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Per Westrin - One of the best experts on this subject based on the ideXlab platform.
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faster recovery after anesthesia in infants after intravenous induction with Methohexital instead of thiopental
Anesthesiology, 1995Co-Authors: A Beskow, Olof Werner, Per WestrinAbstract:Background : To determine possible delays in recovery after intravenous anesthesia induction with thiopental, the drug was compared with Methohexital in infants 1-12 months of age who were scheduled for hernia repair or circumcision. Methods : The infants were given equipotent doses of Methohexital (3.0 mg/kg, n = 21) or thiopental (7.3 mg/kg, n = 20), in random and blind fashion. After tracheal intubation, anesthesia was maintained with isoflurane in nitrous oxide/-oxygen. All children received 0.75 ml/kg caudal bupivacaine (2.5 mg/ml).Isoflurane was discontinued at the beginning of skin closure, and nitrous oxide was terminated immediately after the last suture (end of surgery). Results : There were no differences between the two groups with respect to age, weight, or duration of surgery, which lasted 19 min (14-23 min) in the Methohexital group and 16 min (15-19 min) in the thiopental group (median and inner quartile range). Time from termination of nitrous oxide to extubation did not differ significantly between the groups. Time to spontaneous eye opening after end of surgery was 23 min (5-44 min) after Methohexital induction and 55 min (25-74 min) after thiopental induction (P < 0.05). Recovery, assessed as postanesthetic recovery scores by a blinded observer, was significantly more rapid in the Methohexital group at arrival in the recovery room and 5, 15, and 45 min after arrival. After 120 min, almost all infants of both groups were awake. Conclusions : Recovery after short surgical procedures in infants is faster after intravenous induction with Methohexital than with thiopental.
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Methohexital dissolved in lipid emulsion for intravenous induction of anesthesia in infants and children
Anesthesiology, 1992Co-Authors: Per WestrinAbstract:: The induction dose of thiopental and propofol has been shown previously to vary during childhood. The Methohexital dose needed for satisfactory induction of anesthesia in 50% of patients (ED50) was determined in 75 infants and children, 1 month to 16 yr of age. An intravenous bolus of Methohexital, dissolved in a lipid emulsion to decrease pain on injection, was given over 10 s. After 30 s the anesthesia mask was applied. The patient was considered to be asleep if there were no gross movements when the head was placed in the sniffing position and the anesthesia mask applied, and no response to verbal command (tested in children more than 4 yr of age) during the next 30 s while the patient breathed O2. ED50 (+/- SE) was 2.6 +/- 0.2 mg/kg in infants 1-6 months of age, 1.9 +/- 0.1 mg/kg in infants 7-11 months of age, 1.4 +/- 0.1 mg/kg in children 1-3 yr of age, 1.1 +/- 0.1 mg/kg in children 4-7 yr of age, and 1.3 +/- 0.1 mg/kg in children 8-16 yr of age. ED50 in each of the two groups of infants was significantly greater than ED50 in each of the three other groups (P less than 0.05). Pain or discomfort on injection was observed in 1 infant and 3 children (5%). Eight patients (11%) had apnea longer than 15 s, and excitatory phenomena occurred in 9 (12%). It is concluded that the dose of Methohexital needed for induction of anesthesia varies with age.(ABSTRACT TRUNCATED AT 250 WORDS)
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dissolving Methohexital in a lipid emulsion reduces pain associated with intravenous injection
Anesthesiology, 1992Co-Authors: Per Westrin, Christer Jonmarker, Olof WernerAbstract:Pain often accompanies intravenous injection of 1% Methohexital. The aim of the present study was to test whether pain on injection could be reduced by dissolving Methohexital in a lipid emulsion (study A) and whether this would affect anesthetic potency (study B). In study A, 24 healthy volunteers, 36 +/- 1 yr (mean +/- SE), were given 1 ml 1% Methohexital in saline, 1 ml 1% Methohexital in lipid emulsion, and 5 ml 0.1% Methohexital in saline in random order. The injections were given in a small vein in the forearm at 5-min intervals. One minute after each injection, the subject was asked to assess the injection pain on a visual analog scale (0-100 mm). The pain score (median [range]) was 44.5 (0-77) after 1% Methohexital in saline, 0.5 (0-26) after 1% Methohexital in a lipid emulsion, and 1.0 (0-26) after 0.1% Methohexital in saline. The pain score for 1% Methohexital in saline was significantly greater than those for the other two solutions (P less than 0.001 for each comparison). In study B, 42 patients, 41 +/- 3 yr, were given 1% Methohexital in lipid emulsion (n = 22) or 1% Methohexital in saline (n = 20). A bolus of either solution was administered over 10 s, and the patient was considered asleep if there was no gross movement or response to verbal command 40-70 s after injection.(ABSTRACT TRUNCATED AT 250 WORDS)
Paul F White - One of the best experts on this subject based on the ideXlab platform.
