Abstract :
Introduction: Etomidate’s haemodynamic stability is due to its unique lack of effect on the sympathetic nervous system and on baroreceptor function. Even in cardiac patients an induction dose of etomidate results in very stable haemodynamics. Etomidate also has minimal effects on respiratory system as compared to other induction agents. Since it causes minimal histamine release, this gives an advantage in patients with reactive airway disease, making it less likely that they will have bronchospasm. However, pain on injection and myoclonus are two most common side effects of this drug. Pain on injection has disappeared after the new fat emulsion of etomidate, but the new solvent has not reduced the incidence of myoclonus.
Objectives: 1): To compare the effects of pretreatment with two doses of Dexmedetomidine on the incidence of Etomidate induced myoclonus using numerical based grading; 2): To compare the effects of pretreatment with two doses of Dexmedetomidine on attenuation of stress response at laryngoscopy and intubation after induction with Etomidate.
Materials and Methods: Study area: The proposed study was carried out in the Department of Anesthesiology and Intensive care at a tertiary care teaching hospital, after seeking clearance from the college ethical committee and obtaining written informed consent from patient. Study design: Prospective Interventional Randomized Comparative Study Study period: 1 year
Results: It was a prospective and interventional randomized comparative study where 180 patients with age group 18-65 years, of either sex,ASA grade I & II, BMI, undergoing elective surgical procedures under general anaesthesia with endotracheal intubation were included in the study. They were divided into three groups where patients were randomly allocated into one of the three groups using Block Randomization with sealed envelope system. In Group 2 and 3, 78.3% and 76.6% patients did not have myoclonus during induction with etomidate. Stress response to intubation was suppressed by dexmedetomidine.
Conclusion: Based on the observations of our study, we conclude that pretreatment with 0.5µg/kg and 1µg/kg Dexmedetomidine significantly reduce etomidate induced myoclonus and stress response at intubation. However, dexmedetomidine in dose of 0.5µg/kg is associated with fewer side effects of bradycardia and hypotension.
Keyword :
American Society of Anaesthesiologists (ASA), Diastolic Blood Pressure (DBP), Systolic Blood Pressure (SBP), Mean Arterial Pressure (MAP), Electrocardiogram (ECG), Heart Rate (HR)