Reddy R V, Moorthy S S, Dierdorf S F, Deitch R D, Link L
Department of Neurology, Indiana University School of Medicine, Indianapolis.
Anesth Analg. 1993 Nov;77(5):1008-11. doi: 10.1213/00000539-199311000-00023.
Excitatory movements have been observed during induction of anesthesia with etomidate, thiopental, methohexital, and propofol. We studied the frequency of these excitatory effects and correlated movements with electroencephalographic (EEG) findings in 67 unpremedicated patients (mean age 66.1 yr, range 45-82 yr). Excitatory effects, including myoclonus, tremor, and dystonic posturing, occurred in 86.6% of patients receiving etomidate; 69.2% of the patient responses were myoclonic. Multiple spikes appeared on the EEG in 22.2% of the etomidate patients. The frequency of excitatory effects was 16.6% after thiopental, 12.5% after methohexital, and 5.5% after propofol. None of the patients receiving thiopental, methohexital, or propofol developed myoclonic or seizure activity. In most patients, the excitatory movements were coincident with the early slow phase of the EEG which corresponds to the beginning of deep anesthesia. We conclude that perhaps caution should be exercised when administering etomidate to patients with a history of seizures as the myoclonic activity is associated with seizure activity. The incidence of excitatory movements after administration of propofol is very low.
在使用依托咪酯、硫喷妥钠、甲己炔巴比妥和丙泊酚诱导麻醉期间观察到了兴奋性运动。我们研究了67例未使用术前药的患者（平均年龄66.1岁，范围45 - 82岁）中这些兴奋性效应的发生频率，并将运动与脑电图（EEG）结果进行了关联。接受依托咪酯的患者中，86.6%出现了包括肌阵挛、震颤和张力障碍性姿势在内的兴奋性效应；69.2%的患者反应为肌阵挛。22.2%接受依托咪酯的患者脑电图上出现多个棘波。硫喷妥钠后兴奋性效应的发生率为16.6%，甲己炔巴比妥后为12.5%，丙泊酚后为5.5%。接受硫喷妥钠、甲己炔巴比妥或丙泊酚的患者均未出现肌阵挛或癫痫活动。在大多数患者中，兴奋性运动与脑电图的早期慢波阶段同时出现，这一阶段对应于深度麻醉的开始。我们得出结论，对于有癫痫病史的患者，使用依托咪酯时可能应谨慎，因为肌阵挛活动与癫痫活动有关。丙泊酚给药后兴奋性运动的发生率非常低。
