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Lack of efficacy and generalized seizure: case report A 60-year-old man developed generalised seizures while receiving treatment with methohexital as sedative. He also exhibited lack of efficacy during treatment with adenosine for narrow complex supraventricular tachycardia. The man presented with shortness of breath, chest pain, epigastric pain and feeling generally unwell for the previous 24 hours. He also developed narrow complex supraventricular tachycardia, which was treated with adenosine, without conversion [dosage and route not stated]. He underwent synchronized electrical cardioversion. He was administered with IV methohexital 1 mg/kg (total dose of 120mg) via IV push over 2 minutes for moderate sedation. Within 15 seconds of methohexital administration, he experienced a generalised tonic-clonic convulsion, which was stopped within 90 seconds. He started receiving lorazepam for recurrent seizure prophylaxis. He was successfully cardioverted with return of normal sinus rhythm and returned to his previous baseline level of consciousness within 20 minutes. After the procedure, neurologic examination showed no focal findings, and he denied any headache. He was discharged with the diagnosis of underlying seizure disorder unmasked by methohexital. He was lost to follow-up. Willeford A, et al. Methohexital-Induced Seizure in a Patient Undergoing Conscious Sedation. Journal of Emergency Medicine 59: 224-226, No. 2, Aug 2020. Available from: 803505559 URL: http://doi.org/10.1016/j.jemermed.2020.05.012

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Reactions 10 Oct 2020 No. 1825