Effect of gabapentin pretreatment on myoclonus after etomidate: a randomized, double-blind, placebo-controlled study

Çakırgöz, Mensure Yılmaz; Demirel, İsmail; Duran, Esra; Özer, Ayşe Belin; Hancı, Volkan; Türkmen, Ülkü Aygen; Aydın, Ahmet; Ersoy, Ayşın; Büyükyıldırım, Aslıhan

doi:10.1016/j.bjane.2014.11.014

Cited by 6 publications

(9 citation statements)

References 26 publications

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“…This phenomenon may lead to negative, unpredictable effects during an operation, as well as the subsequent outcome and prognosis, especially for patients with full stomachs or ocular trauma. [5] As shown in recent studies, pretreatment with neuromuscular blocking agent, [6] opioids, [7,8] dexmedetomidine, [9] midazolam, [10] low-dose ketamine, [11] gabapentin, [12] dezocine, [13] and magnesium sulfate [14] could prevent etomidate-related myoclonus. However, these drugs are associated with side effects such as excessive sedation, delayed recovery, and respiratory inhibition.…”

Section: Introductionmentioning

confidence: 99%

Propofol decreases etomidate-related myoclonus in gastroscopy

Liu

Meng

et al. 2017

Medicine

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Objective:Myoclonus, a common complication during intravenous induction with etomidate, is bothersome to both anesthesiologists and patients. This study explored the preventive effect of pretreatment with propofol on etomidate-related myoclonus.Methods:This was a prospective, double-blind, clinical, randomized controlled study. Totally, 363 patients who were scheduled for a short-duration, painless gastrointestinal endoscopy were divided into 5 groups. Four groups received 0 mg/kg (E group), 0.25 mg/kg (LPE group), 0.50 mg/kg (MPE group), or 0.75 mg/kg (HPE group) propofol pretreatment before etomidate anesthesia. Another group only received 1 to 2 mg/kg of propofol (P group) as anesthesia. The incidence and severity of myoclonus, patient circulation and respiratory status, and intraoperative and postoperative complications were recorded.Results:The incidence of myoclonus in the LPE group (26.8%), MPE group (16.4%), HPE group (14.9%), and P group (0) was lower than the E group (48.6%, P < .05). The incidence of grade 1, 2, and 3 of myoclonus in the LPE group, MPE group, HPE group, and P group was significantly lower than the E group, and that in the P group was lower than the LPE group (P < .05). The incidence of hypoxemia in the P group was higher than the E group, and the incidence of adverse events in the HPE group and P group was lower than the E group (P < .05).Discussion:Pretreatment with propofol was feasible for preventing etomidate-related myoclonus. Furthermore, as propofol dosage increased, its effect on reducing the incidence and severity of myoclonic movements induced by etomidate increased.

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Section: Introductionmentioning

confidence: 99%

Propofol decreases etomidate-related myoclonus in gastroscopy

Liu

Meng

et al. 2017

Medicine

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“…Therefore, it is thought that orally administration of medications and their peak plasma concentration levels are affected by preoperative stress. As the degree of stress and anxiety are different among individuals, it seems that our results might be more reliable than the similar studies, which had orally administrated drugs as pretreatment ( 14 ).…”

Section: Discussionmentioning

confidence: 47%

“…A variety of drugs are known that reduce myoclonus due to etomidate to different extends such as dexmedetomidine ( 1 ), opioids ( 4 , 6 , 18 , 22 - 24 ) benzodiazepines ( 25 - 27 ), lidocaine ( 5 , 28 ), magnesium sulfate ( 5 , 21 , 29 ), muscle relaxants ( 17 , 30 ), gabapentin ( 14 ) thiopental ( 31 ) and dezocine ( 32 ). However, offending drugs should be strictly limited to accurate indications.…”

