Efficacy and Safety of Midazolam in the Prevention of Etomidate-induced Myoclonus: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 QIUPeng , QIUShuang ,  DONGYou-jing

Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110022, China;

Corresponding author：

DONGYou-jing, Email: dongyj@sj-hospital.org

Keywords：

Midazolam; Etomidate; Myoclonus; Systematic review; Meta-analysis; Randomized controlled trials

DOI：

10.7507/1672-2531.20150230

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the efficacy and safety of midazolam in the prevention of etomidate-induced myoclonus. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 8, 2015), CBM, WanFang Data, VIP, and CNKI were electronically searched to collect randomized controlled trials (RCTs) about midazolam in the prevention of etomidate-induced myoclonus from inception to August, 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.2 and Stata 12.0 softwares. Results A total of 14 RCTs involving 1 274 patients were included. The results of metaanalysis showed that, compared with placebo, pretreatment with midazolam injection could reduce the incidence of myoclonus (RR=0.28, 95%CI 0.19 to 0.42, P<0.000 01). The sub-group analysis based on different doses of midazolam showed that all three different doses of midazolam (0.015 mg/kg, 0.03 mg/kg and 0.05-0.1 mg/kg) could reduce the incidence of myoclonus effectively (all P values <0.05). Conclusion Pretreatment with midazolam injection can reduce the incidence of etomidate-induced myoclonus without increasing the risk of recovery latency and over sedation. Due to the limited quality of included studies, the above conclusion needs to be further verified by more high quality studies.

Citation： QIUPeng, QIUShuang, DONGYou-jing. Efficacy and Safety of Midazolam in the Prevention of Etomidate-induced Myoclonus: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(12): 1407-1412. doi: 10.7507/1672-2531.20150230 Copy

