Comparative assessment of different doses of midazolam to prevent etomidate-induced myoclonus – A randomized, double-blind, placebo-controlled trial

IF 0.2 Q4 ANESTHESIOLOGY
Lokman Manish, Michell Gulabani, M. Mohta, G. Chilkoti
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引用次数: 0

Abstract

Background: Etomidate is a popular induction agent, due to its several advantages for example, an extremely stable hemodynamic profile with no effects on sympathetic nervous system and baroreceptors, minimal effect on respiration and also prevents histamine release in healthy patients or in those with reactive airway disease. It, however, may be associated with myoclonus whose incidence has been reported as 50%–80% in nonpremedicated patients. Ideally, a pretreatment drug for preventing myoclonic movements should be short acting, not have significant effects on respiration and hemodynamics, and not prolong recovery from anesthesia. Midazolam has been used as a pretreatment to attenuate myoclonus in different doses with varied results, but the optimal dose has not been established. The present study was planned to compare the effect of three doses of midazolam, i.e., 0.015 mg/kg, 0.03 mg/kg, and 0.05 mg/kg in preventing etomidate-induced myoclonus. Materials and Methods: This study comprised 164 American Society of Anesthesiologists I/II consenting patients between 18 and 60 years. They were randomly divided into four groups after which pretreatment with normal saline in group M0, midazolam 0.015 mg/kg in group M0.015, 0.03 mg/kg in group M0.03, and 0.05 mg/kg in group M0.05 was administered. The primary outcome was the incidence of myoclonus after etomidate. The secondary outcome measures included severity of myoclonus and changes in hemodynamic parameters. One-way analysis of variance with Bonferroni's correction was used to compare quantitative data. Chi-square test was applied for qualitative data. Further, as there were four groups with multiple comparisons, Bonferroni's correction was applied and P < 0.01 was considered statistically significant. Results: We observed a significant reduction in the incidence of myoclonus of group M0.015 as compared to group M0 (P < 0.001). A significant reduction in severity of myoclonus was observed in all the three midazolam groups compared to the control group (P < 0.001) without any significance among the patients receiving different doses of midazolam. Conclusion: We recommend using midazolam pretreatment in a dose of 0.015 mg/kg for prevention of etomidate-induced myoclonus.
不同剂量咪达唑仑预防依托咪酯诱导的肌阵挛的比较评估——一项随机、双盲、安慰剂对照试验
背景:依托咪酯是一种流行的诱导剂,因为它有几个优点,例如,对交感神经系统和压力感受器没有影响的极其稳定的血液动力学特征,对呼吸的影响最小,还可以防止健康患者或反应性气道疾病患者的组胺释放。然而,它可能与肌阵挛有关,据报道,非药物治疗患者的发病率为50%-80%。理想情况下,预防肌阵挛运动的预处理药物应该是短效的,对呼吸和血流动力学没有显著影响,并且不会延长麻醉后的恢复时间。咪达唑仑已被用作不同剂量的减轻肌阵挛的预处理,结果各不相同,但最佳剂量尚未确定。本研究旨在比较三种剂量的咪达唑仑(即0.015 mg/kg、0.03 mg/kg和0.05 mg/kg)预防依托咪酯诱导的肌阵挛的效果。材料和方法:这项研究包括164名18至60岁的美国麻醉师协会I/II同意患者。他们被随机分为四组,之后给予生理盐水预处理(M0组)、咪达唑仑0.015mg/kg(M0.015组)、0.03mg/kg(M0.03组)和0.05mg/kg(M0.05组)。主要结果是依托咪酯后肌阵挛的发生率。次要转归指标包括肌阵挛的严重程度和血液动力学参数的变化。使用Bonferroni校正的单向方差分析来比较定量数据。定性数据采用卡方检验。此外,由于有四组进行了多次比较,因此应用了Bonferroni校正,P<0.01被认为具有统计学意义。结果:与M0组相比,M0.015组的肌阵挛发生率显著降低(P<0.001)。与对照组相比,三个咪达唑仑组的肌强直严重程度均显著降低(P=0.001),但在接受不同剂量咪达唑伦的患者中没有任何显着性差异。结论:我们建议使用咪达唑仑预处理0.015mg/kg预防依托咪酯诱导的肌阵挛。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Indian Anaesthetists Forum
Indian Anaesthetists Forum ANESTHESIOLOGY-
自引率
0.00%
发文量
17
审稿时长
6 weeks
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