Effect of preinjection of Nalbuphine on Etomidate - induced myoclonus during induction of general anesthesia
REN Yifeng1 SHI Wei2 CHEN Chengzhe1 LI Huifang1 NIU Chenguang1 ZHENG Xiaozhen1
1.Department of Anesthesiology, the First Affiliated Hospital of He′nan University, He′nan Province, Kaifeng 475001, China;
2.Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan Province, Chengdu 610041, China
Abstract：Objective To evaluate the effect of preinjection of Nalbuphine on Etomidate - induced myoclonus during induction of general anesthesia. Methods Sixty-four adult patients selected from the First Affiliated Hospital of He′nan University for Urological Surgery under general anesthesia from June to September 2018 were selected. The American society of anesthesiologists class Ⅰ -Ⅱ (ASA), age range from 30 to 63. Random number table method was used to divide into Nalbuphine group (N group) and control group (C group), 32 cases of each group. Before anesthesia induction, N group received 0.2 mg/kg Nalbuphine 10 mL, C group received an equal amount of normal saline, and after 150 s, both groups received 0.3 mg/kg Etomidate. The mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO2) of the two groups were recorded immediately before pretreatment (T0), 1 min after pretreatment (T1), immediately before Etomidate administration (T2) and 2 min after Etomidate administration (T3). Myoclonic condition within 2 min after Etomidate administration was recorded and its severity was assessed. Adverse reactions such as nausea and vomiting bradycardia and hypotension before Etomidate administration were recorded. Results Only 3 cases (9.4%) of mild myoclonus in N group, while in group C, 23 cases (71.9%) had myoclonus of varying degrees, among them, 14 cases (43.8%) were mild, 8 cases (25%) of moderate and 1 case (3.1%) of severe. The incidence of myoclonus in N group was significantly lower than that in C group (P ＜ 0.01). Comparison of MAP, HR and SpO2 at different time points in the two groups showed no statistically significant difference (P ＞ 0.05). During the induction of general anesthesia, the incidence of adverse reactions such as nausea, vomiting, bradycardia and hypotension in the two groups showed no statistically significant difference (all P ＞ 0.05). Conclusion Preinjection of 0.2 mg/kg of Nalbuphine 150 s before intravenous Etomidate injection can effectively inhibit the development of Etomidate induced myoclonus during the induction of general anesthesia.
[1] Erdoes G，Basciani RM，Eberle B. Etomidate--a review of robust evidence for its use in various clinical scenarios [J]. Acta Anaesthesiol Scand，2014，58（4）：380-389.
[2] Doenicke AW，Roizen MF，Kugler J，et al. Reducing myoclonus after etomidate [J]. Anesthesiology，1999，90（1）：113-119.
[3] Hueter L，Schwarzkopf K，Simon M，et al. Pretreatment with sufentanil reduces myoclonus after etomidate [J]. Acta Anaesthesiol Scand，2003，47（4）：482-484.
[4] Ri HS，Shin SW，Kim TK，et al. The proper effect site concentration of remifentanil for prevention of myoclonus after etomidate injection [J]. Korean J Anesthesiol，2011，61（2）：127-132.
[5] 汪伟，吕洁，钱燕宁，等.羟考酮或芬太尼预给药对依托咪酯所致肌阵挛的影响[J].临床麻醉学杂志，2015，31（7）：707-708.
[6] Uribe A，Zuleta-Alarcon A，Kassem M，et al. Intraoperative Seizures：Anesthetic and Antiepileptic Drugs [J]. Curr Pharm Des，2017，23（42）：6524-6532.
[7] Wang J，Li QB，Wu YY，et al. Efficacy and Safety of Opioids for the Prevention of Etomidate-Induced Myoclonus：A Meta-Analysis [J]. Am J Ther，2018，25（5）：e517-e523.
[8] He L，Ding Y，Chen H，et al. Butorphanol pre-treatment prevents myoclonus induced by etomidate：a randomised，double-blind，controlled clinical trial [J]. Swiss Med Wkly，2014，144：w14042.
[9] Zhu Y，Zhou C，He Q. Butorphanol effectively prevents etomidate-induced myoclonus：a pooled analysis of 788 patients [J]. J Int Med Res，2018：300060518801457.
[10] Durr A，Tassin J，Vidailhet M，et al. D2 dopamine receptor gene in myoclonic dystonia and essential myoclonus [J]. Ann Neurol，2000，48（1）：127-128.
[11] 文雯，王国年.依托咪酯所致肌阵挛机制与药物防治[J].国际麻醉学与复苏杂志，2015，（7）：640-644.
[12] Du X，Zhou C，Pan L，et al. Effect of dexmedetomidine in preventing etomidate-induced myoclonus：a meta-analysis [J]. Drug Des Devel Ther，2017，11：365-370.
[13] Mizrak A，Koruk S，Bilgi M，et al. Pretreatment with dexmedetomidine or thiopental decreases myoclonus after etomidate：a randomized，double-blind controlled trial [J]. J Surg Res，2010，159（1）：e11-e16.
[14] Lang B，Zhang L，Yang C，et al. Pretreatment with lidocaine reduces both incidence and severity of etomidate-induced myoclonus：a meta-analysis of randomized controlled trials [J]. Drug Des Devel Ther，2018，12：3311-3319.
[15] Loacker S，Sayyah M，Wittmann W，et al. Endogenous dynorphin in epileptogenesis and epilepsy：anticonvulsant net effect via kappa opioid receptors [J]. Brain，2007，130（Pt 4）：1017-1028.
[16] Zhu Y，Yang Y，Zhou C，et al. Using dezocine to prevent etomidate-induced myoclonus：a meta-analysis of randomized trials [J]. Drug Des Devel Ther，2017，11：2163-2170.
[17] Ko BJ，Oh JN，Lee JH，et al. Comparison of effects of fentanyl and remifentanil on hemodynamic response to endotracheal intubation and myoclonus in elderly patients with etomidate induction [J]. Korean J Anesthesiol，2013，64（1）：12-18.
[18] Zeng Z，Lu J，Shu C，et al. A comparision of nalbuphine with morphine for analgesic effects and safety ：meta-analysis of randomized controlled trials [J]. Sci Rep，2015，5：10927.
[19] Sadafule NN，Karhade SS. Comparative Study of Efficacy of Preoperative Nalbuphine Hydrochloride and Pentazocine Lactate on Hemodynamic Response to Tracheal Intubation and Postoperative Analgesia [J]. Anesth Essays Res，2018，12（1）：218-222.
2019, Vol. 16 
京公网安备 11010502046598号