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. 1991 Nov-Dec;38(6):195–199.

Methohexital: a practical review for outpatient dental anesthesia.

C H Martone 1, J Nagelhout 1, S M Wolf 1
PMCID: PMC2148703  PMID: 1842156

Abstract

Methohexital is an ultrashort-acting barbiturate widely used in dentistry because of its rapid onset, predictable effects, and short duration of action. Like other barbiturates, methohexital exerts its effects through the gamma-aminobutyric acid (GABA) receptor complex. By binding to its own receptor on the complex, methohexital augments the inhibitory effect of GABA on neurons and additionally can exert a similar effect independent of GABA. After intravenous injection, maximal brain concentrations are achieved within 30 sec and then quickly fall as the drug is redistributed to other tissues, yielding a duration of action after a single dose of 4 to 7 min. Hepatic metabolism accounts for elimination of the drug. Methohexital at conventional doses in healthy individuals is a mild respiratory depressant with modest cardiovascular effects. Adverse effects, however, can include apnea, cardiovascular depression, laryngospasm, hiccough, and allergic-like reactions. Although more recently introduced drugs, such as midazolam, etomidate, and propofol, have specific advantages, methohexital remains a drug of choice for dental outpatient anesthesia because of its low cost, rapid onset, short duration, lack of secretory or emetic properties, and proven history.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen G. D., Kennedy W. F., Jr, Everett G., Tolas A. G. A comparison of the cardiorespiratory effects of methohexital and thiopental supplementation for outpatient dental anesthesia. Anesth Analg. 1969 Sep-Oct;48(5):730–735. [PubMed] [Google Scholar]
  2. Andrews P. R., Mark L. C. Structural specificity of barbiturates and related drugs. Anesthesiology. 1982 Oct;57(4):314–320. doi: 10.1097/00000542-198210000-00014. [DOI] [PubMed] [Google Scholar]
  3. Baker T. J., Gordon H. L. Midazolam (Versed) in ambulatory surgery. Plast Reconstr Surg. 1988 Aug;82(2):244–246. doi: 10.1097/00006534-198808000-00005. [DOI] [PubMed] [Google Scholar]
  4. Becker D. E. Pharmacological considerations for conscious sedation: clinical applications of receptor function. Anesth Prog. 1991 Mar-Apr;38(2):33–38. [PMC free article] [PubMed] [Google Scholar]
  5. Bernhoff A., Eklund B., Kaijser L. Cardiovascular effects of short-term anaesthesia with methohexitone and propanidid in normal subjects. Br J Anaesth. 1972 Jan;44(1):2–7. doi: 10.1093/bja/44.1.2-a. [DOI] [PubMed] [Google Scholar]
  6. CHRISTENSON G. R., HEBERT C. L., DRISCOLL E. J. Intravenous barbiturate anesthesia for dental outpatients. Anesth Analg. 1961 Jan-Feb;40:77–86. [PubMed] [Google Scholar]
  7. Choi S. D., Spaulding B. C., Gross J. B., Apfelbaum J. L. Comparison of the ventilatory effects of etomidate and methohexital. Anesthesiology. 1985 Apr;62(4):442–447. doi: 10.1097/00000542-198504000-00012. [DOI] [PubMed] [Google Scholar]
  8. DUNDEE J. W. CLINICAL STUDIES OF INDUCTION AGENTS. VII: A COMPARISON OF EIGHT INTRAVENOUS ANAESTHETICS AS MAIN AGENTS FOR A STANDARD OPERATION. Br J Anaesth. 1963 Dec;35:784–794. doi: 10.1093/bja/35.12.784. [DOI] [PubMed] [Google Scholar]
  9. Ghoneim M. M., Mewaldt S. P. Benzodiazepines and human memory: a review. Anesthesiology. 1990 May;72(5):926–938. [PubMed] [Google Scholar]
  10. Gold M. I., Abraham E. C., Herrington C. A controlled investigation of propofol, thiopentone and methohexitone. Can J Anaesth. 1987 Sep;34(5):478–483. doi: 10.1007/BF03014354. [DOI] [PubMed] [Google Scholar]
  11. Gooding J. M., Weng J. T., Smith R. A., Berninger G. T., Kirby R. R. Cardiovascular and pulmonary responses following etomidate induction of anesthesia in patients with demonstrated cardiac disease. Anesth Analg. 1979 Jan-Feb;58(1):40–41. doi: 10.1213/00000539-197901000-00016. [DOI] [PubMed] [Google Scholar]
