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Reducing myoclonus after etomidate.

AbstractBACKGROUND:
The authors hypothesized that myoclonus after etomidate is dose-related, could be suppressed when small doses of etomidate were administered before induction, and is unassociated with seizure-like activity on electroencephalogram (EEG).
METHODS:
Three studies were performed. In the first study, 36 men were randomly assigned to receive 0.025, 0.050, 0.075, 0.100, 0.200, or 0.300 mg/kg of etomidate. In a second crossover study, eight men were randomly allocated to receive either a pretreatment dose of 0.050 mg/kg etomidate or placebo 50 s before 0.300 mg/kg etomidate was injected. EEG was recorded for subjects in the first two studies. In a third study, 60 patients were randomly allocated to one of three pretreatment doses of etomidate: 0.030, 0.050, or 0.075 mg/kg before 0.300 mg/kg was given.
RESULTS:
In Study 1, myoclonus was not observed after 0.025 or 0.050 mg/kg etomidate. One volunteer had myoclonus after 0.075 mg/kg and another after 0.100 mg/kg etomidate; three had myoclonus after 0.200 mg/kg; and five after 0.300 mg/kg. Incidence of myoclonus was dose-related (P < or = 0.01). In Study 2, two volunteers (25%) with etomidate pretreatment had mild myoclonus compared to six (75%) with placebo pretreatment (P < or = 0.05). EEG changes, other than delta waves, were not seen during myoclonic epochs. In Study 3, myoclonus was less likely after the small pretreatment doses (0.030 or 0.050 mg/kg) than after the large dose (0.075 mg/kg, P < or = 0.01).
CONCLUSIONS:
Incidence and intensity of myoclonus after induction with etomidate are dose-related, suppressed by pretreatment, and unassociated with seizure-like EEG activity.
AuthorsA W Doenicke, M F Roizen, J Kugler, H Kroll, J Foss, P Ostwald
JournalAnesthesiology (Anesthesiology) Vol. 90 Issue 1 Pg. 113-9 (Jan 1999) ISSN: 0003-3022 [Print] United States
PMID9915320 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Anesthetics, Intravenous
  • Etomidate
Topics
  • Adult
  • Anesthetics, Intravenous (administration & dosage, adverse effects)
  • Cross-Over Studies
  • Dose-Response Relationship, Drug
  • Electroencephalography (drug effects)
  • Etomidate (administration & dosage, adverse effects)
  • Humans
  • Male
  • Myoclonus (prevention & control)
  • Prospective Studies
  • Single-Blind Method

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