Propofol decreases etomidate-related myoclonus in gastroscopy

Abstract

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.

Safety and efficacy of combined use of propofol and etomidate for sedation during gastroscopy

“…[32,33,39,44] Five RCTs compared propofol plus etomidate with etomidate or propofol alone. [34–36,38,41] Three RCTs compared propofol plus etomidate with propofol alone. [27,37,43] The remaining 2 trials compared propofol plus etomidate with etomidate alone.…”

“…One used a random digital method involving the use of computers, [27] 1 used computer generated random numbers table [7] , 4 RCTs used a random number table. [32,36,38,39] One RCT did not mention whether a random was used. [44] The rest did not provide any detailed information.…”

Clinical observation of the combined use of propofol and etomidate in painless gastroscopy

“…Etomidate may also play a pre-administration role with propofol in the admixture. [ 15 ] Although the overall hypoxemia probability of the PE 1 group is lower than that of the other 2 groups, the probability of severe hypoxemia is higher. It may be that the depth of anesthesia is shallower than that of the other 2 groups, and the patient has a choking reaction that causes severe hypoxia.…”

Effect of fentanyl and nalbuphine for prevention of etomidate-induced myoclonus

“…Although the mechanism of etomidate induced myoclonus is still not clear, several studies suggest that it may represent a type of seizure. [12] However, some cases are also reported which showed that etomidate has caused generalized tonic clonic seizures. [313233] In this study, we made an attempt to quantify the myoclonus biochemically by measuring CPK levels before and after giving etomidate and calculating the difference in CPK levels.…”

“…A large number of drugs, including neuromuscular blocking agents,[78] opioids,[9] dexmedetomidine,[510] midazolam,[611] propofol,[12] ketamine,[13] gabapentin,[14] and magnesium sulphate[1115] have been investigated for their ability to suppress these myoclonic movements. These drugs are; however, associated with side effects such as excessive sedation, delayed recovery, and respiratory inhibition.…”