Myoclonus induced by etomidate during induction of general anesthesia is undesirable. This study evaluated the effect of dexmedetomidine (DEX) pretreatment on the incidence and severity of etomidate-induced myoclonus. Ninety patients undergoing elective surgical procedures were randomly allocated to three groups (n=30 each) for intravenous administration of 10 mL isotonic saline (group I), 0.5 µg/kg DEX in 10 mL isotonic saline (group II), or 1.0 µg/kg DEX in 10 mL isotonic saline (group III) over 10 min. All groups subsequently received 0.3 mg/kg etomidate by intravenous push injection. The incidence and severity of myoclonus were recorded for 1 min after etomidate administration and the incidence of cardiovascular adverse events that occurred between the administration of the DEX infusion and 1 min after tracheal intubation was recorded. The incidence of myoclonus was significantly reduced in groups II and III (30.0 and 36.7%), compared with group I (63.3%). The incidence of severe sinus bradycardia was significantly increased in group III compared with group I (P<0.05), but there was no significant difference in heart rate in groups I and II. There were no significant differences in the incidence of low blood pressure among the 3 groups. Pretreatment with 0.5 and 1.0 µg/kg DEX significantly reduced the incidence of etomidate-induced myoclonus during anesthetic induction; however, 0.5 µg/kg DEX is recommended because it had fewer side effects.
We describe a novel method using electromagnetic navigation bronchoscopy (ENB) without dye marking to perform vectorial localization for an impalpable peripheral lesion in the right lower lobe during diagnostic surgical resection in a 52‐year‐old woman. After the ENB registration process, the anesthetist changed the single‐lumen endotracheal tube to a double‐lumen endobronchial tube. Guided by the ENB system, the operator delivered the probe of the locatable guide to the planned site through the right lumen of the endobronchial tube. The ENB system allows calculation of the direction and distance between the probe and the lesion, confirming the relative location of the lesion. The locatable guide was retained during surgery as an intraoperative indicator, rather than applying dye marking. During video‐assisted thoracoscopic surgery, the protuberant visceral pleura poked by the probe accurately indicated the relative location of the lesion. Accordingly, we performed precise wedge resection for diagnosis, followed by lobectomy, resulting in a diagnosis of invasive adenocarcinoma. Vectorial localization is an alternative method of ENB‐guided localization to peripheral pulmonary lesions, which can provide the accurate location of such lesions for diagnostic surgical resection.
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