The effect of preinduction with midazolam, fentanyl, and ketamine on etomidate induced myoclonic muscle movements

Abstract EN

Objective : to compare the impact of preinduction with Fentanyl, Ketamine or Midazolam on the frequency and intensity of intimidate induced myoclonic muscle movements.

Methods : One hundred five adult, American Society of Anesthesiology class I, of both genders, aged 31-49 years and assigned for elective ENT, ophthalmology and general surgery at King Hussein Medical Center, during the period from July 2009 to Feb 2010 were included in this study.

Subjects who had been given analgesics or sedatives during the past 24 hours were ruled out.

The study was approved by the local ethics committee of the Royal Medical Services Directorate of the Jordanian Army and written informed consent was obtained from all participants.

Patients were divided into one of 3 groups according to the intravenous preinduction agent received : group F, n = 36, received Fentanyl 2 mcg / kg, group M, n = 34, received midazolam 0.015 mg / kg and group K, n = 35, received Ketamine 0.2 mg / kg, ninety seconds before the induction of general anesthesia using intravenous etomidate 0.3 mg / kg.

An Anesthesiologist recorded the etomidate induced myoclonic muscle movements frequency and intensity based on a scale from 0 to 3, where 0 = none, 1 = mild, 2 = moderate, and 3=severe myoclonus.

Results : Two of the 36 subjects in the fentanyl group (5.6 %) reported etomidate induced myoclonic muscle movements, while four subjects (11.8 %) in the Midazolam group and 22 subjects (62.9 %) in the ketamine group had such movements(P < 0.05).

Conclusion : Intravenous Fentanyl 2 mcg / kg administration preintravenous intimidate induction of general anesthesia decreases significantly the frequency and severity of intimidate induced myoclonic muscle movements.