The efficacy and safety of methohexital in the emergency department.

STUDY OBJECTIVE

To determine the efficacy and safety of methohexital sodium (MTX) in emergency department patients.

DESIGN

A consecutive case series; all ED patients who received MTX from July 1989 through July 1990 were studied in a prospective manner.

SETTING

A university hospital ED.

PARTICIPANTS

All 102 adult and pediatric patients who received MTX.

INTERVENTIONS

Emergency physicians trained in the use of MTX administered the drug. A study form was completed that provided data on dosage and response, indications for use, final diagnosis, hemodynamic and respiratory parameters, and an efficacy survey.

RESULTS

Average cumulative dose of MTX was 1.6 +/- 1.3 mg/kg. The average duration of action per dose was 7.6 +/- 5.0 minutes. Leading indications for use were orthopedic procedures (54), endotracheal intubation (18), head computed tomography scan (ten), and wound care (eight). Hemodynamic changes were minimal; the average change in systolic blood pressure five minutes after MTX was -1.8 +/- 20 mm Hg. Average heart rate change was 3.0 +/- 20 beats. Percent respiratory depression was 17 +/- 24%. There was no correlation between MTX dose and the degree of respiratory depression. Narcotics and/or benzodiazepines were given with MTX in 92 cases, with no significant increase in respiratory depression. No major complications attributable to MTX were identified.

CONCLUSION

MTX, when used by trained personnel who adhere to an established protocol, appears to be a safe and effective drug in selected ED patients.