Isitemiz Ilke, Uzman Sinan, Toptaş Mehmet, Vahapoglu Ayşe, Gül Yaşar Gökhan, Inal Ferda Yilmaz, Akkoc Ibrahim
Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey.
Med Sci Monit. 2014 Feb 16;20:262-7. doi: 10.12659/MSM.889833.
In this retrospective comparative study, we aimed to compare the effectiveness of fentanyl, midazolam, and a combination of fentanyl and midazolam to prevent etomidate-induced myoclonus.
This study was performed based on anesthesia records. Depending on the drugs that would be given before the induction of anesthesia with etomidate, the patients were separated into 4 groups: no pretreatment (Group NP), fentanyl 1 µg·kg-1 (Group F), midazolam 0.03 mg·kg-1 (Group M), and midazolam 0.015 mg·kg-1 + fentanyl 0.5 µg·kg-1 (Group FM). Patients who received the same anesthetic procedure were selected: 2 minutes after intravenous injections of the pretreatment drugs, anesthesia is induced with 0.3 mg·kg-1 etomidate injected intravenously over a period of 20-30 seconds. Myoclonic movements are evaluated, which were observed and graded according to clinical severity during the 2 minutes after etomidate injection. The severity of pain due to etomidate injection, mean arterial pressure, heart rate, and adverse effects were also evaluated.
Study results showed that myoclonus incidence was 85%, 40%, 70%, and 25% in Group NP, Group F, Group M, and Group FM, respectively, and were significantly lower in Group F and Group FM.
We conclude that pretreatment with fentanyl or combination of fentanyl and midazolam was effective in preventing etomidate-induced myoclonus.
在这项回顾性比较研究中，我们旨在比较芬太尼、咪达唑仑以及芬太尼与咪达唑仑联合使用预防依托咪酯诱发肌阵挛的效果。
本研究基于麻醉记录进行。根据在依托咪酯麻醉诱导前给予的药物，将患者分为4组：未预处理组（NP组）、芬太尼1μg·kg⁻¹组（F组）、咪达唑仑0.03mg·kg⁻¹组（M组）以及咪达唑仑0.015mg·kg⁻¹ + 芬太尼0.5μg·kg⁻¹组（FM组）。选择接受相同麻醉程序的患者：在静脉注射预处理药物2分钟后，静脉注射0.3mg·kg⁻¹依托咪酯，持续20 - 30秒诱导麻醉。评估肌阵挛运动，在依托咪酯注射后的2分钟内根据临床严重程度进行观察和分级。还评估了依托咪酯注射引起的疼痛严重程度、平均动脉压、心率以及不良反应。
研究结果显示，NP组、F组、M组和FM组的肌阵挛发生率分别为85%、40%、70%和25%，F组和FM组显著更低。
我们得出结论，芬太尼预处理或芬太尼与咪达唑仑联合使用可有效预防依托咪酯诱发的肌阵挛。
