Butorphanol effectively prevents etomidate-induced myoclonus: a pooled analysis of 788 patients

Zhu, Yu; Zhou, Chengmao; He, Qixiong

doi:10.1177/0300060518801457

Cited by 3 publications

(28 citation statements)

References 10 publications

(16 reference statements)

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“…Other studies reported that several drugs could effectively prevent the occurrence of the myoclonus induced by etomidate, such as dezocine, lidocaine and midazolam, fentanyl and remifentanil. [15][16] This study has two limitations: we could not track long-term mortality or survival rate and did not compare the effects of propofol or etomidate in non-burn patients.…”

Section: Discussionmentioning

confidence: 99%

Inhibiting effect of etomidate or propofol combined with remifentanil hydrochloride on adrenal cortex function in severe burn patients : a randomized, double-blind and controlled trial

Liu

Zhang

et al. 2020

Preprint

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Background: Etomidate is widely used for anesthetic induction in clinical practice. Adrenal insufficiency induced by etomidate has been demonstrated. However, a variety of studies present that etomidate plays an important role in patients with severe burn injuries.Methods: Forty patients with severe burns were randomly divided into etomidate group (Group E) and propofol group (Group P). Etomidate, propofol and remifentanil hydrochloride were used for anesthesia induction and maintenance. General patient characteristics, mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) value were measured and recorded at the baseline (t0), before the intubation (t1), 1, 3, 5, and 30 min following the intubation (t2–5), and the end of the surgery (t6). Before induction of anesthesia and at 30 min, 2h, 24h, and 48h after end of surgery (T0, T1, T2, T3 and T4), artery blood (2 ml) was collected and the concentrations of adrenocorticotropic hormone (ACTH), cortisol (Cor) and aldosterone (ALD) were measured.Results: There were no significant difference in general patient characteristics between the two groups (P>0.05). The MAP values decreased significantly, the HR values decreased at the t1 and there was a statistical difference between the two groups; There was no statistical difference between the two groups at each time point. The patient's ACTH levels in two groups decreased significantly compared with that at preanesthesia, and the levels at T4 were apparently higher than T3 in Group E. The patient's Cor levels in Group E significantly decreased at T2, while that in Group P have no significant change. The differences were not statistical significance between the two groups. The patient's ALD levels in Group E were significantly lower than before induction; while the levels in Group P have no significant change at each time point; the levels in Group P were apparently higher than group E at T2, T3 and T4.Conclusion: Propofol and etomidate for anesthesia induction and maintenance could cause hemodynamic changes, but the effect of etomidate was lighter. The propofol and etomidate both suppress adrenal cortex function, that inhibitory effect of etomidate was greater than propofol, therefore etomidate had a certain beneficial effect.

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Section: Discussionmentioning

confidence: 99%

Inhibiting effect of etomidate or propofol combined with remifentanil hydrochloride on adrenal cortex function in severe burn patients : a randomized, double-blind and controlled trial

Liu

Zhang

et al. 2020

Preprint

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“…Criteria 1, 2, 4, 5, and 10 relating to the review question, inclusion criteria, study appraisal, and recommendations for quality and practice were met by all included systematic reviews. Four of 8 systematic reviews stated the likelihood of publication bias 4,8,9,18 ; however, only 1 review 18 specifically mentioned a search of gray literature, so it is possible that up to 87.5% of reviews had some form of this bias (criterion 9). No reviews were excluded based on methodological quality.…”

Section: Methodological Qualitymentioning

confidence: 99%

“…Quantitative findings were also extracted and are provided in the following section. Upon close inspection, 12 primary studies cited in 8 reviews [4][5][6]8,9,[16][17][18] were found to be duplicated across some reviews, resulting in a total of 48 unique RCTs. As the aim of an umbrella review is not to pool data from included reviews, individual data that were duplicated across reviews were not separated out in the final analysis for an overall estimate of effect.…”

Section: Characteristics Of Included Reviewsmentioning

confidence: 99%

“…Wang et al, 8 in their review of opioids as a class, included 2 studies from Lang et al 4 related to remifentanil. 19,20 Two primary studies on the effects of dezocine 21,22 were also cited by Zhu et al, 17 and 1 study 23 on butorphanol was found in Hua et al 16 and Zhu et al 18 Five identical studies [23][24][25][26][27] included by Hua et al 16 and Zhu et al 18 regarding the effect of butorphanol were also identified. Finally, the reviews by Zhou et al 6 and Du et al 5 included 2 of the same studies, but the data were separated in their individual analyses so that only data related to midazolam were analyzed by Zhou et al 6 and only data related to dexmedetomidine in the duplicated studies were analyzed by Du et al 5 All reviews included appraisal by 2 blinded reviewers.…”

Section: Characteristics Of Included Reviewsmentioning

confidence: 99%

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Pharmacological interventions for reducing the incidence of myoclonus in patients receiving etomidate for induction of general anesthesia: an umbrella review

