Doenicke A W, Roizen M F, Kugler J, Kroll H, Foss J, Ostwald P
Institute for Anesthesiology, Ludwig-Maximilians University, Munich, Germany.
Anesthesiology. 1999 Jan;90(1):113-9. doi: 10.1097/00000542-199901000-00017.
The authors hypothesized that myoclonus after etomidate is dose-related, could be suppressed when small doses of etomidate were administered before induction, and is unassociated with seizure-like activity on electroencephalogram (EEG).
Three studies were performed. In the first study, 36 men were randomly assigned to receive 0.025, 0.050, 0.075, 0.100, 0.200, or 0.300 mg/kg of etomidate. In a second crossover study, eight men were randomly allocated to receive either a pretreatment dose of 0.050 mg/kg etomidate or placebo 50 s before 0.300 mg/kg etomidate was injected. EEG was recorded for subjects in the first two studies. In a third study, 60 patients were randomly allocated to one of three pretreatment doses of etomidate: 0.030, 0.050, or 0.075 mg/kg before 0.300 mg/kg was given.
In Study 1, myoclonus was not observed after 0.025 or 0.050 mg/kg etomidate. One volunteer had myoclonus after 0.075 mg/kg and another after 0.100 mg/kg etomidate; three had myoclonus after 0.200 mg/kg; and five after 0.300 mg/kg. Incidence of myoclonus was dose-related (P < or = 0.01). In Study 2, two volunteers (25%) with etomidate pretreatment had mild myoclonus compared to six (75%) with placebo pretreatment (P < or = 0.05). EEG changes, other than delta waves, were not seen during myoclonic epochs. In Study 3, myoclonus was less likely after the small pretreatment doses (0.030 or 0.050 mg/kg) than after the large dose (0.075 mg/kg, P < or = 0.01).
Incidence and intensity of myoclonus after induction with etomidate are dose-related, suppressed by pretreatment, and unassociated with seizure-like EEG activity.
作者推测依托咪酯诱导后的肌阵挛与剂量相关，诱导前给予小剂量依托咪酯可抑制肌阵挛，且与脑电图（EEG）上的癫痫样活动无关。
进行了三项研究。在第一项研究中，36名男性被随机分配接受0.025、0.050、0.075、0.100、0.200或0.300mg/kg的依托咪酯。在第二项交叉研究中，8名男性被随机分配在注射0.300mg/kg依托咪酯前50秒接受0.050mg/kg依托咪酯预处理剂量或安慰剂。对前两项研究中的受试者进行脑电图记录。在第三项研究中，60名患者被随机分配接受三种依托咪酯预处理剂量之一：在给予0.300mg/kg之前给予0.030、0.050或0.075mg/kg。
在研究1中，给予0.025或0.050mg/kg依托咪酯后未观察到肌阵挛。一名志愿者在给予0.075mg/kg依托咪酯后出现肌阵挛，另一名在给予0.100mg/kg依托咪酯后出现肌阵挛；三名在给予0.200mg/kg后出现肌阵挛；五名在给予0.300mg/kg后出现肌阵挛。肌阵挛的发生率与剂量相关（P≤0.01）。在研究2中，与六名（75%）接受安慰剂预处理的志愿者相比，两名（25%）接受依托咪酯预处理的志愿者出现轻度肌阵挛（P≤0.05）。在肌阵挛发作期间，除了δ波外，未观察到脑电图变化。在研究3中，与大剂量（0.075mg/kg）相比，小剂量预处理（0.030或0.050mg/kg）后肌阵挛的发生率较低（P≤0.01）。
依托咪酯诱导后肌阵挛的发生率和强度与剂量相关，可通过预处理抑制，且与癫痫样脑电图活动无关。
