The proper effect site concentration of remifentanil for prevention of myoclonus after etomidate injection

Ri, Hyun-Su; Shin, Sang Chul; Kim, Tae Kyun; Baik, Seung Kug; Yoon, Jonghee; Byeon, Gyeong-Jo

doi:10.4097/kjae.2011.61.2.127

Cited by 11 publications

(14 citation statements)

References 29 publications

(46 reference statements)

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“…High doses of opioids (fentanyl, sufentanil, and remifentanil) effectively reduce myoclonic movements, but at the cost of undesirable adverse adverse effects, including sedation, coughs, apnea, respiratory depression, and chest wall rigidity. 16 – 18 Benzodiazepine analog and midazolam have also shown its capacity to reduce myoclonus. The incidence of myoclonus was reduced from 50% in placebo-treated group to 10% in 0.015-mg/kg midazolam-treated group.…”

Section: Discussionmentioning

confidence: 99%

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

Liu

et al. 2016

Medicine

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Myoclonic movement induced by etomidate is a common but undesirable problem during general anesthesia induction. To investigate the influence of pretreatment with low-dose ketamine on the incidence and severity of myoclonus induced by etomidate, 104 patients were randomized allocated to 1 of 2 equally sized groups (n = 52) to receive either intravenous low-dose ketamine 0.5 mg/kg (group K) or an equal volume of normal saline (group S) 1 minute before induction of anesthesia with 0.3-mg/kg etomidate. The incidence and severity of myoclonus were assessed for 2 minutes after administration of etomidate. Here, we found that the incidence and intensity of myoclonus were both significantly reduced in low-dose ketamine-treated group compared with saline-treated group. The incidence of adverse effects was low and similar between groups. These results demonstrate that intravenous infusion of low-dose ketamine 0.5 mg/kg 1 minute prior to etomidate administration is effective in relieving etomidate-induced myoclonic movements during general anesthesia induction.

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Section: Discussionmentioning

confidence: 99%

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

Liu

et al. 2016

Medicine

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“…The issue of etomidate-induced injection pain has been resolved with etomidate fat milk, but the problem of etomidate-induced myoclonus has yet to be solved; its incidence rate can be as high as 80% 2. Myoclonus can increase the body’s oxygen consumption and accelerate metabolism, posing vital threats to patients with conditions such as coronary heart disease, hypertension, epilepsy, or intracranial aneurysm 3–5. Plenty of clinical studies on preventing etomidate-induced myoclonus have been conducted on opioids such as fentanyl, sufentanil, and remifentanil.…”

Section: Introductionmentioning

confidence: 99%

Using dezocine to prevent etomidate-induced myoclonus: a meta-analysis of randomized trials

Zhu

Yang

Zhou

et al. 2017

DDDT

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ObjectiveThis study was designed to evaluate the efficacy and safety of preinjection of dezocine in preventing etomidate-induced myoclonus.MethodsPubMed, Embase, The Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched to collect relevant randomized controlled trials (RCTs) from inception to July 2016 on the preinjection of dezocine in preventing etomidate-induced myoclonus. Two researchers independently screened literature, extracted data, and evaluated bias risks in accordance with inclusion and exclusion criteria, and then used RevMan 5.2 to perform the meta-analysis.ResultsA total of six RCTs were included in this study. The meta-analysis showed that 1) the preinjection of dezocine can reduce the incidence of etomidate-induced myoclonus (relative risk [RR] =0.25, 95% CI [0.13, 0.50], P<0.0001), which is consistent with the result of subgroup analysis; 2) the preinjection of dezocine can reduce the incidence of mild, moderate, and severe myoclonus; 3) dezocine was not related to an increasing incidence of etomidate-induced dizziness and nausea (RR =2.83, 95% CI [0.66, 12.08], P=0.6); and 4) dezocine did not reduce heart rates after the administration of etomidate (mean difference =1.06, 95% CI [−4.08, 6.19], P=0.69).ConclusionThe preinjection of dezocine has the effect of both lowering the incidence of etomidate-induced myoclonus and easing the severity of myoclonus, but without increasing dizziness and nausea or affecting the heart rate.

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“…One of our pretreatment agents was remifentanil, which is a selective μ receptor agonist. It is metabolized rapidly with a short acting duration ( 23 ). Kelsaka et al ( 22 ) stated that remifentanil as a short acting opioid is effective in prevention of myoclonus but can cause severe bradycardia and chest rigidity.…”

Section: Discussionmentioning

confidence: 99%

“…Kelsaka et al ( 22 ) stated that remifentanil as a short acting opioid is effective in prevention of myoclonus but can cause severe bradycardia and chest rigidity. We chose the remifentanil dosage following the previous studies with promising results in which remifentanil 1 μg/kg as pretreatment was effective with no side effects and with a stable statue of hemodynamics ( 6 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effects of Low-Dose Midazolam, Magnesium Sulfate, Remifentanil and Low-Dose Etomidate on Prevention of Etomidate-Induced Myoclonus in Orthopedic Surgeries

et al. 2016

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BackgroundEtomidate is a potent hypnotic agent with several desirable advantages such as providing a stable cardiovascular profile with minimal respiratory adverse effects and better hemodynamic stability compared with other induction agents. This drug is associated, however, with myoclonic movements which is characterized by a sudden, brief muscle contractions as a disturbing side-effect.ObjectivesThe present study was designed to compare the effectiveness of low- dose midazolam, magnesium sulfate, remifentanil and low-dose etomidate to suppress etomidate-induced myoclonus in orthopedic surgery.Patients and MethodsA double-blind clinical trial study was conducted in an academic hospital from September 2014 to August 2015. Two hundred and eighty-four eligible patients, American society of anesthesiologists class I - II, scheduled for elective orthopedic surgery were randomly allocated into four equal groups (n = 71). They received premedication with intravenous low-dose midazolam 0.015 mg/kg, magnesium sulfate 30 mg/kg, remifentanil 1 μg/kg and low-dose etomidate 0.03 mg/kg two minutes before induction of anesthesia with 0.3 mg/kg intravenous etomidate. Then the incidence and intensity of myoclonus were evaluated on a scale of 0 - 3; 0 = no myoclonus; 1 = mild (movement at wrist); 2 = moderate (movement at arm only, elbow or shoulder); and 3 = severe, generalized response or movement in more than one extremity, within ninety seconds. Any adverse effect due to these premedication agents was recorded.ResultsThe incidence and intensity of myoclonus were significantly lower in the low-dose etomidate group. The incidence rates of myoclonus were 51 (71.85%), 61 (85.9%), 30 (42.3%) and 41 (57.7%), and the percentages of patients who experienced grade III of myoclonus were 30 (58.8%), 32 (52.5%), 9 (30%) and 14 (34.1%) in the midazolam, magnesium sulfate, etomidate and remifentanil groups, respectively. The incidence and intensity of myoclonus were significantly lower in the low-dose etomidate group (P = 0.0001). No notable adverse effect was detected in our patients during the study period.ConclusionsIntravenous etomidate 0.03 mg/kg prior to induction can effectively reduce the incidence and severity of myoclonus linked to etomidate.

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The proper effect site concentration of remifentanil for prevention of myoclonus after etomidate injection

Cited by 11 publications

References 29 publications

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

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

Using dezocine to prevent etomidate-induced myoclonus: a meta-analysis of randomized trials

Comparison of the Effects of Low-Dose Midazolam, Magnesium Sulfate, Remifentanil and Low-Dose Etomidate on Prevention of Etomidate-Induced Myoclonus in Orthopedic Surgeries

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