Prevention of etomidate-induced myoclonus: Which is superior: Fentanyl, midazolam, or a combination? A Retrospective comparative study

Abstract

BackgroundIn this retrospective comparative study, we aimed to compare the effectiveness of fentanyl, midazolam, and a combination of fentanyl and midazolam to prevent etomidate-induced myoclonus.Material/MethodsThis study was performed based on anesthesia records. Depending on the drugs that would be given before the induction of anesthesia with etomidate, the patients were separated into 4 groups: no pretreatment (Group NP), fentanyl 1 μg·kg−1 (Group F), midazolam 0.03 mg·kg−1 (Group M), and midazolam 0.015 mg·kg−1 + fentanyl 0.5 μg·kg−1 (Group FM). Patients who received the same anesthetic procedure were selected: 2 minutes after intravenous injections of the pretreatment drugs, anesthesia is induced with 0.3 mg·kg−1 etomidate injected intravenously over a period of 20–30 seconds. Myoclonic movements are evaluated, which were observed and graded according to clinical severity during the 2 minutes after etomidate injection. The severity of pain due to etomidate injection, mean arterial pressure, heart rate, and adverse effects were also evaluated.ResultsStudy results showed that myoclonus incidence was 85%, 40%, 70%, and 25% in Group NP, Group F, Group M, and Group FM, respectively, and were significantly lower in Group F and Group FM.ConclusionsWe conclude that pretreatment with fentanyl or combination of fentanyl and midazolam was effective in preventing etomidate-induced myoclonus.

Magnesium sulfate versus Lidocaine pretreatment for prevention of pain on etomidate injection: A randomized, double-blinded placebo controlled trial

“…Magnesium blocks NMDA receptor currents in a voltage-dependent manner by blocking the receptor channel. [ 16 17 18 19 ] Guler et al . compared low-dose magnesium and ketamin in preventing the injection pain of etomidate and found ketamin to be superior.…”

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

“…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). Research has shown that using etomidate at a dose of 0.3 mg/kg does not cause significant changes in the cardiac stroke volume, heart rate, right atrial pressure, cardiac index, systemic and pulmonary vascular pressures, leading to the increasing use of this medication (3,4).…”

“…Various studies have reported the incidence of myoclonus in up to 80% of the times when it was administered. 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).…”

“…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.…”

Hemodynamic Responses to Two Different Anesthesia Regimens in Compromised Left Ventricular Function Patients Undergoing Coronary Artery Bypass Graft Surgery: Etomidate-Midazolam Versus Propofol-Ketamine

“…On the other hand, etomidate is the most appropriate drug in patients with compromised cardiopulmonary function because of its minimal cardiovascular and respiratory depressant effects, ( 18 ) however, etomidate has some side effects such as injection pain, adrenal suppression and myoclonus. Pretreatment with low dose of a hypnotic agent such as midazolam ( 19 - 21 ), reduces myoclonus. The incidence of myoclonus due to etomidate depends on the dosage and speed of injection ( 22 ).…”