The effect of remifentanil for reducing myoclonus during induction of anesthesia with etomidate.
10.4097/kjae.2009.57.4.438
- Author:
Sang Woo LEE
1
;
Hyun Jue GILL
;
Sung Chul PARK
;
Jun Young KIM
;
Ji Hyung KIM
;
Jong Yeon LEE
;
Hyeon Jeong YANG
;
Min Ku KIM
Author Information
1. Department of Anesthesiology and Pain medicine, School of Medicine, CHA University, Seongnam, Korea. gill5432@naver.com
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Etomidate;
Myoclonus;
Pretreatment;
Remifentanil
- MeSH:
Androstanols;
Anesthesia;
Arterial Pressure;
Etomidate;
Heart Rate;
Humans;
Incidence;
Intubation;
Myoclonus;
Piperidines
- From:Korean Journal of Anesthesiology
2009;57(4):438-443
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Myoclonic movement is a common problem during induction of anesthesia with etomidate. We investigated the influences of pretreatment with remifentanil on etomidate induced myoclonus. METHODS: Ninety ASA class I patients were divided randomly into three groups. Group NS received normal saline 2 ml as placebo (n = 30), group R0.5 and group R1.0 were pretreated with remifentanil 0.5 microgram/kg (n = 30) or 1.0 microgram/kg (n = 30) 1 minute before induction with etomidate 0.3 mg/kg. Orotracheal intubation was performed after administration of rocuronium 0.5 mg/kg. We assessed the incidence, onset, duration and intensity of myoclonus. Mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) were recorded during induction. RESULTS: Twenty five patients developed myoclonus in group NS (83.3%), 3 patients in group R0.5 developed myoclonus (10%), as did 5 patients in group R1.0 (16.7%). Moderate to severe myoclonus of grade 3 and 4 were found 66.7% of patients in group NS, whereas no patients in both remifentanil pretreated groups developed this grade of myoclonus. The duration of myoclonus was reduced significantly in the remifentanil groups: 93.8 +/- 59.5 sec in group NS, 49.3 +/- 34.9 sec in group R0.5, 36.0 +/- 27.0 sec in group R1.0 (P < 0.05). HR was decreased by pretreatment with remifentanil prior to induction, while MAP and HR were decreased after induction with etomidate (P < 0.05). BIS changes were not different among the three groups. The dose dependent differences between the two remifentanil doses were not noticed. CONCLUSIONS: Pretreatment with remifentanil significantly reduced the incidence, duration and intensity of etomidate induced myoclonus.
