A PROSPECTIVE-STUDY OF RECTAL METHOHEXITAL - EFFICACY AND SIDE-EFFECTS IN 648 CASES

Rectal methohexital has been used for nearly 30 yr in pediatric anesth esia. Despite this long and increasingly varied use, no large prospect ive series has been published detailing safety and efficacy. This stud y prospectively evaluated the efficacy, safety, and side effects of th is 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% methohexita l. Sleep was less likely in patients with myelomeningocele or who were receiving oral phenobarbital or phenytoin. When sleep occurred, the a verage time to onset of sleep was 6 min. Most patients who remained aw ake 15 min after drug were sedated. Defecation (10%) and hiccups (13%) were common but benign side effects. Partial airway obstruction and/o r desaturation to Spo(2), less than or equal to 93%, occurred in 26 pa tients (4%), but was resolved with blow-by oxygen and/or jaw-thrust in all but two eases. These two patients (0.3% of total) required aggres sive airway intervention by the supervising anesthesiologist. Apnea di d not occur in any patient. Methohexital has a high efficacy rate for sleep (85%) or sedation (96%), and has a relatively rapid onset. Signi ficant respiratory side effects occur infrequently, but can be life th reatening if not properly managed.