  12. Hirshman C. A., Edelstein R. A., Ebertz J. M., Hanifin J. M. Thiobarbiturate-induced histamine release in human skin mast cells. Anesthesiology. 1985 Oct;63(4):353–356. doi: 10.1097/00000542-198510000-00002. [DOI] [PubMed] [Google Scholar]
  13. Hudson R. J., Stanski D. R., Burch P. G. Pharmacokinetics of methohexital and thiopental in surgical patients. Anesthesiology. 1983 Sep;59(3):215–219. [PubMed] [Google Scholar]
  14. McCollum J. S., Dundee J. W. Comparison of induction characteristics of four intravenous anaesthetic agents. Anaesthesia. 1986 Oct;41(10):995–1000. doi: 10.1111/j.1365-2044.1986.tb12740.x. [DOI] [PubMed] [Google Scholar]
  15. Olsen R. W. GABA-benzodiazepine-barbiturate receptor interactions. J Neurochem. 1981 Jul;37(1):1–13. doi: 10.1111/j.1471-4159.1981.tb05284.x. [DOI] [PubMed] [Google Scholar]
  16. Prys-Roberts C., Sear J. W., Low J. M., Phillips K. C., Dagnino J. Hemodynamic and hepatic effects of methohexital infusion during nitrous oxide anesthesia in humans. Anesth Analg. 1983 Mar;62(3):317–323. doi: 10.1213/00000539-198303000-00005. [DOI] [PubMed] [Google Scholar]
  17. Reves J. G., Fragen R. J., Vinik H. R., Greenblatt D. J. Midazolam: pharmacology and uses. Anesthesiology. 1985 Mar;62(3):310–324. [PubMed] [Google Scholar]
  18. Rifat K., Gamulin Z., Gemperle M. Etomidate: effets cardio-vasculaires du nouvel agent anesthésique intraveineux. Can Anaesth Soc J. 1976 Sep;23(5):492–504. doi: 10.1007/BF03005978. [DOI] [PubMed] [Google Scholar]
  19. STOELTING V. K. The use of a new intravenous oxygen barbiturate 25398 for intravenous anesthesia; a preliminary report. Anesth Analg. 1957 May-Jun;36(3):49–51. [PubMed] [Google Scholar]
  20. Sear J. W. Toxicity of i.v. anaesthetics. Br J Anaesth. 1987 Jan;59(1):24–45. doi: 10.1093/bja/59.1.24. [DOI] [PubMed] [Google Scholar]
  21. Sebel P. S., Lowdon J. D. Propofol: a new intravenous anesthetic. Anesthesiology. 1989 Aug;71(2):260–277. [PubMed] [Google Scholar]
  22. Sunshine I., Whitwam J. G., Fike W. W., Finkle B., LeBeau J. Distribution and excretion of methohexitone in man. A study using gas and thin layer chromatography. Br J Anaesth. 1966 Jan;38(1):23–28. doi: 10.1093/bja/38.1.23. [DOI] [PubMed] [Google Scholar]
  23. Todd M. M., Drummond J. C., U H. S. The hemodynamic consequences of high-dose methohexital anesthesia in humans. Anesthesiology. 1984 Nov;61(5):495–501. doi: 10.1097/00000542-198411000-00003. [DOI] [PubMed] [Google Scholar]
  24. Van Hamme M. J., Ghoneim M. M., Ambre J. J. Pharmacokinetics of etomidate, a new intravenous anesthetic. Anesthesiology. 1978 Oct;49(4):274–277. doi: 10.1097/00000542-197810000-00010. [DOI] [PubMed] [Google Scholar]
  25. Wagner R. L., White P. F. Etomidate inhibits adrenocortical function in surgical patients. Anesthesiology. 1984 Dec;61(6):647–651. doi: 10.1097/00000542-198412000-00003. [DOI] [PubMed] [Google Scholar]
  26. Wagner R. L., White P. F., Kan P. B., Rosenthal M. H., Feldman D. Inhibition of adrenal steroidogenesis by the anesthetic etomidate. N Engl J Med. 1984 May 31;310(22):1415–1421. doi: 10.1056/NEJM198405313102202. [DOI] [PubMed] [Google Scholar]
  27. Willow M. A comparison of the actions of pentobarbitone and etomidate on [3H]GABA binding to crude synaptosomal rat brain membranes. Brain Res. 1981 Sep 14;220(2):427–431. doi: 10.1016/0006-8993(81)91237-3. [DOI] [PubMed] [Google Scholar]
  28. YOUNG D. S., WHITWAM J. G. OBSERVATIONS ON DENTAL ANAESTHESIA INTRODUCED WITH METHOHEXITONE. I. INDUCTION OF ANAESTHESIA. Br J Anaesth. 1964 Jan;36:31–38. doi: 10.1093/bja/36.1.31. [DOI] [PubMed] [Google Scholar]

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