1.	Doenicke A, Roizen MF, Nebauer AE, et al. A comparison of two formulations for etomidate, 2-hydroxypropyl-beta-cyclodextrin (HPCD) and propylene glycol. Anesth Analg, 1994, 79(5):933-939.
2.	Doenicke AW, Roizen MF, Kugler J, et al. Reducing myoclonus after etomidate. Anesthesiology, 1999, 90(1):113-119.
3.	Hüter L, Schwarzkopf K, Simon M, et al. Pretreatment with sufentanil reduces myoclonus after etomidate. Acta Anaesthesiol Scand, 2003, 47(4):482-484.
4.	Berry JM, Merin RG. Etomidate myoclonus and the open globe. Anesth Analg, 1989, 69(2):256-259.
5.	Shulman MS, Edelmann R. Use of etomidate for elective cardioversion. Anesthesiology, 1988, 68(4):656.
6.	Van Keulen SG, Burton JH. Myoclonus associated with etomidate for ED procedural sedation and analgesia. Am J Emerg Med, 2003, 21(7):556-558.
7.	Ebrahim ZY, DeBoer GE, Luders H, et al. Effect of etomidate on the electroencephalogram of patients with epilepsy. Anesth Analg, 1986, 65(10):1004-1006.
8.	Gancher S, Laxer KD, Krieger W. Activation of epileptogenic activity by etomidate. Anesthesiology, 1984, 61(5):616-618.
9.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
10.	Isitemiz I, Uzman S, Toptaş M, et al. Prevention of etomidateinduced myoclonus:Which is superior:Fentanyl, midazolam, or a combination? A retrospective comparative study. Med Sci Monit, 2014, 20(1):262-267.
11.	Hwang JY, Kim JH, Oh AY, et al. A comparison of midazolam with remifentanil for the prevention of myoclonic movements following etomidate injection. J Int Med Res, 2008, 36(1):17-22.
12.	Schwarzkopf KR, Hueter L, Simon M, et al. Midazolam pretreatment reduces etomidate-induced myoclonic movement. Anaesth Intensive Care, 2003, 31(1):18-20.
13.	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. Anesth Analg, 2007, 105(5):1298-1302.
14.	Gunes Y, Aktolga S, Gündüz M, et al. A comparison of midazolam or dexmedetomidine for the prevention of myoclonic movements and injection pain following etomidate injection. J Anaesthesiol Clin Pharmacol, 2010:162-166.
15.	卢吉灿, 刘超, 贾燕. 咪达唑仑预处理减少依托咪酯所致的肌阵挛. 齐齐哈尔医学院学报, 2009, 30(11):1287-1288.
16.	吴隆岩, 金光辉. 右美托咪定与咪达唑仑预处理对麻醉诱导期依托咪酯所致肌阵挛的影响. 山东医药, 2012, 52(18):92-93.
17.	孙艳红, 刘海梅, 赵芸慧, 等. 依托咪酯麻醉诱导期对血流动力学及不同给药顺序对肌阵挛的影响. 中国医科大学学报, 2010, 39(12):1058-1060.
18.	康振明, 谢文钦, 谢文吉, 等. 右美托咪定与咪达唑仑对依托咪酯全麻诱导时肌阵挛影响的对比研究. 中国医学创新, 2014, 10(5): 11-13.
19.	廖朝辉, 幸标, 沈娴文. 咪唑安定和芬太尼对依托咪酯所致肌阵挛的影响. 临床麻醉学杂志, 2010, 26(2):129-131.
20.	李银宏, 王祖谦, 赵世军. 咪唑安定预处理减少依托咪酯所致肌阵挛. 青海医药杂志, 2009, 39(6):10-11.
21.	王彬, 程庆好, 李蕾. 右美托咪定或咪达唑仑对依托咪酯镇静时肌阵挛的影响. 中国煤炭工业医学杂志, 2014, 17(4):522-525.
22.	王润. 小剂量咪唑安定联合依托咪酯对全麻诱导中减轻肌阵挛的临床作用探讨. 西部医学, 2012, 24(1):104-106.
23.	魏嵘, 王春, 章赛吉, 等. 芬太尼和咪达唑仑给药顺序对小儿麻醉诱导期依托咪酯所致肌阵挛的影响. 上海医学, 2013, 36(8):670-672.
24.	Rosenberg MS. The File-drawer problem revisited:a general weighted method for calculating fail-safe numbers in meta-analysis. Evolution, 2005, 59(2):464-468.
25.	Grant IS, Hutchison G. Epileptiform seizures during prolonged etomidate sedation. Lancet, 1983, 2(8348):511-512.
26.	Reddy RV, Moorthy SS, Dierdorf SF, et al. Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital and propofol. Anesth Analg, 1993, 77(5):1008-1011.
27.	Voss LJ, Sleigh JW, Barnard JP, et al. The howling cortex:seizures and general anesthetic drugs. Anesth Analg, 2008, 107(5):1689-1703.
28.	Kugler J, Doenicke A, Laub M. The EEG after etomidate. Anaesthesiol Resusc, 1977, 106(7):31-48.
29.	王新华, 刘树孝, 王景阳, 等. 依托咪酯引起肌震颤与脑内多巴胺受体关系的实验研究. 中华麻醉学杂志, 1991, 11(3):147-148.
30.	Mizrak A, Koruk S, Bilgi M, et al. Pretreatment with dexmedetomidine or thiopental decreases myoclonus after etomidate:A randomized, double-blind controlled trial. J Surg Res, 2010, 159(1):e11-e16.
31.	陈金仙, 顾晓霞, 蔡树云, 等. 右美托咪定滴鼻预处理对全麻诱导期依托咪酯不良反应的影响. 赣南医学院学报, 2014, 34(3):381-383.

