Abstract Details

Title Intracarotid Ethomidate - WADA Test: A 75 Patient Series

Topic Epilepsy

Presentation(s) P06 - (-)

Poster/Presentation
Number 164

Objective

Background BACKGROUND: Although fMRI allows noninvasive presurgical language and memory function, intracarotid amobarbital test remains the gold standard for memory reserve evaluation. Evaluation of memory reserve is needed in selected cases undergoing temporal lobectomy. Amobarbital has been traditionally used as the anesthesic agent, but legal and commercial constraints limit its use.

Design/Methods DESIGN/METHODS: 75 patients aged 11-58 years received an intracarotid bolus injection of ethomidate. Indication for the procedure was: evaluation of language lateralization in 12 cases, evaluation of memory reserve in 14 cases and research protocol in 48 cases.

Results RESULTS: Initial dose was 0.015mg/kg (total dose range 0,6-2,8 mg). After initial exams, we noted that an 0,8 mg dose caused hemiplegia, without sedation in almost all cases. An additional bolus was necessary in 28 hemispheres (doses 0,2-0,4 mg), due to partial reversal of ethomidate effect. Catheter was maintained in the intracarotid position throughout the test (range 3--8 minutes, median 4,5). One patient presented transient hemiparesis (after catheterization, prior to infusion), that resolved completely in five minutes. After this, catheterization was coupled with continuous infusion of heparinized saline. Catheter was withdrawn towards the end of presentation of the items. No further episodes of hemiparesis were noted. Language lateralization was achieved in all cases. Memory capacity and reserve evaluation was successful in all but one case (difficulty of cooperation). Minor side effects included somnolence (56/75 or 75,6%% of cases), tremor (19/75 or 25% of cases) and dystonia (7/75 or 9,3% of cases). Side effects did not require interruption of the procedure.

Conclusions CONCLUSIONS: Ethomidate appears to be a safe alternative agent to amobarbital in the WADA test.

Authors/Disclosures
PRESENTER	No disclosure on file
Camila Moreira, MD	No disclosure on file
Gordon Mazibrada, MD (Queen Elizabeth Hospital)	No disclosure on file
	No disclosure on file
	No disclosure on file
LECIO FIGUEIRA PINTO, MD (Hospital Das Clinicas Sao Paulo)	No disclosure on file
	No disclosure on file
Rosa M. Valerio, PhD	No disclosure on file
Luiz H. Castro, MD (University of Sao Paulo)	Dr. Castro has nothing to disclose.

��ɫ��

��ɫ��