Low-dose intravenous midazolam reduces etomidate-induced myoclonus: a prospective, randomized study in patients undergoing elective cardioversion.
BACKGROUND
Myoclonic movements are a common problem in unpremedicated patients during induction of anesthesia with etomidate.


METHODS
In a double-blind fashion, 40 patients (ASA physical status III-IV) scheduled for elective cardioversion were randomly assigned to receive either 0.015 mg/kg midazolam or placebo 90 s before the injection of 0.3 mg/kg etomidate. Myoclonic movements and sedation were recorded on a scale between 0 and 3. Pulse oximetry, noninvasive arterial blood pressure, and heart rate were recorded during the study period.


RESULTS
Two patients (10%) in the midazolam group had myoclonic movements after the administration of etomidate, whereas 10 of the 20 patients (50%) receiving placebo experienced such movements (P = 0.006). No other differences were found between the groups; in particular, there was no difference in recovery 5 min after the administration of etomidate.


CONCLUSIONS
IV midazolam 0.015 mg/kg administered 90 s before induction of anesthesia with etomidate is effective in reducing myoclonic movements and does not prolong recovery in unpremedicated patients after short procedures.
Hüter
Lars
L
Klinik für Anästhesiologie und Intensivtherapie, Friedrich-Schiller-Universität Jena, Germany. lars.hueter@med.uni-jena.de
Schreiber
Torsten
T
Gugel
Michael
M
Schwarzkopf
Konrad
K
D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D004311:Double-Blind Method; D004554:Electric Countershock / Q000379:methods; D005045:Etomidate / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D009207:Myoclonus / Q000139:chemically induced / Q000517:prevention & control*; D011446:Prospective Studies; D013997:Time Factors
D018686:Anesthetics, Intravenous; D008874:Midazolam; D005045:Etomidate