Gao Liangliang, Lu Xinyu, Tan Aiping, Liufu Jiaying, Xu Yidan, Wei Lei
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, People's Republic of China.
The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China.
Drug Des Devel Ther. 2024 Dec 7;18:5773-5779. doi: 10.2147/DDDT.S495130. eCollection 2024.
Etomidate has been observed to precipitate myoclonus in patients undergoing induction of general anaesthesia. This study was designed to investigate the effect of pretreatment with a small dose of esketamine on the incidence of myoclonus induced by etomidate.
One hundred adult patients, who were scheduled to undergo selective operations with general anesthesia, were randomly divided into two groups, with one group receiving esketamine (Group E) and the other receiving normal saline (Group C). The group receiving esketamine (Group E) was administered an injection of 0.15 mg/kg of esketamine, while the control group (Group C) was given an equivalent volume of normal saline two minutes before the administration of 0.3 mg/kg of etomidate. The primary objective was to determine the incidence of etomidate-induced myoclonus. Secondary endpoints included the severity of etomidate-induced myoclonus and changes in haemodynamic variables at various time intervals. Additionally, the incidence of adverse effects such as dizziness, bradycardia, hypotension and hallucination were recorded from the administration of esketamine or normal saline to the injection of etomidate.
The incidence of myoclonus was significantly lower in Group E (20%) than in Group C (62%). Compared with the control group, the esketamine group also experienced a reduction in the moderate and severe of myoclonus. However, there was no statistically significant difference between the two groups for mild etomidate-induced myoclonus. The haemodynamic data (mean arterial pressure and heart rate) showed no statistically significant differences between two groups at the three time points. The incidence of dizziness, bradycardia, hypotension and hallucination was similar in both groups.
Pretreatment with 0.15 mg/kg esketamine prior to anaesthesia induction with etomidate was observed to markedly reduce the incidence and severity of myoclonus, while having no effect on mild etomidate-induced myoclonus and maintaining a stable haemodynamic status.
已观察到依托咪酯可使接受全身麻醉诱导的患者发生肌阵挛。本研究旨在探讨小剂量艾司氯胺酮预处理对依托咪酯诱导的肌阵挛发生率的影响。
100例计划接受全身麻醉下择期手术的成年患者被随机分为两组，一组接受艾司氯胺酮（E组），另一组接受生理盐水（C组）。接受艾司氯胺酮的组（E组）注射0.15mg/kg艾司氯胺酮，而对照组（C组）在注射0.3mg/kg依托咪酯前两分钟给予等量生理盐水。主要目的是确定依托咪酯诱导的肌阵挛的发生率。次要终点包括依托咪酯诱导的肌阵挛的严重程度以及不同时间间隔的血流动力学变量变化。此外，记录从注射艾司氯胺酮或生理盐水至注射依托咪酯期间头晕、心动过缓、低血压和幻觉等不良反应的发生率。
E组肌阵挛发生率（20%）显著低于C组（62%）。与对照组相比，艾司氯胺酮组中度和重度肌阵挛也有所减少。然而，两组在轻度依托咪酯诱导的肌阵挛方面无统计学显著差异。血流动力学数据（平均动脉压和心率）在三个时间点两组间无统计学显著差异。两组头晕、心动过缓、低血压和幻觉的发生率相似。
在依托咪酯麻醉诱导前用0.15mg/kg艾司氯胺酮预处理可显著降低肌阵挛的发生率和严重程度，而对轻度依托咪酯诱导的肌阵挛无影响，并维持血流动力学状态稳定。
