Effect of priming in preventing myoclonic movements after intravenous induction with etomidate in adult patients undergoing cardiac surgery: a randomised controlled interventional study

Mukesh K Sunda, K. Chauhan, R. Dr., Krishna Boliwal
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Abstract

Etomidate is a hypnotic drug used as an intravenous anaesthetic induction agent. Etomidate causes myoclonic movements in 50-80% patients after induction which makes it less desirable for induction. Aim: Present study was to determine the effect of priming in preventing myoclonic movements after intravenous injection with etomidate in adult patients undergoing cardiac surgery. Materials and Methods: 108 patients ASA grade III scheduled for elective cardiac surgery were allocated randomly in two groups- Group A (n=54): Patients received induction dose of 0.3mg/kg I.V. etomidate, Group B (n=54): Patients received a priming dose of 0.03mg/kg etomidate I.V. followed after 1 minute by induction dose of 0.3 mg/kg I.V. etomidate over 20 seconds. 3 minutes after the start of induction with etomidate, patients in both groups were given injection fentanyl 4mcg/kg followed by injection Rocuronium (1mg/kg bodyweight) to facilitate tracheal intubation. The occurrence and intensity of myoclonus were observed for 3 min from the start of injection of the induction dose and graded clinically by a blinded observer as: 0=no myoclonus, 1=mild myoclonus, 2=moderate myoclonus and 3=severe myoclonus. Result: The average dose of etomidate used during induction and demographic variables were similar in both the groups. The incidence of myoclonus in priming Group (27/54 [50%] was significantly lower than in control Group (45/54 [83.33%].Myoclonus of moderate or severe grade occurred in significantly more patients in control Group (68.3%) than in priming Group (36.5%).Conclusion: Pre-treatment with etomidate (0.03 mg/kg), given 60 seconds before induction of anaesthesia is more effective in reducing the incidence of etomidate-induced myoclonus without related side-effects.
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心脏手术成人患者静脉注射依托咪酯诱导后,启动对预防肌阵挛运动的影响:一项随机对照介入研究
依托咪酯是一种催眠药物,用作静脉麻醉诱导剂。在50-80%的患者诱导后,依托咪酯会引起肌阵挛性运动,这使得它不适合诱导。目的:本研究旨在确定启动对心脏手术成人患者静脉注射依托咪酯后肌阵挛运动的预防作用。材料与方法:108例ASA III级择期心脏手术患者随机分为两组:A组(n=54):起始剂量为0.3mg/kg静脉滴注依托咪酯;B组(n=54):起始剂量为0.03mg/kg静脉滴注依托咪酯,1分钟后,诱导剂量为0.3mg/kg静脉滴注依托咪酯20秒。两组患者在开始用依咪酯诱导后3分钟,先注射芬太尼4mcg/kg,再注射罗库溴铵(1mg/kg体重),以方便气管插管。从注射诱导剂量开始观察肌阵挛的发生和强度3min,由盲法观察临床分级:0=无肌阵挛,1=轻度肌阵挛,2=中度肌阵挛,3=重度肌阵挛。结果:两组患者诱导时使用依托咪酯的平均剂量和人口学变量相似。启动组肌阵挛发生率(27/54[50%])显著低于对照组(45/54[83.33%])。对照组出现中重度肌阵挛的比例(68.3%)明显高于启动组(36.5%)。结论:麻醉前60秒给予依托咪酯(0.03 mg/kg)预处理,可有效降低依托咪酯所致肌挛的发生率,且无相关副作用。
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