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a cost comparison of Methohexital and propofol for ambulatory anesthesia
Anesthesia & Analgesia, 1999Co-Authors: Rui Sun, Mehernoor F Watcha, Paul F White, Gary D Skrivanek, James D Griffin, Louis A Stool, Mark T MurphyAbstract:Methohexital is eliminated more rapidly than thiopental, and early recovery compares favorably with propofol. We designed this study to evaluate the recovery profile when Methohexital was used as an alternative to propofol for the induction of anesthesia before either sevoflurane or desflurane in combination with nitrous oxide. One hundred twenty patients were assigned randomly to one of four anesthetic groups: (I) Methohexitaldesflurane, (II) Methohexital-sevoflurane, (III) propofoldesflurane, or (IV) propofol-sevoflurane. Recovery times after the anesthetic drugs, as well as the perioperative side effect profiles, were similar in all four groups. A costminimization analysis revealed that Methohexital was less costly for the induction of anesthesia. At the fresh gas flow rates used during this study, the costs of the volatile anesthetics for maintenance of anesthesia did not differ among the four groups. However, at low flow rates (#1 L/min), the Methohexital-desflurane group would have been the least expensive anesthetic technique. In conclusion, Methohexital is a cost-effective alternative to propofol for the induction of anesthesia in the ambulatory setting. At low fresh gas flow rates, the Methohexitaldesflurane combination was the most cost-effective for the induction and maintenance of general anesthesia. Implications: Using Methohexital as an alternative to propofol for the induction of anesthesia for ambulatory surgery seems to reduce drug costs. When fresh gas flow rates #1 L/min are used, the combination of Methohexital for the induction and desflurane for maintenance may be the most cost-effective general anesthetic technique for ambulatory surgery. (Anesth Analg 1999;89:311‐6)
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the cost effectiveness of Methohexital versus propofol for sedation during monitored anesthesia care
Anesthesia & Analgesia, 1999Co-Authors: Monica Sa M Rego, Yoshimi Inagaki, Paul F WhiteAbstract:We designed this study to test the hypothesis that Methohexital is a cost-effective alternative to propofol for sedation during local anesthesia. Sixty consenting women undergoing breast biopsy procedures under local anesthesia were randomly assigned to receive an infusion of either propofol (50 [micro sign]g [center dot] kg-1 [center dot] min-1) or Methohexital (40 [micro sign]g [center dot] kg-1 [center dot] min-1). The sedative infusion rate was titrated to maintain an observer's assessment of alertness/sedation (OAA/S) score of 3 (with 1 = awake/alert to 5 = asleep). Fentanyl 25 [micro sign]g IV was administered as a "rescue" analgesic during the operation. We assessed the level of sedation (OAA/S score), vital signs, time to achieve an OAA/S score of 3 at the onset and a score of 1 after discontinuing the infusion, discharge times, perioperative side effects, and patient satisfaction. The direct cost of Methohexital was lower than that of propofol, based on the milligram dosage infused during the operation. The sedative onset (to achieve an OAA/S score of 3) and the recovery (to return to an OAA/S score of 1) times, as well as discharge times, did not differ between the two groups. Patients receiving Methohexital had a significantly lower incidence of pain on initial injection compared with those receiving propofol (10% vs 23%). Because the use of Methohexital (29.4 +/- 2.7 [micro sign]g [center dot] kg-1 [center dot] min-1) for sedation during breast biopsy procedures has a similar efficacy and recovery profile to that of propofol (36.8 +/- 15.9 [micro sign]g [center dot] kg-1 [center dot] min-1) and is less costly based on the amount infused, it seems to be a cost-effective alternative to propofol for sedation during local anesthesia. However, when the cost of the drug infused and drug wasted was calculated, there was no difference in the overall drug cost. Implications: When administered to maintain a stable level of sedation during local anesthesia, Methohexital is an acceptable alternative to propofol. However, the overall drug costs were similar with the two drugs. (Anesth Analg 1999;88:723-8)
