brevital (9 +/- 1 min) than with chloral hydrate (28 +/- 2 min). The mean duration of sleep was 46 min with Brevital and 66 min with chloral hydrate (p = .0001). Brevital provided adequate sedation in 89 (87%) of 102 imaging studies, and chloral hydrate did so in 73 (83%) of 88 studies. No cardiorespiratory complications or allergic reactions occurred with either drug. Significantly fewer patients were discharged fully awake and alert after sedation with chloral hydrate than with Brevital (p < .002). Children sedated with chloral hydrate also required a longer period of observation in the radiology department (p < .04).

We conclude that rectal Brevital produces sedation of adequate duration for most imaging procedures in children. Ease of administration, wide margin of safety, rapid and pleasant induction, and short recovery time make this drug a favorable alternative to other commonly used sedatives.