Dey Swarnendu, Kumar Meenakshi
Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2018 Jan-Mar;34(1):94-98. doi: 10.4103/joacp.JOACP_297_16.
Myoclonus is a common problem during induction of anesthesia with etomidate. A variety of drugs have been used to decrease the incidence of myoclonus. In this study we compared the effects of dexmedetomidine and midazolam pretreatment on the incidence of etomidate induced myoclonus. We also studied the effects of these drugs on attenuation of stress response at laryngoscopy and intubation on induction with etomidate.
Eighty adult patients (18 to 60 years age) of either sex, American Society of Anestheiologists physical status I and II undergoing elective general surgeries under general anesthesia were randomly allocated into two groups. Group D patients received Inj. Dexmedetomidine (0.5 μg/Kg) and Group M received Inj. Midazolam (0.015 mg/Kg) in 10 ml saline over ten minutes. Myoclonus was graded after intravenous administration of etomidate (0.3mg/Kg) and hemodynamic response to laryngoscopy and intubation were observed at various time intervals. Analysis of statistical data was done using Statistical Package for Social Sciences (SPSS) version 21.0. Quantitative variables were compared using Independent T Test/Mann Whitney test (for non-parametric data). Qualitative variables were compared using Chi-Square test/Fisher's Exact Test. A value of < 0.05 was considered statistically significant.
In Group D, 22 out of 40 (55%) patients did not have any myoclonus during induction with etomidate, and none of the patients had grade 3 (severe) myoclonus. In Group M, 19 out of 40 patients (47.5%) had grade 2 (moderate) and 6 patients (15%) had grade 3 myoclonus. Stress response due to intubation was more effectively suppressed by dexmedetomidine as compared to midazolam.
Incidence of myoclonus among patients who underwent pre-treatment with dexmedetomidine was significantly lesser than those who underwent pre-treatment with midazolam. Greater degree of attenuation of stress response in the dexmedetomidine group was observed as compared to midazolam group.
肌阵挛是依托咪酯麻醉诱导过程中常见的问题。已使用多种药物来降低肌阵挛的发生率。在本研究中，我们比较了右美托咪定和咪达唑仑预处理对依托咪酯诱导的肌阵挛发生率的影响。我们还研究了这些药物对依托咪酯诱导时喉镜检查和插管应激反应减弱的影响。
80例年龄在18至60岁之间、美国麻醉医师协会身体状况分级为I级和II级、接受全身麻醉下择期普通外科手术的成年患者，随机分为两组。D组患者在10分钟内接受右美托咪定注射液（0.5μg/kg），M组患者在10分钟内接受咪达唑仑注射液（0.015mg/kg），均用10ml生理盐水稀释。静脉注射依托咪酯（0.3mg/kg）后对肌阵挛进行分级，并在不同时间间隔观察喉镜检查和插管时的血流动力学反应。使用社会科学统计软件包（SPSS）21.0版进行统计数据分析。定量变量使用独立样本t检验/曼-惠特尼检验（用于非参数数据）进行比较。定性变量使用卡方检验/费舍尔精确检验进行比较。P值<0.05被认为具有统计学意义。
在D组，40例患者中有22例（55%）在依托咪酯诱导期间未出现任何肌阵挛，且无患者出现3级（重度）肌阵挛。在M组，40例患者中有19例（47.5%）出现2级（中度）肌阵挛，6例（15%）出现3级肌阵挛。与咪达唑仑相比，右美托咪定更有效地抑制了插管引起的应激反应。
接受右美托咪定预处理的患者中肌阵挛的发生率显著低于接受咪达唑仑预处理的患者。与咪达唑仑组相比，右美托咪定组对应激反应的减弱程度更大。
