Pretreatment of rocuronium reduces the frequency and severity of etomidate-induced myoclonus.
OBJECTIVE
To investigate the effect of pretreatment with a low dose of rocuronium on the occurrence of etomidate-induced myoclonus.


METHODS
Prospective, randomized, double-blinded study.


METHODS
Medical center in South Korea.


METHODS
110 ASA physical status I, II, and III patients scheduled for elective cardiac or pulmonary surgery with general anesthesia.


METHODS
All patients were randomized to pretreatment with a low dose of rocuronium (0.06 mg/kg; Group R) or placebo (saline; Group S), followed three minutes later by etomidate (0.3 mg/kg).


METHODS
Patients were monitored for myoclonic movements and pain on a scale of 0-3. Bispectral index (BIS) and electromyographic (EMG) activity were recorded continuously throughout the procedure.


RESULTS
Frequency of myoclonus was significantly lower in Group R (25%) than in Group S (63%). In the latter group, there was no difference in the frequency of male (59%) and female (68%) patients experiencing myoclonus. In Group S, EMG activity and BIS were significantly increased in patients who experienced severe myoclonus, and BIS was well correlated with EMG activity.


CONCLUSIONS
Pretreatment with a small dose of rocuronium before induction of anesthesia with etomidate significantly reduced the frequency of myoclonus.
Choi
Jae Moon
JM
Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Choi
In Cheol
IC
Jeong
Yong Bo
YB
Kim
Tae Hee
TH
Hahm
Kyung Don
KD
D000328:Adult; D000368:Aged; D000732:Androstanols / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000379:methods; D004311:Double-Blind Method; D004576:Electromyography; D005045:Etomidate / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007723:Korea; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009207:Myoclonus / Q000139:chemically induced / Q000517:prevention & control*; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use; D011446:Prospective Studies; D013510:Pulmonary Surgical Procedures / Q000379:methods; D000077123:Rocuronium; D012720:Severity of Illness Index
D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium; D005045:Etomidate