A descriptive study of myoclonus associated with etomidate procedural sedation in the ED

Yates, Adam M.; Wolfson, Allan B.; Shum, L.; Kehrl, Thompson

doi:10.1016/j.ajem.2013.02.042

Cited by 16 publications

(9 citation statements)

References 15 publications

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“…After screening the titles and abstracts and removing duplicates, we identified 465 potentially relevant studies. After full‐text review, 55 articles met inclusion criteria . Interobserver agreement (kappa) for phase II of the review was 0.99 (95% CI = 0.98 to 1.0).…”

Section: Resultsmentioning

confidence: 99%

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Bellolio

Gilani

Barrionuevo

et al. 2016

Academic Emergency Medicine

121

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ObjectivesThis was a systematic review and meta‐analysis to evaluate the incidence of adverse events in adults undergoing procedural sedation in the emergency department (ED).MethodsEight electronic databases were searched, including MEDLINE, EMBASE, EBSCO, CINAHL, CENTRAL, Cochrane Database of Systematic Reviews, Web of Science, and Scopus, from January 2005 through 2015. Randomized controlled trials and observational studies of adults undergoing procedural sedation in the ED that reported a priori selected outcomes and adverse events were included. Meta‐analysis was performed using a random‐effects model and reported as incidence rates with 95% confidence intervals (CIs).ResultsThe search yielded 2,046 titles for review. Fifty‐five articles were eligible, including 9,652 procedural sedations. The most common adverse event was hypoxia, with an incidence of 40.2 per 1,000 sedations (95% CI = 32.5 to 47.9), followed by vomiting with 16.4 per 1,000 sedations (95% CI = 9.7 to 23.0) and hypotension with 15.2 per 1,000 sedations (95% CI = 10.7 to 19.7). Severe adverse events requiring emergent medical intervention were rare, with one case of aspiration in 2,370 sedations (1.2 per 1,000), one case of laryngospasm in 883 sedations (4.2 per 1,000), and two intubations in 3,636 sedations (1.6 per 1,000). The incidence of agitation and vomiting were higher with ketamine (164.1 per 1,000 and 170.0 per 1,000, respectively). Apnea was more frequent with midazolam (51.4 per 1,000), and hypoxia was less frequent in patients who received ketamine/propofol compared to other combinations. The case of laryngospasm was in a patient who received ketamine, and the aspiration and intubations were in patients who received propofol. When propofol and ketamine are combined, the incidences of agitation, apnea, hypoxia, bradycardia, hypotension, and vomiting were lower compared to each medication separately.ConclusionsSerious adverse events during procedural sedation like laryngospasm, aspiration, and intubation are exceedingly rare. Quantitative risk estimates are provided to facilitate shared decision‐making, risk communication, and informed consent.

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Section: Resultsmentioning

confidence: 99%

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Bellolio

Gilani

Barrionuevo

et al. 2016

Academic Emergency Medicine

121

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“…Myoclonus can occur after induction with etomidate in 50% to 80% of patients without pretreatment, [4] and it increases muscular tension similar to spasms in patients with severe myoclonus. 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.…”

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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“…Our study was carried out to show that the etomidate-induced myoclonus is less compared to the studies conducted by Yates et al [3] …”

Section: Discussionmentioning

confidence: 75%

“…[2] Etomidate is a carboxylated imidazole [3] that depress central nervous system through gamma-aminobutyric acid. [4] Due to its quick action, low profile for cardiovascular risk, minimal respiratory depression, and reliable sedation, etomidate is optimal for procedural sedation in the emergency department (ED).…”

Section: Introductionmentioning

confidence: 99%

Lower significant rate of etomidate-induced myoclonus for procedural sedation in emergency department of a tertiary care hospital

Fernandez¹,

Neethu²

2017

Natl J Physiol Pharm Pharmacol

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Background: Etomidate drug is commonly used for procedural sedation in the emergency department (ED). The incidence rate of etomidate-induced myoclonus is 33%. Aims and Objectives: In this study, we aimed to contradict that etomidateinduced myoclonus is less significant than the reported incidence rate. Materials and Methods: This prospective study was performed between June 2016 and November 2016 in the ED of Amrita Institute of Medical Sciences, a tertiary care hospital. In the ED, procedural sedation was carried out by the physician. Adult patients receiving etomidate were enrolled for the study. Results: The presence of myoclonus was noticed, and its duration was reported using the myoclonus scale. A total of 166 (116 males and 50 females) patients enrolled in the ED for procedural sedation with etomidate were taken. The dose administered was 0.3 mg/kg. Myoclonus was observed in 4 (2.4%) of 166 sedations. The mean age was observed to be male and female. During procedural sedation, etomidate-induced myoclonus in ED was less significant than the reported values. Conclusion: From this, we came to the conclusion that the incidence to occur myoclonus with administration of etomidate is less when compare with other ED studies.

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A descriptive study of myoclonus associated with etomidate procedural sedation in the ED

Cited by 16 publications

References 15 publications

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Propofol decreases etomidate-related myoclonus in gastroscopy

Lower significant rate of etomidate-induced myoclonus for procedural sedation in emergency department of a tertiary care hospital

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