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the comparative effects of Methohexital propofol and etomidate for electroconvulsive therapy
Anesthesia & Analgesia, 1995Co-Authors: Michail N Avramov, M M Husain, Paul F WhiteAbstract:The intravenous anesthetics which are commonly used for electroconvulsive therapy (ECT) possess dose-dependent anticonvulsant properties. Since the clinical efficacy of ECT depends on the induction of a seizure of adequate duration, it is important to determine the optimal dose of the hypnotic for use during ECT. We compared the duration of seizure activity and cognitive recovery profiles after different doses of Methohexital, propofol, and etomidate administered to induce hypnosis prior to ECT. Ten outpatients with major depressive disorders receiving maintenance ECT participated in this prospective, randomized, cross-over study. Patients were premedicated with glycopyrrolate, 0.2 mg intravenously (i.v.), and labetalol, 20-30 mg i.v., and hypnosis was induced with an i.v. bolus injection of Methohexital or propofol (0.75, 1.0, and 1.5 mg/kg), or etomidate (0.15, 0.2, and 0.3 mg/kg), administered over 10-15 s. Adequate muscle paralysis was achieved with succinylcholine, 1.0-1.4 mg/kg i.v. Each patient's seizure threshold was determined prior to enrollment in the study and the electrical stimulus variables were kept constant throughout the study period. After delivery of a bilateral electrical stimulus, the duration of the resulting electroencephalographic (EEG) and motor seizures were recorded. A total of 90 ECT treatments were evaluated. The durations of EEG and motor seizures were longest after etomidate and shortest after propofol. There were no significant dose-related differences in motor and EEG seizure durations (means +/- SD) after the low, intermediate, and high doses of etomidate of 44 +/- 11 and 77 +/- 19, 43 +/- 10 and 76 +/- 34, 42 +/- 16 and 78 +/- 56 s, respectively. Conversely, both Methohexital and propofol, 0.75, 1.0, and 1.5 mg/kg, produced dose-dependent decreases in motor and EEG seizure durations (i.e., 37 +/- 10 and 58 +/- 12, 36 +/- 8 and 62 +/- 24, and 29 +/- 13 and 48 +/- 20 for Methohexital; 34 +/- 15 and 56 +/- 29, 31 +/- 8 and 50 +/- 17, and 20 +/- 6 and 33 +/- 12 for propofol, respectively). The awakening times were similar, regardless of the hypnotic or dose administered.(ABSTRACT TRUNCATED AT 250 WORDS)
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anesthesia for electroconvulsive therapy effects of propofol and Methohexital on seizure activity and recovery
Anesthesia & Analgesia, 1994Co-Authors: Brian Fredman, J Detienne, Ian Smith, M M Husain, Paul F WhiteAbstract:The influence of Methohexital and propofol on seizure activity and recovery profiles was assessed in a randomized, crossover study involving 13 adult outpatients undergoing electroconvulsive therapy (ECT). Arterial blood pressure, heart rate, hemoglobin oxygen saturation, and electroencephalogram (EEG) activity were monitored during the ECT procedure. After premedication with glycopyrrolate, 0.2 mg intravenously (i.v.), and labetalol 20-30 mg i.v. hypnosis was induced with a bolus injection of either Methohexital or propofol, 0.75 mg/kg. Muscle paralysis was achieved by administering succinylcholine, 1.4 mg/kg i.v. Ventilation was assisted using a face mask while administering 100% oxygen. Thereafter, an electrical stimulus was administered and the length of the resulting motor and EEG seizures was measured. Mood level and cognitive function were assessed prior to induction of anesthesia and after ECT. A total of 72 treatment sessions were evaluated. Each patient underwent a minimum of four treatments and received both induction drugs equally. Although the use of propofol was associated with significantly shorter motor and EEG seizure durations (mean +/- SEM) compared with Methohexital (34 +/- 1.6 s and 52 +/- 2.9 s vs 39 +/- 1.5 s and 61 +/- 3.0 s, respectively), this difference was not clinically significant because the durations exceeded 30 s in both groups. Although awakening times were similar, both hemodynamic stability and cognitive recovery were more favorable after propofol. Compared with Methohexital, the use of propofol was associated with a clinically insignificant decrease in seizure duration. However, propofol was associated with improved hemodynamic stability and an earlier return of cognitive function after ECT.
