Prevention of etomidate-induced myoclonus during anesthetic induction by pretreatment with dexmedetomidine

Luan, Haihong; Zhao, Zeyu; Feng, Jiaojiao; Cui, J.Z.; Zhang, X.B.; Zhu, Ping; Zhang, Y.H.

doi:10.1590/1414-431x20144100

Cited by 32 publications

(42 citation statements)

References 24 publications

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“…Yang X et al 16 also showed a reduction in the etomidate induced myoclonus in lidocaine group when compared with placebo. In the present study, the incidence of myoclonus at one and two minutes with 68% and 64% respectively in the control group and 30% and 38% respectively in the lidocaine group was observed which was in accordance with the findings of Luan HF at al 17 who reported an incidence of etomidate induced myoclonus of 63.3% at one minute with normal saline. Lang B et al 15 reported that there was a significant difference between the lidocaine group and the saline group in the incidence of etomidate induced mild myoclonus (13% with lidocaine versus 21.1% with saline) comparable with the present study.…”

Section: Discussionsupporting

confidence: 92%

Effect of Lidocaine Pre-Treatment on Myoclonus during Induction of Anaesthesia with Etomidate- A Randomised, Double-Blind, PlaceboControlled Study

Rajkumari¹,

Eshori²,

Singh³

et al. 2020

jebmh

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BACKGROUND Etomidate is widely used for induction of general anaesthesia and sedation, especially in elderly patients and hemodynamically unstable patients. However, myoclonus is one of the most prominent problems encountered during induction of anaesthesia with etomidate. Many agents have been used to prevent it including lidocaine. This prospective, randomised controlled study was taken up to evaluate the effect of pre-treatment with lidocaine versus placebo on the incidence and severity of myoclonus at one minute and two minutes after induction of anaesthesia with etomidate for elective surgeries. METHODS One hundred adult patients were randomly assigned into two groups to receive saline placebo (Group I) and IV lignocaine 1 mg/Kg (Group II). Group I (n=50) received 6 ml of normal saline (placebo) and Group II received lidocaine, 1 mg/Kg, diluted with normal saline up to 6 ml. Double blinding was achieved by making the principal investigator and the patient unaware of which drug was given. Two minutes after administering the study drug, intravenous etomidate (Troymidate, Troikaa) 0.3 mg/Kg was administered over 30 seconds and the patient was monitored for myoclonus over the next two minutes. RESULTS At one-minute, myoclonus was seen in 34 patients (68%) and 15 patients (30%) respectively in Group-I and Group-II. There was a statistically significant reduction in the incidence of myoclonus at one minute in Group-II compared to Group-I (p<0.05). At two-minutes myoclonus was seen in 32 patients (64%) and 19 patients (38%) respectively in Group-I and Group-II. There was a statistically significant reduction in the incidence of myoclonus at two minutes in Group-II compared to Group-I (p<0.05). CONCLUSIONS Lignocaine 1 mg/Kg pre-treatment significantly reduces the incidence of Etomidate induced myoclonus (EM) compared with the control group.

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Section: Discussionsupporting

confidence: 92%

Effect of Lidocaine Pre-Treatment on Myoclonus during Induction of Anaesthesia with Etomidate- A Randomised, Double-Blind, PlaceboControlled Study

Rajkumari¹,

Eshori²,

Singh³

et al. 2020

jebmh

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“…10 It can be of a concern in full stomach patients, in penetrating eye injuries, high intraocular pressure. Ko B 11 et al studied the incidence of myoclonus after etomidate induction using fentanyl and remifentanil as premedicants.…”

Section: Myoclonusmentioning

confidence: 99%

Comparison of haemodynamic response to laryngoscopy and endotracheal intubation following induction of general anaesthesia with propofol or etomidate

2020

IJCA

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Aims and Objectives: Propofol and etomidate are most frequently used intravenous induction agents, with very similar onset of action and duration of action, few advantages over each other and few unwanted effects. Recent studies and reintroduction of etomidate has paved way for its routine use in haemodynamically unstable patients. Materials and Methods: One hundred patients belonging to American Society of Anaesthesiologists (ASA) class I and II, aged between 18 to 60 years scheduled to undergo elective surgical procedure under general anaesthesia were selected. All the patients received tablet diazepam 0.2 mg/kg as premedication and fentanyl 2 mcg/kg body weight before induction. Patients were be randomly allocated to group P ((n = 50), who received propofol 2 mg/kg or group E (n = 50) who received, Etomidate 0.3 mg/kg as induction agent for general anaesthesia. Endotracheal intubation was facilitated by vecuronium 0.1mg/kg body weight. Heart rate (HR), Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) were recorded at basal, after fentanyl, 1, 3, 5 and 10 min following induction. Results: There was no significant change in the heart rate at and after the induction, intubation in either group P or group E. There was significant decrease in SBP, DBP and MAP in group P following induction, whereas there was less decrease in Group E. There was increase in the SBP, DBP and MAP after intubation in both the groups, but in group P it did not increase above the basal and remained below the basal levels at 5 and 10 minutes following intubation. Conclusion: Etomidate provides stable haemodynamics at induction of general anaesthesia. But it does not attenuate the haemodynamic response to laryngoscopy and intubation. Propofol causes significant hypotension at induction and attenuates the pressor response to laryngoscopy and intubation.

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“…When etomidate was first introduced in 1973, it was known as an agent with hypnotic properties that possessed minimal cardiovascular and pulmonary complications (1). Etomidate maintains hemodynamic stability and eliminates histamine release more profoundly than other drugs (2).…”

Section: Introductionmentioning

confidence: 99%

“…Myoclonus can be detrimental to full-stomach patients undergoing emergency surgery, patients with an open eye injury, and those with a history of cardiovascular disease (2,6). Although the mechanism of myoclonus is not fully understood, various medications have been used to prevent the occurrence of myoclonus (1), including fentanyl (2), benzodiazepines (7), rocuronium (8), opioids (9), Copyright © 2019, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.…”

Section: Introductionmentioning

confidence: 99%

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

Nazemroaya

Mousavi

2019

Anesth Pain Med

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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).

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Prevention of etomidate-induced myoclonus during anesthetic induction by pretreatment with dexmedetomidine

Cited by 32 publications

References 24 publications

Effect of Lidocaine Pre-Treatment on Myoclonus during Induction of Anaesthesia with Etomidate- A Randomised, Double-Blind, PlaceboControlled Study

Effect of Lidocaine Pre-Treatment on Myoclonus during Induction of Anaesthesia with Etomidate- A Randomised, Double-Blind, PlaceboControlled Study

Comparison of haemodynamic response to laryngoscopy and endotracheal intubation following induction of general anaesthesia with propofol or etomidate

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

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