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

Abstract

BACKGROUND:

In 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 AND METHODS:

This 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.

RESULTS:

Study 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.

CONCLUSIONS:

We conclude that pretreatment with fentanyl or combination of fentanyl and midazolam was effective in preventing etomidate-induced myoclonus.

• Authors: Ilke Isitemiz, Sinan Uzman, Mehmet Toptaş, Ayşe Vahapoglu, Yaşar Gökhan Gül, Ferda Yilmaz Inal, Ibrahim Akkoc
• Journal: Medical science monitor : international medical journal of experimental and clinical research (Med Sci Monit) Vol. 20 Pg. 262-7 (Feb 16 2014) ISSN: 1643-3750 [Electronic] United States
• PMID: 24535067 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anesthetics, Intravenous
• Midazolam
• Fentanyl
• Etomidate

Topics

• Anesthetics, Intravenous (adverse effects)
• Blood Pressure (drug effects)
• Drug Therapy, Combination (methods)
• Etomidate (adverse effects)
• Fentanyl (therapeutic use)
• Heart Rate (drug effects)
• Humans
• Midazolam (therapeutic use)
• Myoclonus (chemically induced, prevention & control)
• Retrospective Studies
• Statistics, Nonparametric