Comparison of Premedication with Low-Dose Midazolam Versus Etomidate for Reduction of Etomidate-Induced Myoclonus During General Anesthesia for Electroconvulsive Therapy: A Randomized Clinical Trial

Abstract

Background: A variety of anesthetics including methohexital, thiopental sodium, propofol, ketamine, and etomidate are used for electroconvulsive therapy (ECT), each accompanied by adverse effects that can cause unpleasant experiences for patients. Etomidateinduced myoclonus is among the adverse effects. We attempted to assess the effect of premedication with low-dose midazolam compared to etomidate on the reduction of this complication. Objectives: This study was designed to compare the effectiveness of low-dose etomidate and low-dose midazolam to suppress etomidate-induced myoclonus in ECT. Methods: This randomized double-blinded clinical trial was conducted on 132 patients who were candidates for ECT. They were divided into three groups of 44 patients to receive 0.015 mg/kg midazolam, 0.03 mg/kg etomidate, or placebo. Independent t-test and chi-square test were used for comparison of variables. Results: The frequency of myoclonic movements during anesthesia was different between the three groups (P value < 0.001). Myoclonic movements were significantly lower in the midazolam group than in the placebo (P value < 0.001) and etomidate (P value = 0.002) groups. In addition, the intensity of myoclonic movements was significantly higher in the midazolam group than in the placebo and etomidate groups (P value < 0.001). Conclusions: Low-dose midazolam (0.015 mg/kg) before anesthesia induction with etomidate was accompanied with significantly lower incidence and intensity of myoclonus than low-dose etomidate (0.03 mg/kg).

Comparative assessment of dexmedetomidine and butorphanol for attenuation of etomidate-induced myoclonus: A double-blind, randomised controlled study

“…[ 11 12 ] There is a never-ending pursuit among anaesthesiologists to find an ideal drug to attenuate etomidate-induced myoclonus, which would possess attributes like having a short duration of action with minimal systemic effects and without prolonging the duration of anaesthesia. The various agents that have been employed to suppress this effect include midazolam,[ 6 7 ] fentanyl,[ 13 ] remifentanil,[ 14 ] magnesium sulphate,[ 10 15 ] lignocaine,[ 16 ] butorphanol,[ 3 9 17 18 ] dexmedetomidine,[ 1 2 8 19 20 21 22 ] thiopental[ 21 ] and sub-hypnotic doses of etomidate. [ 23 ] Dexmedetomidine has the edge over the other agents, given its diverse actions, including conscious sedation, analgesia and preventing haemodynamic response to laryngoscopy and intubation.…”

“…[ 3 4 5 ] Literature review advocates the use of a variety of agents for the attenuation of myoclonus, including benzodiazepines, opioids, local anaesthetics and also a smaller dose of etomidate itself, with varied results. [ 5 6 7 ] Dexmedetomidine, an α2 receptor agonist, has been used in different doses for preventing myoclonus. [ 1 2 8 ] Similarly, butorphanol, an opioid agonist–antagonist analgesic, has also been found efficacious.…”

Evaluation of the Efficacy of the ECT Patients Preparation Checklist in Reducing the Cancellation Rate in an Academic Hospital

“…Therefore, it is important to find a practical solution so that the treatment session is not canceled while the patient is managed safely. The successful management of ECT patients results from team-work and proper communication between anesthesiologists and psychiatrists (9). It has been well documented that this procedure was considered inhumane before anesthesia was used in the ECT process (10).…”

A Comparative Study of Valsalva Maneuver, Lidocaine, and Valsalva Maneuvers with Administration of Lidocaine to Reduce the Pain Associated with Administration of Etomidate During General Anesthesia

“…This medication can be solely used as an IV medicine. The reason that etomidate is a desirable medication is that Etomidate possesses acceptable hemodynamic characteristics when used during anesthesia induction, meaning that it causes a negligible extent of reduction in blood pressure, therefore etomidate is considered to be an acceptable drug in trauma anesthesia which has caused the patient to go into shock, or in patients suffering from hypovolemia, and those with a history of serious cardiovascular conditions (2,3). Additionally, it has been safely utilized for the induction of general anesthesia and also in rapid sequence intubation.…”