Alipour Mohammad, Firuzabadi Seyed Javad Purafzali
Department of Anesthesiology and Critical Care, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
BMC Anesthesiol. 2025 Apr 30;25(1):224. doi: 10.1186/s12871-025-03099-7.
Etomidate is a short-acting intravenous anesthetic used to induce general anesthesia. However, myoclonus caused by the administration of etomidate is seen in 50-80% of untreated patients. Due to the high prevalence of myoclonus following etomidate injection, the present study aimed to investigate the effect of ondansetron in reducing myoclonic movements caused by the intravenous administration of etomidate.
The current research was a double-blind clinical study conducted on 72 adult patients who were candidates for elective eye surgery and had visited Khatam Al-Anbia Eye Hospital affiliated to Mashhad University of Medical Sciences between November to December 2022. Before sampling, the designed proposal was approved by the Ethics Committee of Mashhad University of Medical Sciences and clinical trial was registered by the code IRCT20190510043545N2 at 2021-10-02. Candidate patients for elective eye surgery with ASA class I-II were selected using the available sampling method. Prior to study entrance the study protocol was fully explained and an informed constant was obtained from each participant. The patients were randomly assigned into two groups; 4 mg (IV) ondansetron was prescribed for the study group and 5 cc of normal saline (IV) was administered for the placebo group. The mentioned drugs were administered as a pre-medication 180 s before etomidate induction with a dosage of 0.3 mg/kg. After examining and recording the induced myoclonus, a full dose of narcotics and muscle relaxants was prescribed for each patient.
Each group consisted of 36 patients who did not differ significantly in terms of age, gender, comorbidities and ASA class. The mean time of myoclonus in the placebo and ondansetron groups was 43.48 ± 53.17 and 14.07 ± 5.75, respectively, which was significantly shorter in the ondansetron group (Z=-5.19, P < 0.005). The severity (χ2 = 14.62, P < 0.005) and incidence (χ2 = 25.89, P < 0.005) of myoclonus were also significantly lower in the ondansetron group compared to placebo.
The administration of ondansetron in combination with etomidate can have a remarkable effect on reducing the duration and severity of myoclonus induced by etomidate.
依托咪酯是一种用于诱导全身麻醉的短效静脉麻醉剂。然而，在未经治疗的患者中，50%-80%会出现因使用依托咪酯而导致的肌阵挛。由于依托咪酯注射后肌阵挛的高发生率，本研究旨在探讨昂丹司琼对减少静脉注射依托咪酯引起的肌阵挛性运动的作用。
本研究为双盲临床研究，对72例择期眼科手术患者进行了研究，这些患者于2022年11月至12月就诊于马什哈德医科大学附属哈塔姆·安比耶眼科医院。在抽样前，设计方案经马什哈德医科大学伦理委员会批准，临床试验于2021年10月2日以代码IRCT20190510043545N2注册。采用便利抽样法选择ASA分级为I-II级的择期眼科手术候选患者。在研究入组前，向每位参与者充分解释研究方案并获得知情同意。患者被随机分为两组；研究组给予4mg（静脉注射）昂丹司琼，安慰剂组给予5ml生理盐水（静脉注射）。上述药物在依托咪酯诱导前180秒作为术前用药给予，剂量为0.3mg/kg。在检查并记录诱发的肌阵挛后，为每位患者开具全剂量的麻醉剂和肌肉松弛剂。
每组有36例患者，两组在年龄、性别、合并症和ASA分级方面无显著差异。安慰剂组和昂丹司琼组的肌阵挛平均时间分别为43.48±53.17秒和14.07±5.75秒，昂丹司琼组明显更短（Z=-5.19，P<0.005）。与安慰剂组相比，昂丹司琼组肌阵挛的严重程度（χ2=14.62，P<0.005）和发生率（χ2=25.89，P<0.005）也显著更低。
昂丹司琼与依托咪酯联合使用对减少依托咪酯诱发的肌阵挛的持续时间和严重程度有显著效果。