M Hoke - One of the best experts on this subject based on the ideXlab platform.
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Methohexital induced changes in spectral power of neuromagnetic signals reduced β band enhancement over the hemisphere ipsilateral to the epileptogenic focus
2000Co-Authors: Christian Wienbruch, Christian E Elger, Carsten Eulitz, Klaus Lehnertz, Anke Brockhaus, Thomas Elbert, M HokeAbstract:Effects of anesthetics on electroencephalographic (EEG) activity are used to localize brain lesions as well as epileptogenic areas. Small doses of barbiturates (up to 200 mg) result in an increase of fast activity in the β-band of the EEG. This increase of β-band activity is known to be larger over normal brain areas as compared to areas with cerebral lesions (e.g. [1]). Furthermore, it has been reported that some barbiturates as amobarbital, thiopental, or Methohexital or other narcotics as propofol may provoke epileptiform activity resulting in spike activity and spike-burst-suppression patterns. As an additional feature, various authors ([1] [2]) described qualitatively a loss of Methohexital-induced β-band activity in the electrocorticogramm (ECoG) over the epileptogenic area. A quantitative analysis of the spectral contents of the ECoG is mandatory before the clinical use of Methohexital induced changes in β-band activity can be rated.
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Methohexital induced changes in spectral power of neuromagnetic signals beta augmentation is smaller over the hemisphere containing the epileptogenic focus
Brain Topography, 1997Co-Authors: Christian Wienbruch, Christian E Elger, Carsten Eulitz, Klaus Lehnertz, Anke Brockhaus, Thomas Elbert, M HokeAbstract:Previous research has suggested that Methohexital, a short-term barbiturate, alters activity in the primary epileptogenic area. It can be assumed that drug-induced activation of the epileptogenic focus provides a rapid and safe method to obtain a sufficient amount of information relevant for the lateralization and localisation of the primary epileptogenic area. This study shows that Methohexital changes spectral power in the beta band derived from magnetoencephalographic (MEG) signals over the hemisphere ipsilateral to the primary epileptogenic area. This effect was demonstrated for 10/13 of the investigated patients suffering from unilateral temporal lobe epilepsy (TLE). The side and location of the primary epileptogenic area of these patients (5 left TLE, 8 right TLE) was determined invasively during presurgical evaluation. During a 1-2 minute interval after intravenous bolus injection of 100 mg Methohexital a clear lateralization effect in the beta band was observed, which differed marginally between fronto-central, fronto-temporal and temporo-parietal brain regions. In addition, bilateral spectral power changes were obtained in the theta, alpha and gamma bands that differed between brain regions. Analyses of simultaneously recorded scalp electroencephalographic (EEG) data revealed effects consistent with those of the MEG analysis. The reduced enhancement of beta band spectral power of MEG recordings provides a potential application for the non-invasive lateralization of the primary epileptogenic area.
Olof Werner - One of the best experts on this subject based on the ideXlab platform.
