Comparison of the influence of low dose etomidate and propofol as priming dose on the incidence of etomidate induced myoclonus: a randomised, double-blind clinical trial

Moningi, Srilata; Reddy, G. Poojitha; Nikhar, Sapna Annaji; Chikkala, Ramakrishna; Kulkarni, Dilip Kumar; Ramachandran, Gopinath

doi:10.1016/j.bjane.2021.02.047

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…To exclude possible neurological symptoms caused by central nervous system hypoxia, patients undergoing mechanical ventilation were not considered in the primary analysed group. Significant hypoxia remains a known causative factor in the occurrence of myoclonus [93], as are some of the anaesthetic agents [94]. This is consistent with the obtained data, which showed that as many as 80.43% of mechanically ventilated patients presented myoclonus.…”

Section: Discussionsupporting

confidence: 88%

Autoimmune mediated hyperkinetic movement disorders in SARS-CoV-2 infection — a systematic review

Hirschfeld

2021

Neurol Neurochir Pol.

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Introduction. Various neurological symptoms have been confirmed in the course of SARS-CoV-2 infection. Some of these are undoubtedly the aftermath of the developing inflammation and increased coagulation processes. However, there is also a group of symptoms that derive from possible autoimmune processes. These include primary hyperkinetic movement disorders such as myoclonus, ataxia, opsoclonus, and tremors. This study systematically reviews scientific reports presenting patients with hyperkinetic movement disorders as one of the neurological symptoms. Material and methods.The available literature was systematically reviewed as per the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PubMed database was used in the range from 1 April, 2020, to 31 July, 2021.Results. The PubMed database search identified 102 cases of patients with SARS-CoV-2 infection who developed hyperkinetic movement disorders. After excluding patients undergoing mechanical ventilation (n = 46) and a few other cases (n = 7), a group of 49 non-intubated patients was obtained. The mean age of the patients was 57.92 years, and 75.51% of the patients were male. The most common hyperkinetic movement disorders were ataxia (83.67%), myoclonus (67.35%), and tremor (30.61%). Symptoms appeared on average within two weeks of the first symptoms of infection. Most patients had symptoms significantly reduced or withdrawn (67.44%) or early partial improvement (30.23%). Conclusions.Based on the meta-analysis, it can be concluded that hyperkinetic movement disorders in the course of SARS--CoV-2 infection are an early symptom with a potential autoimmune background. They have a good prognosis with the applied treatment. Further observations are needed to determine their frequency and the most effective methods of treatment.

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Section: Discussionsupporting

confidence: 88%

Autoimmune mediated hyperkinetic movement disorders in SARS-CoV-2 infection — a systematic review

Hirschfeld

2021

Neurol Neurochir Pol.

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“…However, many theories have been postulated to explain this, which include a seizure-like activity, suppression of inhibitory pathways before the excitatory ones after etomidate injection and activation of spontaneous nerve transmissions. [ 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.…”

Section: Discussionmentioning

confidence: 99%

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

Rautela,

Gulabani,

Kumar

et al. 2023

Indian Journal of Anaesthesia

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Background and Aims: Etomidate is a popular induction agent, but its use is associated with myoclonus in 50%–80% of non-premedicated patients. This study aims to compare dexmedetomidine and butorphanol for their relative efficacy in preventing etomidate-induced myoclonus. Methods: This randomised study was conducted after obtaining institutional ethical committee clearance and written informed consent from sixty American Society of Anesthesiologists (ASA) I or II consenting patients between 18 and 60 years of age of either sex who had been scheduled for elective surgeries under general anaesthesia. Patients were randomly allocated to dexmedetomidine 0.5 μg/kg (Group D) or butorphanol 0.015 mg/kg (Group B). Both the drugs were given as an infusion over a period of 10 min before induction of anaesthesia. The primary outcome was the incidence of myoclonic movements after etomidate, and the secondary outcomes were the severity of myoclonus, changes in the haemodynamic parameters and incidence of airway complications. Normally distributed variables were compared using Student’s t-test, and non-normally distributed variables were compared using Mann–Whitney U test. Qualitative data were analysed using Chi-square/Fisher’s exact test. A P-value <0.05 was considered significant. Results: The incidence of etomidate-induced myoclonus was significantly higher in group B compared to group D (P = 0.035). The median (interquartile range [IQR]) of myoclonus grade in patients of group D was 0.00 (0.00–3.00), and group B was 2.50 (0.00–3.00) (P = 0.035). Haemodynamics and airway-related complications were comparable between the groups. Conclusion: Dexmedetomidine was more effective than butorphanol in preventing etomidate-induced myoclonus.

