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Juhn Wada1 and W. James Gardner2 were among the first investigators to anesthetize the cerebral cortex, although their agents and aims differed. Gardner directly injected procaine hydrochloride (Novocain) through holes drilled into the brain, for the purpose of localizing speech in two left-handed patients scheduled for resection of brain tumors. Dr. Wada first used intracarotid amobarbital injections to treat a patient in status epilepticus, and later to direct placement of electrodes for electroconvulsive therapy in psychiatric patients. Subsequently, Dr. Wada and colleagues at the Montreal Neurologic Institute extended his technique to assessment of language and memory in epilepsy surgery patients. The intracarotid amobarbital procedure has emerged in epilepsy surgery centers around the world as the standard method to lateralize speech and memory functions and to prevent or predict the magnitude of related declines following epilepsy surgery.
The continuation of this practice has recently been challenged on two fronts, however. First, some have proposed that new methodologies and technologies can replace the Wada. Second, a recent interruption in the supply of amobarbital has caused some centers to seek out novel anesthetic agents. In 2003–2004, there was a shortage of amobarbital on a worldwide basis for at least several months when the manufacturing …
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