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faster recovery after anesthesia in infants after intravenous induction with Methohexital instead of thiopental
Anesthesiology, 1995Co-Authors: A Beskow, Olof Werner, Per WestrinAbstract:Background : To determine possible delays in recovery after intravenous anesthesia induction with thiopental, the drug was compared with Methohexital in infants 1-12 months of age who were scheduled for hernia repair or circumcision. Methods : The infants were given equipotent doses of Methohexital (3.0 mg/kg, n = 21) or thiopental (7.3 mg/kg, n = 20), in random and blind fashion. After tracheal intubation, anesthesia was maintained with isoflurane in nitrous oxide/-oxygen. All children received 0.75 ml/kg caudal bupivacaine (2.5 mg/ml).Isoflurane was discontinued at the beginning of skin closure, and nitrous oxide was terminated immediately after the last suture (end of surgery). Results : There were no differences between the two groups with respect to age, weight, or duration of surgery, which lasted 19 min (14-23 min) in the Methohexital group and 16 min (15-19 min) in the thiopental group (median and inner quartile range). Time from termination of nitrous oxide to extubation did not differ significantly between the groups. Time to spontaneous eye opening after end of surgery was 23 min (5-44 min) after Methohexital induction and 55 min (25-74 min) after thiopental induction (P < 0.05). Recovery, assessed as postanesthetic recovery scores by a blinded observer, was significantly more rapid in the Methohexital group at arrival in the recovery room and 5, 15, and 45 min after arrival. After 120 min, almost all infants of both groups were awake. Conclusions : Recovery after short surgical procedures in infants is faster after intravenous induction with Methohexital than with thiopental.
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dissolving Methohexital in a lipid emulsion reduces pain associated with intravenous injection
Anesthesiology, 1992Co-Authors: Per Westrin, Christer Jonmarker, Olof WernerAbstract:Pain often accompanies intravenous injection of 1% Methohexital. The aim of the present study was to test whether pain on injection could be reduced by dissolving Methohexital in a lipid emulsion (study A) and whether this would affect anesthetic potency (study B). In study A, 24 healthy volunteers, 36 +/- 1 yr (mean +/- SE), were given 1 ml 1% Methohexital in saline, 1 ml 1% Methohexital in lipid emulsion, and 5 ml 0.1% Methohexital in saline in random order. The injections were given in a small vein in the forearm at 5-min intervals. One minute after each injection, the subject was asked to assess the injection pain on a visual analog scale (0-100 mm). The pain score (median [range]) was 44.5 (0-77) after 1% Methohexital in saline, 0.5 (0-26) after 1% Methohexital in a lipid emulsion, and 1.0 (0-26) after 0.1% Methohexital in saline. The pain score for 1% Methohexital in saline was significantly greater than those for the other two solutions (P less than 0.001 for each comparison). In study B, 42 patients, 41 +/- 3 yr, were given 1% Methohexital in lipid emulsion (n = 22) or 1% Methohexital in saline (n = 20). A bolus of either solution was administered over 10 s, and the patient was considered asleep if there was no gross movement or response to verbal command 40-70 s after injection.(ABSTRACT TRUNCATED AT 250 WORDS)
Christian E Elger - One of the best experts on this subject based on the ideXlab platform.
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Methohexital induced changes in spectral power of neuromagnetic signals reduced β band enhancement over the hemisphere ipsilateral to the epileptogenic focus
2000Co-Authors: Christian Wienbruch, Christian E Elger, Carsten Eulitz, Klaus Lehnertz, Anke Brockhaus, Thomas Elbert, M HokeAbstract:Effects of anesthetics on electroencephalographic (EEG) activity are used to localize brain lesions as well as epileptogenic areas. Small doses of barbiturates (up to 200 mg) result in an increase of fast activity in the β-band of the EEG. This increase of β-band activity is known to be larger over normal brain areas as compared to areas with cerebral lesions (e.g. [1]). Furthermore, it has been reported that some barbiturates as amobarbital, thiopental, or Methohexital or other narcotics as propofol may provoke epileptiform activity resulting in spike activity and spike-burst-suppression patterns. As an additional feature, various authors ([1] [2]) described qualitatively a loss of Methohexital-induced β-band activity in the electrocorticogramm (ECoG) over the epileptogenic area. A quantitative analysis of the spectral contents of the ECoG is mandatory before the clinical use of Methohexital induced changes in β-band activity can be rated.