Section: Discussionmentioning

confidence: 99%

“…Yilmaz Cakirgoz et al ( 14 ) reported that pretreatment with 800 mg gabapentin orally 2 hours before surgery reduced the incidence and severity of myoclonus due to etomidate. It is noticeable that in the period before surgery, 60% - 80% of patients experience stress and anxiety about anesthesia and surgery, which results in delay in gastric emptying ( 34 , 35 ).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, during the jerky movements ECG leads may become detached. It should be noted that ECG leads detachment during myoclonic movements leads to delay of monitoring and success of early intervention ( 1 , 2 , 4 , 9 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Effects of Low-Dose Midazolam, Magnesium Sulfate, Remifentanil and Low-Dose Etomidate on Prevention of Etomidate-Induced Myoclonus in Orthopedic Surgeries

et al. 2016

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BackgroundEtomidate is a potent hypnotic agent with several desirable advantages such as providing a stable cardiovascular profile with minimal respiratory adverse effects and better hemodynamic stability compared with other induction agents. This drug is associated, however, with myoclonic movements which is characterized by a sudden, brief muscle contractions as a disturbing side-effect.ObjectivesThe present study was designed to compare the effectiveness of low- dose midazolam, magnesium sulfate, remifentanil and low-dose etomidate to suppress etomidate-induced myoclonus in orthopedic surgery.Patients and MethodsA double-blind clinical trial study was conducted in an academic hospital from September 2014 to August 2015. Two hundred and eighty-four eligible patients, American society of anesthesiologists class I - II, scheduled for elective orthopedic surgery were randomly allocated into four equal groups (n = 71). They received premedication with intravenous low-dose midazolam 0.015 mg/kg, magnesium sulfate 30 mg/kg, remifentanil 1 μg/kg and low-dose etomidate 0.03 mg/kg two minutes before induction of anesthesia with 0.3 mg/kg intravenous etomidate. Then the incidence and intensity of myoclonus were evaluated on a scale of 0 - 3; 0 = no myoclonus; 1 = mild (movement at wrist); 2 = moderate (movement at arm only, elbow or shoulder); and 3 = severe, generalized response or movement in more than one extremity, within ninety seconds. Any adverse effect due to these premedication agents was recorded.ResultsThe incidence and intensity of myoclonus were significantly lower in the low-dose etomidate group. The incidence rates of myoclonus were 51 (71.85%), 61 (85.9%), 30 (42.3%) and 41 (57.7%), and the percentages of patients who experienced grade III of myoclonus were 30 (58.8%), 32 (52.5%), 9 (30%) and 14 (34.1%) in the midazolam, magnesium sulfate, etomidate and remifentanil groups, respectively. The incidence and intensity of myoclonus were significantly lower in the low-dose etomidate group (P = 0.0001). No notable adverse effect was detected in our patients during the study period.ConclusionsIntravenous etomidate 0.03 mg/kg prior to induction can effectively reduce the incidence and severity of myoclonus linked to etomidate.

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Comparison of the influence of low dose etomidate and propofol as priming dose on the incidence of etomidate induced myoclonus: a randomised, double-blind clinical trial

Moningi

Reddy

Nikhar

et al. 2022

Brazilian Journal of Anesthesiology (English Edition)

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Effect of gabapentin pretreatment on myoclonus after etomidate: a randomized, double-blind, placebo-controlled study

Abstract: Pretreatment with 800mg and 1200mg gabapentin 2h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate.

Cited by 6 publications

References 26 publications

Propofol decreases etomidate-related myoclonus in gastroscopy

Propofol decreases etomidate-related myoclonus in gastroscopy

Comparison of the Effects of Low-Dose Midazolam, Magnesium Sulfate, Remifentanil and Low-Dose Etomidate on Prevention of Etomidate-Induced Myoclonus in Orthopedic Surgeries

Comparison of the influence of low dose etomidate and propofol as priming dose on the incidence of etomidate induced myoclonus: a randomised, double-blind clinical trial

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