Efficacy of Pretreatment of Vecuronium Combined with Dilution of Etomidate on Etomidateinduced Myoclonus_West China Medical Journal

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Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu Sichuan 610041, China;

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Keywords：

依托咪酯; 肌阵挛; 维库溴铵; 预注法; 稀释法

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目的:旨在评价预注维库溴铵联合稀释依托咪酯减轻依托咪酯全麻诱导中肌阵挛的效果。方法:本研究为前瞻性、双盲、随机对照研究。80名ASA I-II级、年龄18～60岁、拟行胆囊切除术的全麻患者被随机分为4组:组1,预注维库溴铵0.01 mg/kg;组2,依托咪酯用生理盐水由2 mg/mL 稀释为1 mg/mL;组3,预注维库溴铵联合稀释依托咪酯;组4,生理盐水对照组+非稀释依托咪酯组。根据分组给予患者预注维库溴铵0.01 mg/kg或同等量的生理盐水,观察并询问患者有无呼吸困难,并记录呼吸频率和脉搏氧饱和度(SpO2)。3分钟后推注稀释或无稀释依托咪酯0.3 mg/kg,询问患者有无注射痛并做疼痛评分,观察有无肌阵挛并评估其程度。2分钟后给予维库溴铵0.1 mg/kg、芬太尼3 μg/kg和丙泊酚1 mg/kg行气管插管。实验期间同时记录无创动脉血压(BP)和心率(HR)。结果:组1和组4分别有2例(10%)和3例(15%)患者述轻度注射疼痛,而组2和组3无患者述注射疼痛。组1、组2和组3肌阵挛的发生率明显低于组4(30%、40%和15% vs 70%,P lt;0.05)。且组1、组2和组3肌阵挛的程度多为轻中度,而组4多为中重度。四组患者均未述任何呼吸困难,呼吸频率无明显降低,SpO2无明显变化。四组患者BP和HR变化一致,无明显差别。结论:预注小剂量维库溴铵或稀释依托咪酯可明显降低依托咪酯引起肌阵挛的发生率并减轻其程度。且这两种方法联合应用比单独应用效果更佳,具有一定程度的协同作用。

Citation： YU Hai,FANG Liqun,DU Runzi,et al.. Efficacy of Pretreatment of Vecuronium Combined with Dilution of Etomidate on Etomidateinduced Myoclonus. West China Medical Journal, 2009, 24(8): 1988-1991. doi: Copy

1.	DOENICKE A W, ROIZEN M F, KUGLER J, et al.Reducing myoclonus after etomidate[J]. Anesthesiology, 1999, 90(1): 113-9.
2.	HUETER L, SCHWARZKOPF K, SIMON M, et al. Pretreatment with sufentanil reduces myoclonus after etomidate[J]. Acta Anaesthesiol Scand, 2003, 47(4): 482-4.
3.	KELSAKA E, KARAKAYA D, SARIHASAN B, et al. Remifentanil pretreatment reduces myoclonus after etomidate[J]. J Clin Anesth, 2006, 18(2): 83-6.
4.	SCHWARZKOPF K R, HUETER L, SIMON M, et al. Midazolam pretreatment reduces etomidateinduced myoclonic movements[J]. Anaesth Intensive Care, 2003, 31(1): 18-20.
5.	HüTER L, SCHREIBER T, GUGEL M, et al. Lowdose intravenous midazolam reduces etomidateinduced myoclonus: a prospective, randomized study in patients undergoing elective cardioversion[J]. Anesth Analg, 2007, 105(5): 1298-302.
6.	CHOI J M, CHOI IC, JEONG Y B, et al. Pretreatment of rocuronium reduces the frequency and severity of etomidateinduced myoclonus[J]. J Clin Anesth, 2008, 20(8): 601-4.
7.	TUNCALI B, KARCI A, TUNCALI B E,et al. Dilution of rocuronium to 05 mg/mL with 09% NaCl eliminates the pain during intravenous injection in awake patients[J]. Anesth Analg, 2004, 99(3): 740-3.
8.	YU H, YANG X Y, ZHANG X, et al. The effect of dilution and prolonged injection time on fentanylinduced coughing[J]. Anaesthesia, 2007, 62(9): 919-22.
9.	SOSIS M. On the use of vecuronium 001 mg/kg to prevent suxamethoniuminduced myalgia[J]. Acta Anaesthesiol Scand, 1991, 35(1): 92.
10.	SCHWARZ S, ILIASW, LACKNER F, et al. Rapid tracheal intubation with vecuronium: the priming principle[J]. Anesthesiology, 1985, 62(4): 388-91.
11.	REDDY R V, MOORTHY S S, DIERDORF S F, et al. Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol[J]. Anesth Analg, 1993, 77(5): 1008-11.

1. DOENICKE A W, ROIZEN M F, KUGLER J, et al.Reducing myoclonus after etomidate[J]. Anesthesiology, 1999, 90(1): 113-9.
2. HUETER L, SCHWARZKOPF K, SIMON M, et al. Pretreatment with sufentanil reduces myoclonus after etomidate[J]. Acta Anaesthesiol Scand, 2003, 47(4): 482-4.
3. KELSAKA E, KARAKAYA D, SARIHASAN B, et al. Remifentanil pretreatment reduces myoclonus after etomidate[J]. J Clin Anesth, 2006, 18(2): 83-6.
4. SCHWARZKOPF K R, HUETER L, SIMON M, et al. Midazolam pretreatment reduces etomidateinduced myoclonic movements[J]. Anaesth Intensive Care, 2003, 31(1): 18-20.
5. HüTER L, SCHREIBER T, GUGEL M, et al. Lowdose intravenous midazolam reduces etomidateinduced myoclonus: a prospective, randomized study in patients undergoing elective cardioversion[J]. Anesth Analg, 2007, 105(5): 1298-302.
6. CHOI J M, CHOI IC, JEONG Y B, et al. Pretreatment of rocuronium reduces the frequency and severity of etomidateinduced myoclonus[J]. J Clin Anesth, 2008, 20(8): 601-4.
7. TUNCALI B, KARCI A, TUNCALI B E,et al. Dilution of rocuronium to 05 mg/mL with 09% NaCl eliminates the pain during intravenous injection in awake patients[J]. Anesth Analg, 2004, 99(3): 740-3.
8. YU H, YANG X Y, ZHANG X, et al. The effect of dilution and prolonged injection time on fentanylinduced coughing[J]. Anaesthesia, 2007, 62(9): 919-22.
9. SOSIS M. On the use of vecuronium 001 mg/kg to prevent suxamethoniuminduced myalgia[J]. Acta Anaesthesiol Scand, 1991, 35(1): 92.
10. SCHWARZ S, ILIASW, LACKNER F, et al. Rapid tracheal intubation with vecuronium: the priming principle[J]. Anesthesiology, 1985, 62(4): 388-91.
11. REDDY R V, MOORTHY S S, DIERDORF S F, et al. Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol[J]. Anesth Analg, 1993, 77(5): 1008-11.

West China Medical Journal

Efficacy of Pretreatment of Vecuronium Combined with Dilution of Etomidate on Etomidateinduced Myoclonus

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