Etomidate 투여 후 간대성근경련을 예방하기 위한 Alfentanil 전투여의 적정용량 = The optimal dosage of alfentanil pretreatment for prevention of myoclonus after injection of etomidate

다국어 초록 (Multilingual Abstract)

Background: Myoclonus is a common problem during induction of general anesthesia with etomidate. We investigated the optimal dosage of alfentanil pretreatment for prevention of myoclonus after injection of etomidate.
Methods: In a double blinded fashion, 76 patients scheduled for outpatient elective surgery were randomized into 4 groups according to pretreatment drug: alfentanil 2.5μg/kg, alfentanil 5μg/kg, alfentanil 10μg/kg, or normal saline. The pretreatment was followed by etomidate 0.3 mg/kg IV. Laryngeal mask airway (LMA) was inserted at 5 minutes after the induction. The patients were observed for any myoclonic movement. Onset time, duration and intensity of myoclonus, side effects of alfentanil, mean arterial pressure and heart rate were measured during the study period.
Results: There were significant differences in the incidence and intensity of myoclonus. An injection of 5, and 10μg/kg alfentanil before etomidate prevented increase of mean arterial pressure and heart rate after LMA insertion. But injection of 10 μg/kg alfentanil before etomidate appeared generalized muscle rigidity, bradycardia and hypotension.
Conclusions: An injection of 2.5, 5, and 10μg/kg alfentanil before etomidate decreases the incidence and intensity of myoclonus. But injection of 10μg/kg alfentanil before etomidate appeared side effects. Therefore the optimal dosage of alfentanil pretreatment for prevention of myoclonus after injection of etomidate is 5μg/kg.

다국어 초록 (Multilingual Abstract)

Background: Myoclonus is a common problem during induction of general anesthesia with etomidate. We investigated the optimal dosage of alfentanil pretreatment for prevention of myoclonus after injection of etomidate.
Methods: In a double blinded fashion, 76 patients scheduled for outpatient elective surgery were randomized into 4 groups according to pretreatment drug: alfentanil 2.5μg/kg, alfentanil 5μg/kg, alfentanil 10μg/kg, or normal saline. The pretreatment was followed by etomidate 0.3 mg/kg IV. Laryngeal mask airway (LMA) was inserted at 5 minutes after the induction. The patients were observed for any myoclonic movement. Onset time, duration and intensity of myoclonus, side effects of alfentanil, mean arterial pressure and heart rate were measured during the study period.
Results: There were significant differences in the incidence and intensity of myoclonus. An injection of 5, and 10μg/kg alfentanil before etomidate prevented increase of mean arterial pressure and heart rate after LMA insertion. But injection of 10 μg/kg alfentanil before etomidate appeared generalized muscle rigidity, bradycardia and hypotension.
Conclusions: An injection of 2.5, 5, and 10μg/kg alfentanil before etomidate decreases the incidence and intensity of myoclonus. But injection of 10μg/kg alfentanil before etomidate appeared side effects. Therefore the optimal dosage of alfentanil pretreatment for prevention of myoclonus after injection of etomidate is 5μg/kg.

참고문헌 (Reference)

1 Kugler J, "The EEG after etomidate" 106 : 31-48, 1977

2 Hill-Venning C, "Subunit-dependent interaction of the general anaesthetic etomidate with the gamma-aminobutyric acid type A receptor" 120 : 749-756, 1997

3 Whiting PJ, "Structure and pharmacology of vertebrate GABAA receptor subtypes" 38 : 95-138, 1995

4 Kelsaka E, "Remifentanil pretreatment reduces myoclonus after etomidate" 18 : 83-86, 2006

5 Doenicke AW, "Reducing myoclonus after etomidate" 90 : 113-119, 1999

6 Krasowski MD, "Propofol and other intravenous anesthetics have sites of action on the gamma-aminobutyric acid type A receptor distinct from that for isoflurane" 53 : 530-538, 1998

7 Hueter L, "Pretreatment with sufentanil reduces myoclonus after etomidate" 47 : 482-484, 2003

8 Van Keulen SG, "Myoclonus associated with etomidate for ED procedural sedation and analgesia" 21 : 556-558, 2003

9 Franks NP, "Molecular and cellular mechanisms of general anaesthesia" 367 : 607-614, 1994

10 Miller RD, "Miller's Anesthesia. 6th" 2605-2606, 2005

11 Miller RD, "Miller's Anesthesia. 6th" 445-, 2005

12 Schwarzkopf KR, "Midazolam pretreatment reduces etomidate-induced myoclonic movements" 31 : 18-20, 2003

13 Yang J, "Mechanisms of etomidate potentiation of GABAA receptor-gated currents in cultured postnatal hippocampal neurons" 73 : 69-78, 1996

14 Guler A, "Magnesium sulfate pretreatment reduces myoclonus after etomidate" 101 : 705-709, 2005

15 Huter L, "Low-dose intravenous midazolam reduces etomidate-induced myoclonus: a prospective, randomized study in patients undergoing elective cardioversion" 105 : 1298-1302, 2007

16 Stockham RJ, "Fentanyl pretreatment modifies anaesthetic induction with etomidate" 16 : 171-176, 1988

17 권미숙, "Etomidate의 간대성 근경련에 대한 Midazolam 전투여효과" 대한마취과학회 43 (43): 395-400, 2002

18 Nyman Y, "Etomidate-Lipuro is associated with considerably less injection pain in children compared with propofol with added lidocaine" 97 : 536-539, 2006

19 Giese JL, "Etomidate versus thiopental for induction of anesthesia" 64 : 871-876, 1985

20 Moody EJ, "Distinct loci mediate the direct and indirect actions of the anesthetic etomidate at GABA(A) receptors" 69 : 1310-1313, 1997

21 Sanna E, "Differential subunit dependence of the actions of the general anesthetics alphaxalone and etomidate at gamma-aminobutyric acid type A receptors expressed in Xenopus laevis oocytes" 51 : 484-490, 1997

22 Korttila K, "Comparison of etomidate in combination with fentanyl or diazepam, with thiopentone as an induction agent for general anaesthesia" 51 : 1151-1157, 1979

23 Barash PG, "Clinical anesthesia. 5th" Lippincott Williams & Wilkins 344-, 2006

24 Kulka PJ, "Anesthesia induction using etomidate in a lipid emulsion" 42 : 205-209, 1993

25 Khalil SN, "Alfentanil decreases myoclonus caused by etomidate" 15 : 185-192, 1999

26 Gancher S, "Activation of epileptogenic activity by etomidate" 61 : 616-618, 1984