1. Doenicke A, Roizen MF, Nebauer AE, et al. A comparison of two formulations for etomidate, 2-hydroxypropyl-beta-cyclodextrin (HPCD) and propylene glycol. Anesth Analg, 1994, 79(5):933-939.
2. Doenicke AW, Roizen MF, Kugler J, et al. Reducing myoclonus after etomidate. Anesthesiology, 1999, 90(1):113-119.
3. Hüter L, Schwarzkopf K, Simon M, et al. Pretreatment with sufentanil reduces myoclonus after etomidate. Acta Anaesthesiol Scand, 2003, 47(4):482-484.
4. Berry JM, Merin RG. Etomidate myoclonus and the open globe. Anesth Analg, 1989, 69(2):256-259.
5. Shulman MS, Edelmann R. Use of etomidate for elective cardioversion. Anesthesiology, 1988, 68(4):656.
6. Van Keulen SG, Burton JH. Myoclonus associated with etomidate for ED procedural sedation and analgesia. Am J Emerg Med, 2003, 21(7):556-558.
7. Ebrahim ZY, DeBoer GE, Luders H, et al. Effect of etomidate on the electroencephalogram of patients with epilepsy. Anesth Analg, 1986, 65(10):1004-1006.
8. Gancher S, Laxer KD, Krieger W. Activation of epileptogenic activity by etomidate. Anesthesiology, 1984, 61(5):616-618.
9. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
10. Isitemiz I, Uzman S, Toptaş M, et al. Prevention of etomidateinduced myoclonus:Which is superior:Fentanyl, midazolam, or a combination? A retrospective comparative study. Med Sci Monit, 2014, 20(1):262-267.
11. Hwang JY, Kim JH, Oh AY, et al. A comparison of midazolam with remifentanil for the prevention of myoclonic movements following etomidate injection. J Int Med Res, 2008, 36(1):17-22.
12. Schwarzkopf KR, Hueter L, Simon M, et al. Midazolam pretreatment reduces etomidate-induced myoclonic movement. Anaesth Intensive Care, 2003, 31(1):18-20.
13. 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. Anesth Analg, 2007, 105(5):1298-1302.
14. Gunes Y, Aktolga S, Gündüz M, et al. A comparison of midazolam or dexmedetomidine for the prevention of myoclonic movements and injection pain following etomidate injection. J Anaesthesiol Clin Pharmacol, 2010:162-166.
15. 卢吉灿, 刘超, 贾燕. 咪达唑仑预处理减少依托咪酯所致的肌阵挛. 齐齐哈尔医学院学报, 2009, 30(11):1287-1288.
16. 吴隆岩, 金光辉. 右美托咪定与咪达唑仑预处理对麻醉诱导期依托咪酯所致肌阵挛的影响. 山东医药, 2012, 52(18):92-93.
17. 孙艳红, 刘海梅, 赵芸慧, 等. 依托咪酯麻醉诱导期对血流动力学及不同给药顺序对肌阵挛的影响. 中国医科大学学报, 2010, 39(12):1058-1060.
18. 康振明, 谢文钦, 谢文吉, 等. 右美托咪定与咪达唑仑对依托咪酯全麻诱导时肌阵挛影响的对比研究. 中国医学创新, 2014, 10(5): 11-13.
19. 廖朝辉, 幸标, 沈娴文. 咪唑安定和芬太尼对依托咪酯所致肌阵挛的影响. 临床麻醉学杂志, 2010, 26(2):129-131.
20. 李银宏, 王祖谦, 赵世军. 咪唑安定预处理减少依托咪酯所致肌阵挛. 青海医药杂志, 2009, 39(6):10-11.
21. 王彬, 程庆好, 李蕾. 右美托咪定或咪达唑仑对依托咪酯镇静时肌阵挛的影响. 中国煤炭工业医学杂志, 2014, 17(4):522-525.
22. 王润. 小剂量咪唑安定联合依托咪酯对全麻诱导中减轻肌阵挛的临床作用探讨. 西部医学, 2012, 24(1):104-106.
23. 魏嵘, 王春, 章赛吉, 等. 芬太尼和咪达唑仑给药顺序对小儿麻醉诱导期依托咪酯所致肌阵挛的影响. 上海医学, 2013, 36(8):670-672.
24. Rosenberg MS. The File-drawer problem revisited:a general weighted method for calculating fail-safe numbers in meta-analysis. Evolution, 2005, 59(2):464-468.
25. Grant IS, Hutchison G. Epileptiform seizures during prolonged etomidate sedation. Lancet, 1983, 2(8348):511-512.
26. Reddy RV, Moorthy SS, Dierdorf SF, et al. Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital and propofol. Anesth Analg, 1993, 77(5):1008-1011.
27. Voss LJ, Sleigh JW, Barnard JP, et al. The howling cortex:seizures and general anesthetic drugs. Anesth Analg, 2008, 107(5):1689-1703.
28. Kugler J, Doenicke A, Laub M. The EEG after etomidate. Anaesthesiol Resusc, 1977, 106(7):31-48.
29. 王新华, 刘树孝, 王景阳, 等. 依托咪酯引起肌震颤与脑内多巴胺受体关系的实验研究. 中华麻醉学杂志, 1991, 11(3):147-148.
30. Mizrak A, Koruk S, Bilgi M, et al. Pretreatment with dexmedetomidine or thiopental decreases myoclonus after etomidate:A randomized, double-blind controlled trial. J Surg Res, 2010, 159(1):e11-e16.
31. 陈金仙, 顾晓霞, 蔡树云, 等. 右美托咪定滴鼻预处理对全麻诱导期依托咪酯不良反应的影响. 赣南医学院学报, 2014, 34(3):381-383.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Midazolam in the Prevention of Etomidate-induced Myoclonus: A Meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content