Greenwood

Crull

Graves

et al. 2023

JBI Evidence Synthesis

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Objective: The objectives of this umbrella review were to examine various pharmacologic interventions for their potential to reduce etomidate-induced myoclonus. A secondary objective was to compare the relative effectiveness of those medications in reducing the incidence of myoclonus when etomidate is utilized for the induction of general anesthesia. Introduction: Etomidate is the drug of choice when inducing general anesthesia in hemodynamically unstable patients. However, its use is limited among the general surgical population due to its ability to cause adrenal suppression, vomiting, and myoclonus. Myoclonus can lead to damage of muscle fibers, myalgias, patient discomfort, and be detrimental in patients with low cardiac reserve. Several systematic reviews have reported on the effectiveness of various intravenous medications in reducing mild, moderate, and severe myoclonus; however, a more thorough examination of their influence was lacking. Inclusion criteria: This review included systematic reviews and meta-analyses of randomized controlled trials involving the use of pharmacologic interventions to reduce etomidate-induced myoclonus. Reviews in English and conducted after 1965 were considered for inclusion. Methods: A comprehensive search of 11 databases was conducted to identify published and unpublished reviews up to March 2022. Critical appraisal of 8 systematic reviews was conducted by 2 independent reviewers using the standardized JBI appraisal tool. Quantitative findings were summarized according to the dose, timing of administration, and relative risk using a data matrix, and synthesized in tabular format with supporting narrative text. Results were organized by severity of myoclonus (overall, mild, moderate, and severe) and type of intervention. Results: Eight systematic reviews were included in this umbrella review, which included 48 relevant studies, after removal of duplicates (3909 participants included in the primary studies). Five of the systematic reviews examined the effectiveness of various types of opioids in the prevention of myoclonus, and 3 systematic reviews examined the effectiveness of non-opioid interventions, such as lidocaine, midazolam, and dexmedetomidine. Seven reviews searched at least 4 databases for pertinent studies and specifically indicated that blinded reviewers appraised the articles. All reviews used a published and validated appraisal instrument. The overall quality of all included reviews was judged to be moderate to high. The absolute risk reduction indicating the effectiveness of the prophylactic medications ranged from 47% to 81% for mild, 52% to 92% for moderate, and 61% to 96% for severe myoclonus. Opioids demonstrated the most consistent and substantial effect on the reduction in myoclonus. Conclusions: All pharmacologic interventions reviewed demonstrated a statistically significant reduction in the incidence of myoclonus. Future studies and reviews should focus on elucidating the particular dose range and timing that is most effective. Anesthesia providers should consider a pre-treatment dose of one of the medications described in this umbrella review as a means to reduce myoclonus and the untoward effects of that condition.

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“…The variety of drugs available is appreciated by many anesthesiologists. Some traditional pairwise meta-analyses have evaluated the efficacy of two drugs or a drug versus a placebo to guide agent selection ( 8 – 15 ). However, when faced with a wide range of interventions, most anesthesiologists still struggle to choose the best option, and instead, use the drug empirically.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Effectiveness of Various Drug Interventions to Prevent Etomidate-Induced Myoclonus: A Bayesian Network Meta-Analysis

et al. 2022

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BackgroundMyoclonic movement is a very common but undesirable phenomenon during the induction of general anesthesia using etomidate. Such movement may cause unnecessary problems. Currently, there is an increasing number of drugs for preventing etomidate-induced myoclonus (EM). However, direct comparisons of various drugs are lacking, and this interferes with clinical decision-making. Our network meta-analysis (NMA) aimed to compare the efficacy of different drugs for the prevention of moderate-to-severe general myoclonus.MethodsUsing several biomedical databases, randomized controlled trials (RCTs) published in English from inception to August 22, 2021 were searched. Among the various interventions, we selected nine types of intervention drugs (dexmedetomidine, etomidate, lidocaine, NMDA receptor antagonist, κ opioid receptor agonist, μ opioid receptor agonist, muscle relaxant, gabapentin, and midazolam) for comparison, according to the number of studies. Bayesian NMA was performed using STATA16 and R softwares. The relative risk of EM was assessed using risk ratios (RRs) and the corresponding 95% confidence intervals (CI).ResultsA total of 31 RCTs (3209 patients) were included. NMA results showed that, compared with a placebo, etomidate (RR 4.0, 95%CI 2.1–7.8), κ opioid receptor agonist (RR 2.9, 95%CI 1.9–4.6), μ opioid receptor agonist (RR 3.1, 95%CI 2.3–4.3), NMDA receptor antagonist (RR 1.7, 95%CI 1.0–2.8), dexmedetomidine (RR 2.4, 95%CI 1.5–3.9), lidocaine (RR 2.1, 95%CI 1.2–3.9), and midazolam (RR 2.2, 95%CI 1.5–3.2) can significantly reduce the risk of EM. In contrast, the effects of muscle relaxants (RR 2.1, 95%CI 0.81–5.3) and gabapentin (RR 2.8, 95%CI 0.92–9.3) were inconclusive. Further subgroup analyses showed that preoperative low-dose etomidate, μ-opioid receptor agonist, and κ-opioid receptor agonist were significantly better than other interventions in the prevention of moderate to severe EM.ConclusionPreoperative use of small doses of etomidate or opioids may be the most effective way to avoid EM, especially moderate and severe EM, which makes anesthesia induction safer, more stable, and aligns better with the requirements of comfortable medicine.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], [CRD4202127706].

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Butorphanol effectively prevents etomidate-induced myoclonus: a pooled analysis of 788 patients

Cited by 3 publications

References 10 publications

Inhibiting effect of etomidate or propofol combined with remifentanil hydrochloride on adrenal cortex function in severe burn patients : a randomized, double-blind and controlled trial

Inhibiting effect of etomidate or propofol combined with remifentanil hydrochloride on adrenal cortex function in severe burn patients : a randomized, double-blind and controlled trial

Pharmacological interventions for reducing the incidence of myoclonus in patients receiving etomidate for induction of general anesthesia: an umbrella review

Comparison of the Effectiveness of Various Drug Interventions to Prevent Etomidate-Induced Myoclonus: A Bayesian Network Meta-Analysis

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