Low-Dose Ketamine Pretreatment Reduces the Incidence and Severity of Myoclonus Induced by Etomidate

Wu, Guannan; Xu, Haijun; Liu, Fangfang; Wu, Xian; Zhou, Hai

doi:10.1097/md.0000000000002701

Cited by 13 publications

(17 citation statements)

References 30 publications

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“…[ 20 ] However, the explicit mechanism of myoclonus development remains unclear. [ 11 , 21 , 22 ] In our study, the incidence of myoclonus in the etomidate group was 48.6%, which was close to the rate of 50% to 80% reported by Doenicke et al [ 17 ] The slight difference might be because of the administration of 0.3 mg/kg lidocaine in this study, which could inhibit the myoclonus partially induced by etomidate. [ 23 ]…”

Section: Discussionsupporting

confidence: 86%

“…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%

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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: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Propofol decreases etomidate-related myoclonus in gastroscopy

Liu

Meng

et al. 2017

Medicine

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“…(10) Low-dose ketamine pretreatment was successfully used to reduce the incidence and severity of etomidate-induced myoclonus. (11) However, no available data about its role in controlling etomidate-induced adrenal suppression. So, we aimed to evaluate the e cacy of low-dose ketamine pretreatment to etomidate on serum cortisol levels in anesthesia for critically ill cardiac patients.…”

Section: Introductionmentioning

confidence: 99%

Effect of low-dose ketamine pretreatment to etomidate on serum cortisol levels in critically ill cardiac patients: A Randomized clinical trial

El-Hamamsy

Aldemerdash

Zahran

et al. 2021

Preprint

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Background: This study aimed to evaluate the effect of low-dose ketamine pretreatment to etomidate on serum cortisol levels in critically ill cardiac patients with acute anemia undergoing upper endoscopy and ColonoscopyPatients and Methods: Sixty adult cardiac patients, ≥ 18 years, who underwent upper endoscopy and Colonoscopy to manage acute anemia in the cardiac intensive care units were enrolled. Patients were randomly divided into two groups: Group (E): received etomidate 0.2 mg/kg IV followed by etomidate 0.05 mg/kg IV, and Group (KE): received ketamine 0.5 mg/kg IV, then etomidate 0.1 mg/kg IV, followed by etomidate 0.05 mg/kg IV. The primary outcome was Serum cortisol level at 6 hours after the procedure. The secondary outcomes: Estimated change in serum cortisol level (6-hours postoperative value compared to preoperative one), the incidence of any adverse effects, patient satisfaction, and total etomidate dose. Results: The mean postoperative cortisol level significantly reduced in group E than group KE; (295.60±49.218) mcg/dL versus (461.00 ±67.946) mcg/dL respectively With 95% CI = 351.94 to 404.66. In addition, the estimated serum cortisol reduction level was also significant between groups; In group E, the estimated cortisol level decreased nearly 53% from 632.40±35.066 mcg/dL to 295.60±49.218 mcg/dL six hours postoperative. While in group KE, the estimated cortisol level decreased only 27% from 639.13±43.035 mcg/dL to 461.00±67.946 mcg/dL.Conclusions: low-dose ketamine pretreatment to etomidate can successfully control etomidate-induced adrenocortical suppression and minimize the decrease in serum cortisol level in critically ill cardiac patients with no additional adverse effects.Trial Registration: This study is registered on ClinicalTrials.gov (NCT04857450; principal investigator: Mostafa Mohammed Elsaid Elhamamsy; registration date: 23/04/ 2021).

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“…2 Various drugs including neuromuscular blocking agents (NMBA), opioids, dexmedetomidine, midazolam, propofol, gabapentin and magnesium have been used to suppress etomidate induced myoclonus. [3][4][5][6][7] However their use is associated with side effects like excessive sedation, delayed recovery and respiratory depression.…”

Section: Introductionmentioning

confidence: 99%

A comparison of fentanyl and dexamethasone pretreatment for prevention of etomidate induced myoclonus, a randomized double blind placebo controlled study

Mehra¹,

Makker²,

Khanna³

2020

IJCA

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Background and Aims: Etomidate is used for induction of anaesthesia in haemodynamically unstable patients but its use is associated with undesirable side effects like myoclonus, incidence of which is 50-80%. This prospective, randomized, placebo controlled study is to compare the effect of dexamethasone and fentanyl for prevention of etomidate induced myoclonus. Materials and Methods: Ninety adult patients were randomly assigned into three groups to receive Dexamethasone (group D), Fentanyl (group F) and placebo (group P) five min before injection etomidate 0.3mg/kg IV. The patients were assessed for myoclonus using a four point intensity scoring system over a period of 5 min. ANOVA and chi square test were used for statistical analysis and P<0.05 was considered as statistically significant. Results: The incidence of myoclonus was significantly reduced in groups D and F compared with group P (p value 0.001).The incidence of pain associated with Etomidate induced myoclonus also was significantly reduced in groups D and F compared to group P (p value 0.001). Conclusion: Dexamethasone significantly reduces the incidence of myoclonus as compared to placebo. It also significantly reduces the pain associated with Etomidate injection. However its efficacy to reduce pain and myoclonus as compared to Fentanyl is much less.

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Low-Dose Ketamine Pretreatment Reduces the Incidence and Severity of Myoclonus Induced by Etomidate

Cited by 13 publications

References 30 publications

Propofol decreases etomidate-related myoclonus in gastroscopy

Propofol decreases etomidate-related myoclonus in gastroscopy

Effect of low-dose ketamine pretreatment to etomidate on serum cortisol levels in critically ill cardiac patients: A Randomized clinical trial

A comparison of fentanyl and dexamethasone pretreatment for prevention of etomidate induced myoclonus, a randomized double blind placebo controlled study

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