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Methohexital induced changes in spectral power of neuromagnetic signals beta augmentation is smaller over the hemisphere containing the epileptogenic focus
Brain Topography, 1997Co-Authors: Christian Wienbruch, Christian E Elger, Carsten Eulitz, Klaus Lehnertz, Anke Brockhaus, Thomas Elbert, M HokeAbstract:Previous research has suggested that Methohexital, a short-term barbiturate, alters activity in the primary epileptogenic area. It can be assumed that drug-induced activation of the epileptogenic focus provides a rapid and safe method to obtain a sufficient amount of information relevant for the lateralization and localisation of the primary epileptogenic area. This study shows that Methohexital changes spectral power in the beta band derived from magnetoencephalographic (MEG) signals over the hemisphere ipsilateral to the primary epileptogenic area. This effect was demonstrated for 10/13 of the investigated patients suffering from unilateral temporal lobe epilepsy (TLE). The side and location of the primary epileptogenic area of these patients (5 left TLE, 8 right TLE) was determined invasively during presurgical evaluation. During a 1-2 minute interval after intravenous bolus injection of 100 mg Methohexital a clear lateralization effect in the beta band was observed, which differed marginally between fronto-central, fronto-temporal and temporo-parietal brain regions. In addition, bilateral spectral power changes were obtained in the theta, alpha and gamma bands that differed between brain regions. Analyses of simultaneously recorded scalp electroencephalographic (EEG) data revealed effects consistent with those of the MEG analysis. The reduced enhancement of beta band spectral power of MEG recordings provides a potential application for the non-invasive lateralization of the primary epileptogenic area.
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localization of the epileptic focus during Methohexital induced anesthesia
Epilepsia, 1992Co-Authors: Andreas Hufnagel, Wieland Burr, Christian E Elger, J Nadstawek, Gerda HefnerAbstract:Summary: A short anesthesia was provided by Methohexital for painless percutaneous removal of subdural electrodes in 27 patients with medically intractable, complex partial seizures who had undergone invasive preoperative evaluation. Electrocorticographic(ECoG) recordings performed before and during the narcosis were submitted to visual (n = 27) and computerized (n = 3) analysis to obtain additional information about the location of the epileptic focus (or foci). The following observations were made: focal epileptiform potentials were induced in 24 of 27 patients (89%); (b) in 20 of these 24, the induced spikes appeared amid or were followed by isoelectric or subdelta activity. These spikes were characterized by high amplitude as well as rhythmic and synchronized appearance over a circumscribed focal area (or areas) known to be spontaneously epileptogenic. This phenomenon, termed spike-burst-suppression (SBS) pattern, allowed identification of the primary epileptic focus in many patients with temporal lobe epilepsy. Further-more, it indicated a good outcome of epilepsy surgery. Computerized analysis of the induced synchronized spikes (n = 3) allowed further delineation of the primary site of epileptogenicity and quantitative comparison of multiple epileptic generators. ECoG recording during deep Methohexital-induced narcosis is a valuable tool for lateralization and delineation of the primary epileptogenic focus. RESUME Chez 27 patients presentant des crises partielles complexes resistant au traitement medical, chez lesquels avait ete effectuee une evaluation prechirurgicale invasive, une courte anesthesie par methohexical a permis de retirer sans douleur les electrodes sous-durales. Les enregistrements electro-corticographiques realises avant et pendant l'anesthesie ont ete soumis a une analyse visuelle (n ? 27) et informatisee (n ? 