Online ISSN: 2515-8260

Keywords : Myoclonus

Dexmedetomidine in prevention of myoclonus: Side effects and haemodynamic study

Dr. Mohamed Faizuddin, Dr. Lokesh SB, Dr. Geetha M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 535-543

Dexmedetomidine the S-enantiomer of medetomidine a highly sedative and potent α2-
adrenergic agonists has a potentially useful role as a sedative agent. In healthy volunteers
dexmedetomidine increases sedation, analgesia and amnesia and decreases heart rate, cardiac
output and circulating catecholamine in a dose dependent fashion. Anaesthesia workstation
was checked. Appropriate size endotracheal tubes, working laryngoscope with medium and
large sized blades, stylet and working suction apparatus were kept ready before the induction
of general anaesthesia. Emergency drug tray consisting of atropine, adrenaline and
mephentermine were also kept ready for any eventuality. Post extubation Ramsay sedation
score was significantly higher in group D compared to group S at 30th, 60th and 90th minute
with p value = 0.001, 0.001 and 0.051 respectively. However no patients in group D required
intervention for sedation and were easily arousable. There was no statistically significance
between the groups immediately after extubation and at 120th minute postoperatively. 3
patients in group D (8.57%) and 3 patients in group S (8.57%) had vomiting immediately
following extubation which was statistically not significant (p = 0.721). 1 patients in group D
(2.86%) and 2 patients in group S (5.71%) had vomiting after 30 minutes of extubation which
was statistically not significant (p = 0.555).

A double blind randomized controlled study to evaluate the effect of dexmedetomidine in prevention of myoclonus occurring due to etomidate induction

Dr. Lokesh SB, Dr. Geetha M, Dr. Mohamed Faizuddin

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 544-554

Etomidate is a popular intravenous induction agent because it has a stable haemodynamic profile and
results in minimal histamine release. Myoclonus is observed in 50%–80% of patients who did not
receive pretreatment before etomidate administration, which increases the risk of regurgitation and
aspiration in emergency conditions. Various drugs were used in the treatment of myoclonus but the
results have been inconclusive. Dexmedetomidine, a new alpha-2 agonist has been tried by several
authors to suppress the myoclonus induced by etomidate. A prospective randomized controlled double
blind study was conducted in seventy patients aged between 18-55 years belonging to ASA I and II
scheduled for elective surgery under general anaesthesia. After obtaining informed written consent, a
detailed preanaesthetic evaluation was done and investigations were obtained as indicated. The patients
were randomized into 2 groups with 35 patients each, received either 0.5 μg/kg of dexmedetomidine in
10 ml saline (Group D) or 10 ml of Saline (Group S) over a period of 10 minutes prior to etomidate
induction. The incidence of severe myoclonus was significantly less in group D compared to saline
group with p = 0.031 (8.57% in group D and 28.5% in group S). However there was no change in the
incidence of myoclonus (P = 0.237) and pain on injection (p = 0.309) in both groups. Recovery profile
was comparable in both groups. Our study shows that pretreatment with dexmedetomidine 0.5 μg/kg
IV is effective in reducing the severity of etomidate induced myoclonic muscle movements without
however dexmedetomidine does not have any significant effect on the incidence of myoclonus
following etomidate induction.

A Prospective Randomized Comparative Study of Hemodynamic Effects of Etomidate vs Propofol During Induction and Intubation Under General Anaesthesia

Sarpatwar Sailesh, Boini Chiranjeevi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4749-4756

Background:The aim of the study is to compare induction with etomidate and propofol
on hemodynamic response to laryngoscopy and intubation.
Materials and Methods: The study was conducted in 60 ASA I & II patients in the age
group of 18 to 60 years who were posted for elective surgeries under general
anaesthesia. Their baseline heart rate, systolic blood pressure, diastolic blood pressure,
SpO2 and ETCO2 were recorded. Both the groups were premedicated with iv
glycopyrrolate 5mcg/kg, iv midazolam 0.025mg/Kg, iv fentanyl 2mcg/Kg. Following
premedication, the above variables were again recorded. Group P patients were
induced with iv propofol at the dose of 2 mg/Kg and Group E patients received iv
etomidate at 0.4mg/Kg. In both the groups, Injection vecuronium was given at the dose
0.08mg/Kg and they were maintained with O2:N2O =33%:66% and Isoflurane 1% dial
concentration. Laryngoscopy was performed by trained anesthesiologists after 5 mins.
Duration of laryngoscopy was kept at a maximum of 10 seconds. Trachea was intubated
with appropriate size endotracheal tube. The variables (HR, SBP, DBP, MAP, SpO2)
were measured during induction, intubation and post intubation at intervals of 1,2,3,5
and 10 mins.
Results: On comparing the two groups, the following results were obtained – Age, Sex,
Weight and ASA status were comparable in both the groups. Propofol was found to
produce hypotension in more or less 20%- 30% of patients irrespective of the
underlying condition. Etomidate was found to maintain hemodynamic stability though
there were no significant difference in heart rate variability in both the groups during
laryngoscopy and intubation. Myoclonus was seen in 4 out of 30 patients induced with
Etomidate, pain on injection was more common with Propofol. Apnea occurred in 12
out of 30 patients induced with Etomidate,28 patients out of 30 in propofol group,
vomiting and nausea are more with Etomidate than propofol but the difference was
statistically insignificant.
Conclusion: As per the results of the study, Propofol produced more hemodynamic
changes than Etomidate. Thus, we conclude that Etomidate is more stable in terms of
hemodynamic stability.