title: Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol.
abstract: 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.
authors.affiliation: Department of Neurology, Indiana University School of Medicine, Indianapolis.
authors.forename: R V
authors.initials: RV
authors.lastname: Reddy
authors.forename: S S
authors.initials: SS
authors.lastname: Moorthy
authors.forename: S F
authors.initials: SF
authors.lastname: Dierdorf
authors.forename: R D
authors.initials: RD
authors.lastname: Deitch
authors.forename: L
authors.initials: L
authors.lastname: Link
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000771:Anesthesia, Intravenous / Q000009:adverse effects*; D004421:Dystonia / Q000139:chemically induced; D004569:Electroencephalography; D005045:Etomidate / Q000009:adverse effects*; D006801:Humans; D008723:Methohexital / Q000009:adverse effects*; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology*; D009207:Myoclonus / Q000139:chemically induced; D013508:Ophthalmologic Surgical Procedures; D015742:Propofol / Q000009:adverse effects*; D013874:Thiopental / Q000009:adverse effects*; D014202:Tremor / Q000139:chemically induced
chemical_list: D008723:Methohexital; D013874:Thiopental; D015742:Propofol; D005045:Etomidate