Pretreatment of rocuronium reduces the frequency and severity of etomidate-induced myoclonus

Choi, Jae Moon; Choi, In‐Cheol; Jeong, Yong Bo; Kim, Tae Hee; Hahm, Kyung‐Don

doi:10.1016/j.jclinane.2008.06.010

Cited by 28 publications

(21 citation statements)

References 36 publications

(46 reference statements)

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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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“…Also, in recent research Choi et al [16] showed that pretreatment with rocuronium significantly reduced the frequency of myoclonus due to etomidate by blocking transmission at the neuromuscular junction. But clinically distressing side effects are frequently observed, for example sedation, apnea, chest muscle rigidity, cardiovascular depression for opioids, delayed recovery for benzodiazepines, and airway obstruction, regurgitation, and aspiration for muscle relaxants [10,13,16]. An ideal pretreatment drug for preventing myoclonic movements should be shortacting, not have significant effects on respiration and hemodynamics, and not prolong recovery from anesthesia [10].…”

mentioning

confidence: 97%

“…Pretreatment with benzodiazepines and opioids, drugs known to inhibit subcortical neuronal activity, abolish myoclonus [15]. Also, in recent research Choi et al [16] showed that pretreatment with rocuronium significantly reduced the frequency of myoclonus due to etomidate by blocking transmission at the neuromuscular junction. But clinically distressing side effects are frequently observed, for example sedation, apnea, chest muscle rigidity, cardiovascular depression for opioids, delayed recovery for benzodiazepines, and airway obstruction, regurgitation, and aspiration for muscle relaxants [10,13,16].…”

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confidence: 99%

Lidocaine pretreatment reduces the frequency and severity of myoclonus induced by etomidate

et al. 2010

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The objective of this study was to assess the effects of lidocaine on the incidence and severity of myoclonic movements induced by etomidate. Sixty patients were randomly assigned to receive either 20 mg lidocaine or saline (n = 30, each), 30 s before administration of etomidate (0.3 mg/kg). One minute after etomidate administration we assessed severity of myoclonus. Pretreatment with lidocaine significantly reduced both the incidence and severity of myoclonic movements. As a conclusion, lidocaine is an effective and safe drug to reduce the etomidate-induced myoclonus without significant side effects.

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“…The mechanisms of etomidate induced myoclonus are not clarified yet. Myoclonus has features like tonic-clonic seizures, as muscle movements generally increase [6]. When myoclonus occurred, RE and SE values were higher than those without myoclonus at T1, but BIS was rarely influenced by existence of myoclonus.…”

Section: Discussionmentioning

confidence: 99%

“…But, it often causes myoclonus to affect EMG [5,6]. Accordingly, author hypothesized that EMG activity after etomidate injection would affect interpretation of hypnotic levels as determined by BIS and spectral entropy.…”

Section: Introductionmentioning

confidence: 99%

Effects of etomidate on bispectral index scale and spectral entropy during induction of anesthesia by means of the raw electroencephalographic and electromyographic characteristics

Kim

Shin

Yoon

et al. 2012

Korean J Anesthesiol

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BackgroundEtomidate frequently induces myoclonus, so it may affect electromyographics (EMG). And EMG commonly has an effect on the bispectral index scale (BIS) and spectral entropy. This study was performed to compare the effect of etomidate on BIS, response entropy (RE) and state entropy (SE) during induction of anesthesia.MethodsFifty patients (ASA I or II) scheduled for elective surgery were included in this study. Anesthesia was induced with etomidate (0.3 mg/kg) and rocuronium (0.6 mg/kg). Patients also inhaled 4 vol% sevoflurane and 100% oxygen and, then intubated. BIS, RE, SE and Modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S) were measured 4 times (before injection of etomidate [T0], at loss of eyelash reflex [T1], 90 seconds after rocuronium injection [T2], and after intubation [T3]). We also checked whether myoclonus occurred.ResultsBaseline values (T0) were 93.1 ± 4.7 for BIS, 95.8 ± 3.7 for RE and, 87.3 ± 3.5 for SE. In comparison with T0, there were significantly differences in BIS (50.2 ± 16.3), RE (76.8 ± 18.5) and SE (66.3 ± 17.4) at T1 (all P < 0.05). There were no significant differences at T2 and T3. Thirty one patients had myoclonus. At the occurrence of myoclonus, RE and SE values significantly increased but not BIS (P < 0.05).ConclusionsIn patients with myoclonus, at the loss of consciousness, spectral entropy did not decrease where as BIS did, suggesting that BIS may evaluate hypnotic levels better than spectral entropy during induction of anesthesia with etomidate.

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Pretreatment of rocuronium reduces the frequency and severity of etomidate-induced myoclonus

Cited by 28 publications

References 36 publications

Propofol decreases etomidate-related myoclonus in gastroscopy

Propofol decreases etomidate-related myoclonus in gastroscopy

Lidocaine pretreatment reduces the frequency and severity of myoclonus induced by etomidate

Effects of etomidate on bispectral index scale and spectral entropy during induction of anesthesia by means of the raw electroencephalographic and electromyographic characteristics

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