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“…Compared with propofol, etomidate is especially suitable for anesthesia, procedural sedation and analgesia (PSA) in the emergency department for patients with trauma, shock, and acute abdomen, with hemodynamic instability. However, in some areas, etomidate use is partially limited by its ability to cause adrenocortical depression, myoclonus, and injection pain ( 31 ). Etomidate can induce myoclonus which may increase the risk of aspiration in satiated patients and patients with a decreased cardiac reserve and increased cardiac oxygen consumption ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effectiveness of Various Drug Interventions to Prevent Etomidate-Induced Myoclonus: A Bayesian Network Meta-Analysis

et al. 2022

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BackgroundMyoclonic movement is a very common but undesirable phenomenon during the induction of general anesthesia using etomidate. Such movement may cause unnecessary problems. Currently, there is an increasing number of drugs for preventing etomidate-induced myoclonus (EM). However, direct comparisons of various drugs are lacking, and this interferes with clinical decision-making. Our network meta-analysis (NMA) aimed to compare the efficacy of different drugs for the prevention of moderate-to-severe general myoclonus.MethodsUsing several biomedical databases, randomized controlled trials (RCTs) published in English from inception to August 22, 2021 were searched. Among the various interventions, we selected nine types of intervention drugs (dexmedetomidine, etomidate, lidocaine, NMDA receptor antagonist, κ opioid receptor agonist, μ opioid receptor agonist, muscle relaxant, gabapentin, and midazolam) for comparison, according to the number of studies. Bayesian NMA was performed using STATA16 and R softwares. The relative risk of EM was assessed using risk ratios (RRs) and the corresponding 95% confidence intervals (CI).ResultsA total of 31 RCTs (3209 patients) were included. NMA results showed that, compared with a placebo, etomidate (RR 4.0, 95%CI 2.1–7.8), κ opioid receptor agonist (RR 2.9, 95%CI 1.9–4.6), μ opioid receptor agonist (RR 3.1, 95%CI 2.3–4.3), NMDA receptor antagonist (RR 1.7, 95%CI 1.0–2.8), dexmedetomidine (RR 2.4, 95%CI 1.5–3.9), lidocaine (RR 2.1, 95%CI 1.2–3.9), and midazolam (RR 2.2, 95%CI 1.5–3.2) can significantly reduce the risk of EM. In contrast, the effects of muscle relaxants (RR 2.1, 95%CI 0.81–5.3) and gabapentin (RR 2.8, 95%CI 0.92–9.3) were inconclusive. Further subgroup analyses showed that preoperative low-dose etomidate, μ-opioid receptor agonist, and κ-opioid receptor agonist were significantly better than other interventions in the prevention of moderate to severe EM.ConclusionPreoperative use of small doses of etomidate or opioids may be the most effective way to avoid EM, especially moderate and severe EM, which makes anesthesia induction safer, more stable, and aligns better with the requirements of comfortable medicine.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], [CRD4202127706].

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Comparison of the influence of low dose etomidate and propofol as priming dose on the incidence of etomidate induced myoclonus: a randomised, double-blind clinical trial

Cited by 5 publications

References 22 publications

Autoimmune mediated hyperkinetic movement disorders in SARS-CoV-2 infection — a systematic review

Autoimmune mediated hyperkinetic movement disorders in SARS-CoV-2 infection — a systematic review

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

Comparison of the Effectiveness of Various Drug Interventions to Prevent Etomidate-Induced Myoclonus: A Bayesian Network Meta-Analysis

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