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Category: Volume 06 Issue 04 April 2018
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Title: To Evaluate the effect of Dexmedetomidine Pretreatment on Myoclonus during Anaesthetic Induction with Etomidate

Authors: Dr Priyanka Dixit, Dr Pramila Soni, Dr Anita Pareek, Dr Rashmi Jain, Dr Madhu Saxena, Dr Deepika Meena

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.24

Abstract

Etomidate is frequently used nowadays as an inducing agent in patients with compromised cardiovascular function, but it leads to undesirable side effects like myoclonus during induction. Several drugs have been considered before induction to reduce the incidence of myoclonus. This prospective, randomized double blinded study was aimed to compare the effect of dexmedetomidine (DEX) pretreatment on the incidence and severity of etomidate­induced myoclonus. 100 patients undergoing elective surgical procedures were randomly allocated to two groups for i.v. administration of 1.0 µg/kg DEX in 100 mL isotonic saline (group D) and 100 mL isotonic saline (group NS)  10 minutes prior to induction. All groups subsequently received 0.3 mg/kg etomidate by intravenous injection. The incidence and severity of myoclonus were recorded for 1 min after etomidate administration and the incidence of cardiovascular adverse effects were also recorded. The incidence of myoclonus was 38% was in group D and 70% in group NS. The severity of myoclonus was graded as mild, moderate and severe. In group D and group NS number of patients who had mild, moderate and severe myoclonus were 10,5,4 and 11,15,9 respectively. It was concluded that pretreatment with 1.0 µg/kg DEX significantly reduced the incidence and severity of etomidate­induced myoclonus during anesthetic induction.

Keywords: Dexmedetomidine; Etomidate; Myoclonus.

References

  1. Ruth WJ, Burton JH, Bock AJ. Intravenous etomidate for procedural sedation in emergency department patients. Acad Emerg Med 2001; 8: 13­18, doi: 10.1111/j.1553­2712.2001.
  2. Moss E, Powell D, Gibson RM, McDowall DG. Effects of etomidate on intracranial pressure and cerebral perfusion pressure. Br J Anaesth 1979; 51:347-51.
  3. Doenicke A, Roizen MF, Nebauer AE, Kugler A, Hoernecke R, Beger­Hintzen H. A comparison of two formulations for etomidate, 2­hydroxypropyl­beta­cyclodextrin (HPCD) and propylene glycol. Anesth Analg 1994; 79: 933­939, doi: 10.1213/00000539­199411000­00020
  4. Doenicke AW, Roizen MF, Kugler J, Kroll H, Foss J, Ostwald P. Reducing myoclonus after etomidate.Anesthesiology 1999; 90: 113­119, doi: 10.1097/00000542­199901000­00017. [ Links ]
  5. Hueter L, Schwarzkopf K, Simon M, Bredle D, Fritz H. Pretreatment with sufentanil educes myoclonus after etomidate. Acta Anaesthesiol Scand 2003; 47: 482­484, doi: 10.1034/j.1399­6576.2003.00081
  6. Van Keulen SG,Burton JH. Myoclonus associated with etomidate for ED procedural sedation and analgesia. Am J Emerg Med 2003:21:556-558.
  7. Reddy RV, Moorthy SS, Dierdorf SF, Deitch RD, Jr, Link L. Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol. Anesth Analg. 1993;77:1008–1011. [PubMed]
  8. Modica PA, Tempelhoff R, White PF. Pro­ and anticonvulsant effects of anesthetics (part I) Anesth Analg. 1990;70:303–315
  9. Schwarzkopf KR, Hueter L, Simon M, Fritz HG. Midazolam pretreatment reduces etomidate­induced myoclonic movements. Anaesth Intensive Care 2003; 31: 18­20.
  10. Hueter L, Schwarzkopf K, Simon M, Bredle D, Fritz H. Pretreatment with sufentanil reduces myoclonus after etomidate. Acta anaesthesiologica-scandinavica. 2003 Apr 1;47(4):482-4.
  11. Guler A, Satilmis T, Akinci SB, Celebioglu B, Kanbak M. Magnesium sulfate pretreatment reduces myoclonus after etomidate. Anesthesia & Analgesia. 2005 Sep 1;101(3):705-9.
  12. Choi JM, Choi IC, Jeong YB, Kim TH, Hahm KD. Pretreatment of rocuronium reduces the frequency and severity of etomidate induced myoclonus. J Clin Anesth 2008; 20: 601­604, doi: 10.1016/j.jclinane.2008.06.010
  13. Ramsay MA, Newman KB, Leeper B, Hamman BL, Hebeler RF Jr, Henry AC, et al. Dexmedetomidine infusion for analgesia up to 48 hours after lung surgery performed by lateral thoracotomy. Proc (Bayl Univ Med Cent) 2014; 27: 3­10.
  14. Wujtewicz M, Maciejewski D, Misiolek H, Fijalkowska A, Gaszynski T, Knapik P, et al. Use of dexmedetomidine in the adult intensive care unit. Anaesthesiol Intensive Ther 2013; 45: 235­240, doi: 10.5603/ AIT.2013.0045.
  15. Salman N, Gurbuz HA, Oguzalp H, Ucar HI, Yorgancıoglu C, Sekerci S. Comparison of dexmedetomidine and midazolam in prevention of myoclonus occurring due to etomidate in coronary bypass surgery. Journal-Cardiovascular Surgery. 2013;1(3):52-6.
  16. Mizrak A, Koruk S, Bilgi M, Kocamer B, Erkutlu I, Ganidagli S, Oner U. Pretreatment with dexmedetomidine or thiopental decreases myoclonus after etomidate: a randomized, double-blind controlled trial. Journal of Surgical Research. 2010 Mar 31;159(1):e11-6.
  17. Luan HF, Zhao ZB, Feng JY, Cui JZ, Zhang XB, Zhu P, Zhang YH. Prevention of etomidate-induced myoclonus during anesthetic induction by pretreatment with dexmedetomidine. Brazilian Journal of Medical and Biological Research. 2015 Feb;48(2):186-90.

Corresponding Author

Dr. Priyanka Dixit

Dept of Anaesthesia, SP Medical College and Associated Group of Hospitals, Bikaner, India