Department of Anesthesiology, Funing People's Hospital of Jiangsu, Yancheng, Jiangsu province, China.
Department of Clinical Medicine, Medical School of Nantong University, Nantong, Jiangsu, China.
Medicine (Baltimore). 2023 Sep 8;102(36):e35138. doi: 10.1097/MD.0000000000035138.
This study compared the effectiveness of nalmefene and fentanyl in reducing the incidence and severity of etomidate-induced myoclonus.
One hundred fifty patients were randomized to receive 0.25ug/kg of nalmefene, 1ug/kg of fentanyl, or the same volume of normal saline 3 minutes prior to etomidate-induced anesthesia. The primary observational indexes were the severity level and incidence of etomidate-induced myoclonus, and the secondary observational index included blood pressure, heart rate, and the incidence of adverse effects from anesthesia induction to resuscitation, such as cough, chest wall rigidity, dizziness, nausea, pain after awakening, and intraoperative awareness.
The incidence of myoclonus was significantly lower in the nalmefene group (8.0%) than in the fentanyl group (32.0%) (P = .003) and in the normal saline group (72.0%) (P = .000). The severity level of myoclonus in the nalmefene group was significantly lower than the fentanyl group (P = .001) and normal saline group (P = .000). Meanwhile, the incidences of cough and chest wall rigidity during anesthesia induction were significantly lower in the nalmefene group compared with the fentanyl group (P = .003, P = .027). There were no statistically significant differences in heart rate and mean arterial pressure among the 3 gruops (P > .05). There was no difference in the incidence of adverse effects among the 3 groups during recovery from anesthesia (P > .05).
Intravenous injection of 0.25ug/kg of nalmefene 3 minutes prior to etomidate is more effective in preventing etomidate-induced myoclonus during general anesthesia than 1ug/kg of fentanyl.
本研究比较了纳美芬和芬太尼在降低依托咪酯诱导肌阵挛的发生率和严重程度方面的效果。
150 例患者随机分为纳美芬 0.25μg/kg 组、芬太尼 1μg/kg 组和生理盐水对照组，于依托咪酯麻醉诱导前 3 分钟分别给予相应药物。主要观察指标为依托咪酯诱导肌阵挛的严重程度和发生率，次要观察指标包括血压、心率以及麻醉诱导至复苏过程中的不良反应发生率，如咳嗽、胸壁僵硬、头晕、恶心、苏醒后疼痛和术中知晓等。
纳美芬组肌阵挛的发生率（8.0%）明显低于芬太尼组（32.0%）（P =.003）和生理盐水对照组（72.0%）（P =.000）。纳美芬组肌阵挛的严重程度明显低于芬太尼组（P =.001）和生理盐水对照组（P =.000）。同时，纳美芬组麻醉诱导时咳嗽和胸壁僵硬的发生率明显低于芬太尼组（P =.003，P =.027）。3 组间心率和平均动脉压差异均无统计学意义（P >.05）。3 组麻醉恢复期间不良反应发生率差异无统计学意义（P >.05）。
依托咪酯麻醉诱导前 3 分钟静脉注射 0.25μg/kg 纳美芬预防全麻中依托咪酯诱导肌阵挛的效果优于 1μg/kg 芬太尼。
