Impact Of Fentanyl Alone Vs. Fentanyl And Midazolam Pre-Treatment On Preventing Etomidate-Induced Myoclonus In Cardiothoracic Patients

Authors

  • Naveen D
  • P. B. Jamale
  • Vithal k dhulked
  • Naseema Kanase
  • Rabnna I. Mulla
  • Salman mulla
  • Meghana

Keywords:

Etomidate, fentanyl, midazolam, myoclonus

Abstract

Background: A steady cardiovascular profile and little respiratory depression are among its most noteworthy therapeutic characteristics. These characteristics make etomidateparticularly helpful in the management of anesthesia in patients with hemodynamic instability, such as those with shock, hypovolemia, or significant cardiac comorbidities. Because of this, etomidate is still often utilized in both emergency and elective surgical situations, particularly where preserving circulatory stability during induction is crucial. This study aims to fill this knowledge gap by evaluating the effectiveness of these pre-treatment strategies and providing information that will guide clinical practice, improve patient outcomes, and optimize perioperative care for this high-risk patient population.

Material and Methods:  This prospective, randomised, double-blind study was conducted on 90 surgical patients allocated to 45 in each group. Group A patients received intravenous (IV) fentanyl 2 μg/kg and 5 mL saline. Group B patients received IV fentanyl 2 μg/kg and midazolam 0.03 mg/kg. The study drugs were administered intravenously over 30 s. Five minutes after study drug administration; etomidate 0.3 mg kg−1 was administered over 60 s. Patients were observed for 1 min for occurrence and severity of EIM.

Results: The incidence of myoclonus was markedly lower in Group B (15.6%) versus Group A (48.9%), with a significant reduction in higher severity grades. Patients experiencing myoclonus showed elevated haemodynamic responses, including increased heart rate and blood pressure, emphasizing the clinical importance of preventing myoclonus during anesthesia induction.  

Conclusion: According to these findings, preparation with fentanyl-midazolam provides a more secure and safe induction method, enhancing patient outcomes in high-risk surgical situations.

Downloads

Download data is not yet available.

References

Schwarzkopf KR, Hueter L, Simon M, Fritz HG. Midazolam pretreatment reduces etomidate-induced myoclonic move¬ments. Anaesth Intensive Care 2003; 31: 18-20.

Doenicke AW, Roizen MF, Kugler J, Kroll H, Foss J, Ostwald P. Reducing myoclonus after etomidate. Anesthesiology 1999; 90: 113-9.

Stockham RJ, Stanley TH, Pace NL, Gillmor S, Groen F, Hilkens P. Fentanyl pretreatment modifies anesthetic induc¬tion with etomidate. Anaesth Intensive Care 1998; 16: 171-6.

Giese JL, Stockham RJ, Stanley TH, Pace NL, Nelissen RH.Etomidate versus thiopental for induction of anesthesia. AnesthAnalg 1985; 64: 871-6.

Van Keulen SG, Burton JH. Myoclonus associated with etomi¬date for ED procedural sedation and analgesia. Am J EmergMed 2003; 21: 556-8.

Huter L, Schreiber T, Gugel M, Schwarzkopf K. Low-dose in¬travenous midazolam reduces etomidate-induced myoclonus: aprospective, randomized study in patients undergoing electivecardioversion. Anesth Analg 2007; 105: 1298-302.

Berry JM, Merin RG. Etomidate myoclonus and the openglobe. Anesth Analg 1989; 69: 256-9.

Hwang JY, Kim JH, Oh AY, Do SH, Jeon YT, Han SH. A com¬parison of midazolam with remifentanil for the prevention ofmyoclonic movements following etomidate injection. J Int MedRes 2008; 36: 17-22.

Khalil SN, Lawson KS, Hanis CL, Lemak NA, Ruiz RS. Alfen¬tanil decreases myoclonus caused by etomidate. Middle East JAnesthesiol 1999; 15: 185-92.

Guler A, Satilmis T, Akinci SB, Celebioglu B, Kanbak M. Mag¬nesium sulphate pretreatment reduces myoclonus after etomi¬date. Anesth Analg 2005; 101: 705-9.

Dey S, Kumar M. Comparison of pretreatment with dexmede¬tomidine with midazolam for prevention of etomidate-inducedmyoclonus and attenuation of stress response at intubation: Arandomized controlled study. J Anaesthesiol Clin Pharmacol2018; 34: 94-8.

Do SH, Han SH, Park SH, Kim JH, Hwang JY, Son IS, KimMS. The effect of injection rate on etomidate-induced myoclo¬nus. Korean J Anethesiol 2008; 55: 305-7.

Hodgson RE, Burrows RC. Midazolam and etomidate for in¬duction of anaesthesia in ophthalmic surgery. South Afr J An¬aesth Analg 2002; 8: 4-7.

Adinehmehr L, Shetabi H, Moradi Farsani D, Salehi A, Noorbakhsh M. Comparison of the Sedation Quality of Etomidate, Propofol, and Midazolam in Combination with Fentanyl During Phacoemulsification Cataract Surgery: A Double-Blind, Randomized, Controlled, Clinical Trial. Anesth Pain Med. 2019 Apr 27;9(2): e87415.

Isitemiz I, Uzman S, Toptaş M, Vahapoglu A, Gül YG, Inal FY, Akkoc I. Prevention of etomidate-induced myoclonus: which is superior: Fentanyl, midazolam, or a combination? A Retrospective comparative study. Med Sci Monit. 2014 Feb 16; 20:262-7.

Prakash S, Mullick P, Virmani P, Talwar V, Singh R. Effect of Pre-Treatment with a Combination of Fentanyl and Midazolam for Prevention of Etomidate- Induced Myoclonus. Turk J Anaesthesiol Reanim. 2021 Feb;49(1):11-17.

Souvatzis X, Kalogridaki M, Mavrakis HE, Kanoupakis EM, Marouli D, Vardas P, Askitopoulou H. Adding fentanyl to etomidate fails to reduce painful recall of external direct current cardioversion in adults: a randomised trial. Hell J Cardiol. 2015 Mar 1;56(2):142e148.

Luan HF, Zhao ZB, Feng JY, Cui JZ, Zhang XB, Zhu P, Zhang YH. Prevention of etomidate-induced myoclonus during anesthetic induction by pretreatment with dexmedetomidine. Brazilian Journal of Medical and Biological Research. 2014 Oct 24; 48:186-90

Sojitra NP, Kantharia BN, Nakum R, Padsala K. Effect of pre-treatment on induction on anaesthesia with etomidate: A comparison between dexmedetomidine and midazolam–fentanyl combination. Current Medicine Research and Practice. 2023 Nov 1;13(6):275-9.

Downloads

Published

2025-07-05

How to Cite

1.
D N, Jamale PB, dhulked V k, Kanase N, I. Mulla R, mulla S, Meghana M. Impact Of Fentanyl Alone Vs. Fentanyl And Midazolam Pre-Treatment On Preventing Etomidate-Induced Myoclonus In Cardiothoracic Patients. J Neonatal Surg [Internet]. 2025Jul.5 [cited 2025Oct.14];14(32S):3806-11. Available from: https://jneonatalsurg.com/index.php/jns/article/view/8013

Issue

Vol. 14 No. 32S (2025): Journal of Neonatal Surgery

Section

Original Article

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

You are free to:

  • Adapt — remix, transform, and build upon the material for any purpose, even commercially.

Terms:

  • Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
  • No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.