Clinical College of Anhui Medical University, Beijing 100101, China.
Department of Anesthesiology, The 306th Hospital of PLA, Beijing 100101, China.
Am J Ther. 2018 Sep/Oct;25(5):e517-e523. doi: 10.1097/MJT.0000000000000404.
Etomidate is a widely used hypnotic drug for induction of general anesthesia and sedation, especially in elderly patients and hemodynamically unstable patients. Myoclonus, however, is the most prominent problem during induction of anesthesia with etomidate. Many agents have been used to prevent it and opioid is one of them. This meta-analysis was to evaluate effects of opioids pretreatment for preventing etomidate-induced myoclonus. We searched the PubMed, EMBASE, and the Cochrane Library databases and published studies in English updated to September 2015. Randomized controlled trials of opioids versus placebo/control in patients were included. We evaluated the prophylactic effect of opioids on etomidate-induced myoclonus. All statistical analysis was performed using RevMan 5.2 software. Nine randomized controlled trials involving 604 participants were included. The results indicated that compared with placebo/control, opioids allow more patients to experience no myoclonic movements after etomidate injection [risk ratio (RR) 2.76, 95% confidence interval (CI) 1.75-4.37, P < 0.0001]. The numbers of patients with mild myoclonus [(RR) 0.53, 95% (CI) 0.36-0.78, P = 0.001], moderate myoclonus [(RR) 0.36, 95% (CI) 0.23-0.55, P < 0.00001], and severe myoclonus [(RR) 0.20, 95% (CI) 0.08-0.52, P = 0.0009] after etomidate injection were significantly decreased with the pretreatment of opioids. This meta-analysis suggests that pretreatment with opioids before injecting etomidate was effective for preventing etomidate-induced myoclonus and can reduce the intensity of myoclonus without any adverse effects.
依托咪酯是一种广泛用于全身麻醉诱导和镇静的催眠药物，尤其适用于老年患者和血流动力学不稳定的患者。然而，依托咪酯诱导麻醉时最突出的问题是肌阵挛。为了预防肌阵挛，已经使用了许多药物，其中包括阿片类药物。本荟萃分析旨在评估阿片类药物预处理预防依托咪酯诱导肌阵挛的效果。我们检索了 PubMed、EMBASE 和 Cochrane 图书馆数据库，并检索了截至 2015 年 9 月发表的英文研究。纳入了阿片类药物与安慰剂/对照在患者中比较的随机对照试验。我们评估了阿片类药物预防依托咪酯诱导肌阵挛的效果。所有统计分析均使用 RevMan 5.2 软件进行。共纳入 9 项随机对照试验，涉及 604 名参与者。结果表明，与安慰剂/对照相比，阿片类药物可使更多患者在依托咪酯注射后无肌阵挛运动[风险比（RR）2.76，95%置信区间（CI）1.75-4.37，P<0.0001]。轻度肌阵挛患者的数量[RR]0.53，95%（CI）0.36-0.78，P=0.001]、中度肌阵挛[RR]0.36，95%（CI）0.23-0.55，P<0.00001]和重度肌阵挛[RR]0.20，95%（CI）0.08-0.52，P=0.0009]在依托咪酯注射后明显减少，阿片类药物预处理可显著减少依托咪酯引起的肌阵挛。本荟萃分析表明，依托咪酯注射前给予阿片类药物预处理可有效预防依托咪酯引起的肌阵挛，并可降低肌阵挛的强度而无不良反应。
