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Title

COMPARISON OF THE EFFECTS OF LOW-DOSE MIDAZOLAM, MAGNESIUM SULFATE, REMIFENTANIL AND LOW-DOSE ETOMIDATE ON PREVENTION OF ETOMIDATE-INDUCED MYOCLONUS IN ORTHOPEDIC SURGERIES

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Abstract

 Background: ETOMIDATE is a potent hypnotic agent with several desirable advantages such as providing a stable cardiovascular profile withminimalrespiratory adverse effectsandbetterhemodynamicstabilitycomparedwith other induction agents. Thisdrug is associated, however, with myoclonic movements which is characterized by a sudden, brief muscle contractions as a disturbing side-effect.Objectives: The present study was designed to compare the effectiveness of low- dose MIDAZOLAM, MAGNESIUM SULFATE, REMIFENTANIL and low-dose ETOMIDATE to suppress ETOMIDATE-induced MYOCLONUS in orthopedic surgery.Patients and Methods: A double-blind clinical trial study was conducted in an academic hospital from September 2014 to August 2015. Two hundred and eighty-four eligible patients, American society of anesthesiologists class I - II, scheduled for elective orthopedic surgery were randomly allocated into four equal groups (n=71). They received premedication with intravenous low-dose MIDAZOLAM 0.015 mg/kg, MAGNESIUM SULFATE 30 mg/kg, REMIFENTANIL 1mg/kg and low-dose ETOMIDATE 0.03 mg/kg two minutes before induction of anesthesia with 0.3 mg/kg intravenous ETOMIDATE. Then the incidence and intensity of MYOCLONUS were evaluated on a scale of 0 - 3; 0=no MYOCLONUS; 1=mild (movement at wrist); 2=moderate (movement at arm only, elbow or shoulder); and 3=severe, generalized response or movement in more than one extremity, within ninety seconds. Any adverse effect due to these premedication agents was recorded.Results: The incidence and intensity of MYOCLONUS were significantly lower in the low-dose ETOMIDATE group. The incidence rates of MYOCLONUS were 51 (71.85%), 61 (85.9%), 30 (42.3%) and 41 (57.7%), and the percentages of patients who experienced grade III of MYOCLONUS were 30 (58.8%), 32 (52.5%), 9 (30%) and 14 (34.1%) in the MIDAZOLAM, MAGNESIUM SULFATE, ETOMIDATE and REMIFENTANIL groups, respectively. The incidence and intensity of MYOCLONUS were significantly lower in the low-dose ETOMIDATE group (P=0.0001). No notable adverse effect was detected in our patients during the study period.Conclusions: Intravenous ETOMIDATE 0.03 mg/kg prior to induction can effectively reduce the incidence and severity of MYOCLONUS linked to ETOMIDATE.

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