3) afin d'obtenir une information supplementaire sur la localisation du ou des foyers epileptiques. Les auteurs ont fait les observations suivantes: (1) des potentiels epileptiformes focaux etaient induits chez 24 patients sur 27 (89%); (2) chez 20 de ces 24 patients, les potentiels induits survenaient parmi ou etaient suivis par une activite iso-electrique infra-delta. Ces pointes etaient caracterisees par une amplitude elevee, une apparence rythmique et synchronisee au niveau d'une ou deux zones focales circonscrites, spontanement epileptogenes. Ce phenomene, qui a ete qualifie de pattern de burst-suppression, a permis I'identification du foyer epileptique primaire dans une grande proportion des patients presentant une epilepsie temporale. De plus, il a permis de predire une bonne evolution apres chirurgie de I'epilepsie. L'analyse informatisee des pointes synchronisees induites (n ? 3) a permis de preciser encore le site primarie epileptogene et la comparaison quantitative de generateurs epileptogenes multiples. En conclusion, l'enregistrement electro-corticographique pendant une anesthesie profonde induite par Methohexital represente un outil important pour la lateralisation et la delimitation du foyer epileptogene primarie. RESUMEN En 27 pacientes con ataques parciales complejos medicamente intratables que habian sido sometidos a una evaluacion invasiva prequirurgica se les aplico una anestesia breve con metohexital para la extraccion indolora y percutanea de los electrodos subdurales. Los registros electrocorticograficos realizados antes y durante la anestesia fueron sometidos a analisis visual (n ? 27) y computerizado (n ? 3) para obtener information adicional acerca de la localizacion del foco o de los focos epilepticos. Se obtuvieron las siguientes informaciones: (I) se indujeron potenciales epileptiformes focales en 24 de los 27 pacientes (89%).; (11) en 20 de estos 24 pacientes las puntas inducidas aparecieron mezcladas o se siguieron de actividad isoelectrica o subdelta. Estas puntas se caracterizaron por: elevada amplitud y apariencia ritmica y sincronizada sobre un area focal circunscrita (o areas) conocida por ser espontaneamente epileptogenica. Este fenomeno, denominado patron de punta-brote-supresion, permitio la identification del foco epileptogenico primario en una proportion elevada de los enfermos con epileptsia del lobulo temporal. Ademas indico un pronostico satisfactorio de la cirugia para la epilepsia. El analisis computerizado de las puntas sincronas inducidas (n ? 3) permitio una delineacion anadida del lugar primario de la capacidad epileptogenica y una comparacion cuantitativa de los multiples generadores epilepticos. En conclusion los registros electrocorticograificos durante la narcosis profunda inducida por el metohexital es un instrumento valido para la localization de la lateralizacion y de la delineacion del foco epileptogemico primario. ZUSAMMENFASSUNG Bei 27 Patienten mit medikamentos therapieresistenten komplex partiellen Anfallen uberwiegend temporalen Ursprungs wurde nach Abschluβ der invasiven Phase der prachirurgischen Epilepsiediagnostik eine kurze, durch Methohexital induzierte, Narkose durchgefuhrt um chronisch implantierte subdurale Elektroden schmerzfrei perkutan explantieren zu konnen. Wahrend der Kurznarkose wurden elektrocorticographische Aufzeichnungen durchgefuhrt und einer visuellen (n ? 27) oder computerisierten (n ? 3) Analyse unterzogen um Zusatzinformationen uber die Lokalisation des epileptischen Fokus zu erhalten. Die folgenden Beobachtungen wurden gemacht: I. Epileptiforme Potentiale wurden bei 24 der 27 Patienten (=89%) induziert. 2. Bei 20 dieser 24 Patienten wurden im Bereich des spontanen epileptischen Fokus hochamplitudeig Spikes induziert, welche synchronisiert und rhythmisch erschienen und umgeben oder gefolgt waren von Isoelektrischer-oder Subdelta-Aktivitat. Mit Hilfe dieses Phanomens, welches als Spike-Burst-Suppression-Muster bezeichnet wurde, lieβ sich die Lokalisation des primaren epileptischen Fokus bei der Mehrzahl der Patienten mit Temporallappenepilepsie festlegen. Zudem weist das Spike-Burst-Suppression-Muster bei diesen Patienten auf eine gunstige Prognose nach erfolgter Temporallapprenresektion hin. Durch computerisierte Analyse der induzierten synchronisierten Spikes (n ? 3) lieβ sich das primar epileptogene Hirnareal weiter eingrenzen. Zusammenfassend laβt sich sagen, das electrocorticographische Aufzeichnungen wahrend einer tiefen, durch Methohexital induzierten, Narkose wertvolle Zusatzinformation fur die Lateralisation und Eingrenzung des primaren epileptogenen Hirnareals liefern konnen.