Indian Journal of Clinical Anaesthesia


Comparison of Butorphanol with Fentanyl for reducing Etomidate-induced myoclonus: A Prospective, Randomised Clinical Trial


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Author Details: Alka Kewalramani (Chhabra), Savita Choudhary, Rakesh Kushwaha, Nagendra Prasad Sharma, Sourabh Bhate

Volume : 3

Issue : 3

Online ISSN : 2394-4994

Print ISSN : 2394-4781

Article First Page : 329

Article End Page : 333


Abstract

Background and Aims: Etomidate is frequently used nowadays as an inducing agent in patients with compromised cardiovascular function, but it leads to undesirable side effect like myoclonus and pain on injection during induction in unpre-medicated patients. Several drugs are considered alone and in combination, before induction to reduce the incidence of myoclonus. This prospective, randomized study was aimed to compare butorphanol and fentanyl administered before the induction of etomidate to reduce the myoclonic movements.
Material and Methods: Sixty patients of ASA I-II, aged 18-50 years undergoing surgeries in general anaesthesia were divided into two groups and pretreated either with intravenous butorphanol 0.02mg/kg and iv midazolam 1mg(Group BM) or intravenous fentanyl 1mcg/kg and iv midzolam(Group FM) followed by induction with etomidate until loss of eyelash reflex. Incidence and severity of myoclonus, pain on injection, apnoea and postoperative nausea and vomiting were noted. Induction dose of etomidate and induction time were observed and compared between the two groups.
Results: Study results showed the incidence of myoclonus of grade 1 were 6.7% and 10% in group BM and group FM respectively(p=1.000). The mean dose of etomidate for induction and induction time  were found to be 10.00±1.5mg and 32±4.50 seconds in group BM as compared to 12.00±1.8mg and 40±5.00seconds respectively in group FM.(p<0.001)
Conclusion: The incidence and severity of etomidate induced myoclonus is reduced by combination of midazolam with butorphanol or fentanyl if administered before induction. Also the dose of etomidate for induction is decreased by butorphanol in combination with midazolam.

Keywords
: Etomidate, Myoclonus, Butorphanol, Fentanyl, Midazolam