title: Safety and effectiveness of methohexital for procedural sedation in the emergency department.
abstract: Use of methohexital as an agent for moderate procedural sedation in the Emergency Department (ED) recently has increased. As a barbiturate, potential complications include respiratory and myocardial depression. We conducted a retrospective review of medical records and procedural flow charts for all use of methohexital in our ED during a 31-month period. We collected data on medication use, adjunctive medications, indications, procedural success, and complications. Overall, there were 114 orthopedic procedures performed using methohexital (mean dose of 1.43 mg/kg) for sedation on 104 patients. Procedures included shoulder dislocation reduction (26.3%), hip dislocation reduction (25.4%), elbow dislocation reduction (15.2%), and fracture reduction (25.4%). There was an 80.8% success rate with the first dose of methohexital. Complications occurred in 20.2% of patients and included oxygen desaturation, hypotension, hypoventilation, vomiting, tremor, and airway obstruction. All complications were transient and managed without sequelae. Use of concurrent parenteral opioid medications had no significant impact on success or complications.
authors.affiliation: Department of Emergency Medicine, Medical Center, University of California-San Diego, 200 West Arbor Drive #8676, San Diego, CA 92103-8676, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Austin
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.forename: Ellen
authors.initials: E
authors.lastname: Nyheim
authors.forename: Donna
authors.initials: D
authors.lastname: Kelly
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous; D002648:Child; D016292:Procedural Sedation; D004636:Emergency Service, Hospital; D006801:Humans; D008723:Methohexital; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D018686:Anesthetics, Intravenous; D008723:Methohexital