Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.047
Brazilian Journal of Anesthesiology
Original Investigation

Comparison of the influence of low dose etomidate and propofol as priming dose on the incidence of etomidate induced myoclonus: a randomised, double-blind clinical trial

Comparação da influência de baixa dose de etomidato e propofol como dose inicial na incidência de mioclonia induzida por etomidato: um ensaio clínico randomizado e duplo-cego

Srilata Moningi, G. Poojitha Reddy, Sapna Annaji Nikhar, Ramakrishna Chikkala, Dilip Kumar Kulkarni, Gopinath Ramachandran

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Abstract

Background
Though hemodynamically stable, etomidate is known for its myoclonus side effect following induction. The main aim of this study is an effective attempt to decrease the incidence of myoclonus with a priming agent.

Methods
A prospective, double-blind study was carried out on 50 adults posted for elective surgery. After premedication, priming was done with etomidate 0.03 mg.kg-1 (Group E) and propofol 0.2 mg.kg-1 (Group P), i.e., 1/10th of induction dose. After 60 seconds of priming, patients were induced with etomidate by titrating dose over 60 seconds until loss of verbal command and eyelash reflex. The grading of myoclonus, induction dosage, and hemodynamics for 10 minutes post induction were recorded.

Results
In the study, only 4 cases had myoclonus. Grade 1 myoclonus was encountered in three cases of etomidate group, while only one case in the propofol group had grade 2 myoclonus which was not statistically significant (p-value: 0.12). There was a significant reduction in the etomidate induction dosage in both groups.

Conclusion
Priming with etomidate and propofol is equally effective in reducing myoclonus with the added benefit of hemodynamic stability and reduction of an induction dose of etomidate (> 50%).

Keywords

Myoclonus,  Priming,  Etomidate,  Propofol

Resumo

Objetivo: Embora hemodinamicamente estável, o etomidato é conhecido por seu efeito colateral de mioclonia após a indução. O principal objetivo deste estudo é uma tentativa eficaz de diminuir a incidência de mioclonia com um agente de priming. Métodos: Foi realizado um estudo prospectivo, duplo-cego, em 50 adultos encaminhados para cirurgia eletiva. Após a pré-medicação, foi feito o priming com etomidato 0,03 mg kg-1 (Grupo E) e propofol 0,2 mg kg-1 (Grupo P), ou seja, 1/10 da dose de indução. Após 60 segundos de priming, os pacientes foram induzidos com etomidato por titulação da dose ao longo de 60 segundos até a perda do comando verbal e reflexo ciliar. A graduação da mioclonia, dosagem de indução e hemodinâmica por 10 minutos após a indução foram registrados. Resultados: No estudo, apenas 4 casos apresentaram mioclonia. Mioclonia grau 1 foi encontrada em três casos do grupo etomidato, enquanto apenas um caso no grupo propofol apresentou mioclonia grau 2, que não foi estatisticamente significante (p-valor 0,12). Houve redução significativa na dose de indução de etomidato em ambos os grupos. Conclusão: O priming com etomidato e propofol é igualmente eficaz na redução da mioclonia com o benefício adicional de estabilidade hemodinâmica e redução de uma dose de indução de etomidato (>50%).

Palavras-chave

Mioclonia; Priming; Etomidato; Propofol.

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