title: Prevention of etomidate-induced myoclonus: which is superior: Fentanyl, midazolam, or a combination? A Retrospective comparative study.
abstract: BACKGROUND
  In this retrospective comparative study, we aimed to compare the effectiveness of fentanyl, midazolam, and a combination of fentanyl and midazolam to prevent etomidate-induced myoclonus.
  
  
  METHODS
  This study was performed based on anesthesia records. Depending on the drugs that would be given before the induction of anesthesia with etomidate, the patients were separated into 4 groups: no pretreatment (Group NP), fentanyl 1 µg·kg-1 (Group F), midazolam 0.03 mg·kg-1 (Group M), and midazolam 0.015 mg·kg-1 + fentanyl 0.5 µg·kg-1 (Group FM). Patients who received the same anesthetic procedure were selected: 2 minutes after intravenous injections of the pretreatment drugs, anesthesia is induced with 0.3 mg·kg-1 etomidate injected intravenously over a period of 20-30 seconds. Myoclonic movements are evaluated, which were observed and graded according to clinical severity during the 2 minutes after etomidate injection. The severity of pain due to etomidate injection, mean arterial pressure, heart rate, and adverse effects were also evaluated.
  
  
  RESULTS
  Study results showed that myoclonus incidence was 85%, 40%, 70%, and 25% in Group NP, Group F, Group M, and Group FM, respectively, and were significantly lower in Group F and Group FM.
  
  
  CONCLUSIONS
  We conclude that pretreatment with fentanyl or combination of fentanyl and midazolam was effective in preventing etomidate-induced myoclonus.
authors.affiliation: Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ilke
authors.initials: I
authors.lastname: Isitemiz
authors.affiliation: Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Uzman
authors.affiliation: Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Toptaş
authors.affiliation: Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Vahapoglu
authors.affiliation: Department of Anesthesiology and Reanimation, Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey.
authors.forename: Yaşar Gökhan
authors.initials: YG
authors.lastname: Gül
authors.affiliation: Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ferda Yilmaz
authors.initials: FY
authors.lastname: Inal
authors.affiliation: Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akkoc
mesh_terms: D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D004359:Drug Therapy, Combination / Q000379:methods*; D005045:Etomidate / Q000009:adverse effects*; D005283:Fentanyl / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008874:Midazolam / Q000627:therapeutic use*; D009207:Myoclonus / Q000139:chemically induced* / Q000517:prevention & control*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl; D005045:Etomidate