Sodium methohexital (Brevital) as an anesthetic in the Wada test

Purposes: We report our experience with sodium methohexital (Brevital) as an anesthetic used in the Wada test for language and memory in 86 epilepsy surgery patients (173 procedures). Methods: The methods are compared with those of the more commonly used anesthetic sodium amobarbital (Amytal). Results: Despite differences between the methohexital and amobarbital test protocols, the behavioral and neurologic effects of the two anesthetics are similar. Because of the brief duration of methohexital, two successive injections are made on each side rather than one, to lengthen the time available for testing both language and memory. Behavioral and EEG indices return to baseline more quickly and more completely with methohexital than with amobarbital, allowing, several repetitions of the procedure without incremental drowsiness, and the total time taken for the procedure is less With methohexital than with amobarbital. Conclusions: The results of language and memory testing in the Wada test are equivalent for amobarbital and methohexital, except that methohexital has a briefer duration of action and is associated with less sedation.