Abstract
Background
Methohexital is a short-acting barbiturate used for procedural sedation in the emergency
department (ED). As with other sedatives, adverse effects with methohexital include
excess sedation and hypotension, but this agent can also lower the seizure threshold.
We report a patient who developed a generalized seizure after administration of methohexital.
Case Report
A 60-year-old man presented to the ED by ambulance with chest pain and shortness of
breath. Paramedics had administered adenosine for supraventricular tachycardia without
conversion before arrival to the ED. He had no history of seizures. His initial vital
signs in the ED included heart rate of 189 beats/min with a supraventricular rhythm,
blood pressure 137/108 mm Hg, respiration 22 breaths/min, and oxygen saturation of
98% on room air. It was decided to attempt synchronized electrical cardioversion,
and methohexital 1 mg/kg (120 mg) was administered over 2 min for moderate sedation.
Within 15 s of methohexital administration, the patient developed a generalized seizure
that lasted for 90 s. After seizure termination, he was successfully cardioverted,
returned to his previous baseline level of consciousness within 20 min, and discharged
without further problems with a follow-up referral to neurology.
Why Should an Emergency Physician Be Aware of This?
Methohexital is a short-acting barbiturate used for moderate sedation. Its adverse
effects are unique in that it can lower the seizure threshold in some patients. Alternative
agents for sedation should be considered in individuals with possible seizure disorders.
Keywords
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Article info
Publication history
Published online: June 18, 2020
Accepted:
May 4,
2020
Received:
April 7,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
