Nooraei Navid, Solhpour Ali, Mohajerani Seyed Amir
Department of Anesthesiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Anesthesiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Acta Anaesthesiol Taiwan. 2013 Dec;51(4):145-8. doi: 10.1016/j.aat.2013.12.005. Epub 2014 Jan 20.
Etomidate is a hypnotic drug widely used as an intravenous anesthetic induction agent. The incidence of etomidate-induced myoclonus has been reported as much as 50-80% after induction making it an undesirable drug for induction.
Our aim is to use a priming dose of atracurium to suppress etomidate-induced myoclonus during induction of anesthesia.
In a double-blinded clinical trial 80 patients were randomly given either atracurium (20% of ED95 × kg) or saline as a priming agent. Then, induction of anesthesia was performed using 0.4 mg/kg etomidate. Age, weight, body mass index, bispectral index (BIS) monitor, and duration and grade of myoclonus were recorded.
The demographic characteristics, age, body mass index, BIS score, and weight were not significantly different between the atracurium (ATRA) priming group and control groups. The binomial regression model showed that BMI was an independent predictor variable for myoclonus (OR: 2.1, CI 95%: 1.7-7.5, p = 0.032). In this model, adjusted odds ratios (OR) of myoclonus (multivariate logistic regression analysis) in the control group was 6.6 (95% CI: 1.5-9.7, p = 0.013).
Low-dose atracurium priming could effectively suppress etomidate-induced myoclonus.
依托咪酯是一种广泛用作静脉麻醉诱导剂的催眠药物。据报道，诱导后依托咪酯诱发肌阵挛的发生率高达50%-80%，这使其成为一种不理想的诱导药物。
我们的目的是使用阿曲库铵预充剂量来抑制麻醉诱导期间依托咪酯诱发的肌阵挛。
在一项双盲临床试验中，80例患者被随机给予阿曲库铵（ED95×kg的20%）或生理盐水作为预充剂。然后，使用每千克体重0.4毫克依托咪酯进行麻醉诱导。记录年龄、体重、体重指数、脑电双频指数（BIS）监测结果以及肌阵挛的持续时间和分级。
阿曲库铵预充组与对照组之间的人口统计学特征、年龄、体重指数、BIS评分和体重无显著差异。二项式回归模型显示，体重指数是肌阵挛的独立预测变量（比值比：2.1，95%置信区间：1.7-7.5，p = 0.032）。在该模型中，对照组肌阵挛的校正比值比（多因素逻辑回归分析）为6.6（95%置信区间：1.5-9.7，p = 0.013）。
低剂量阿曲库铵预充可有效抑制依托咪酯诱发的肌阵挛。
