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The proper effect site concentration of remifentanil for prevention of myoclonus after etomidate injection

Hyun Su Ri1, Sang Wook Shin, Tae Kyun Kim

  • 1Department of Anesthesiology and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea.

Korean Journal of Anesthesiology
|September 20, 2011
PubMed
Abstract

Insights

Remifentanil pretreatment effectively prevents etomidate-induced myoclonus during anesthesia induction. A 2 ng/ml concentration significantly reduced myoclonus incidence without causing adverse effects like bradycardia or hypotension.

Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Etomidate bolus injection commonly causes myoclonus during anesthetic induction, posing challenges for anesthesiologists.
  • Investigating optimal remifentanil dosing is crucial for mitigating this side effect.

Purpose of the Study:

  • To determine the effective dose of remifentanil for preventing etomidate-induced myoclonus.
  • To assess the safety profile of remifentanil pretreatment at varying concentrations.

Main Methods:

  • Patients (ASA I-III) received etomidate (0.3 mg/kg) for induction.
  • Three groups were pretreated with remifentanil via target-controlled infusion (TCI) at effect-site concentrations of 0, 2, or 4 ng/ml.
  • Myoclonus incidence and side effects were monitored.

Main Results:

  • Myoclonus incidence was significantly reduced with remifentanil pretreatment (81% in control vs. 12% at 2 ng/ml and 0% at 4 ng/ml).
  • No significant bradycardia or hypotension occurred in the 2 ng/ml or 4 ng/ml groups.
  • Chest wall rigidity was observed in 45% of patients in the 4 ng/ml group.

Conclusions:

  • A 2 ng/ml effect-site concentration of remifentanil effectively reduces etomidate-induced myoclonus.
  • This dose prevents myoclonus without significant adverse cardiovascular effects or chest wall rigidity.
Keywords:
EtomidateMyoclonusRemifentanil

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