Effect Of The Combined Use Of Fentanyl And Dezocine On Etomidate-Induced Myoclonus During Anesthesia Induction

Background and ObjectiveWith the progress of medical technology, more and more anesthesiologists select general anesthesia as the first choice of anesthesia. This not only reduces the pain of the patient but also increases the safety of the operation and reducing the workload of the anesthesiologists. But at the same time more and more general anesthesia complications and side effects of general anesthetics appear in our clinic work thus need us pay more attention to it.The etomidate is a nonbarbiturate hypnotic intravenous anesthetics with ultra short acting which we frequently use in now days. It has many advantages over other anesthetics. For example,it is a potent intravenous anesthetic with a quick effect but has slight effects on the respiratory and cardiovascular system. So when we use the etomidate during induction of anesthesia the patients will get a more comfortable and stable experience. So it is widely used in patients who is old or with poor cardiac function and even the patients who is shock. The etomidate now has become the first choice of the induction of anesthesia. Before the etomidate fat emulsion come into use, the etomidate has many side effects like the soreness at the injection site and myoclonus. But the fat emulsion also has no improvement of myoclonus. Now the most often use drugs to prevent the myoclonus is fentanyl,sufentanil remifentanil, midazolam and dezocine.Fentanyl is a synthetic opioid analgesic with potent effect, medium effective time and slight effects on the cardiovascular system so it is often used in cardiovascular surgery patients. But the use of fentanyl during anesthesia induction has a high risk of bucking which will bring great influence to patients especially the internal pressure imbalance. The high pressure of pleural cavity,cerebrospinal fluid and eyes will cause serious complications. Other opioid analgesic like sufentanil has the same side effects. In order to prevent the myoclonus of etomidate we must increase the dose of opioid drugs but this will lead to respiratory depression, bucking and chest wall rigidity.Fentanyl induced bucking response may be related to its effect on the opioid receptor. Dezocine isкreceptor agonist andμreceptor antagonist. It was reported that using dezocine can suppress fentanyl induced bucking response and also reported that the etomidate-induced myoclonus is a kind of convulsions.When the κ receptor is activated it will have a suppress on convulsion and tremor. The combined use of fentanyl and dezocine on etomidate-induced myoclonus during anesthesia induction is not reported yet.So the purpose of this study is to observe the effect of the combined use of fentanyl and dezocine on etomidate-induced myoclonus. MethodsA total of 120 ASA physical status Ⅰ or Ⅱpatients undergoing general anesthesia in our hospital were selected.Fifty-seven females and sixty-three males. Patients with mental disorders, endocrine and metabolic diseases and those who are allergic to drugs that used in the study were excluded. the random number method patients were divided into 3 groups. Each group contains 40 patients.After entered the operation room the patients were given riger’s solution 5 ml/(kg?h)and penehyclidine hydrochloride 0.5 mg,Then the patients were continuously monitored with BP,ECG,HR,SPO2, PETCO2,BIS.After 5 min high flow mask oxygen inhalation, the patients were undergoing induced by anesthesiologist.GroupⅠreceived dezocine 0.1 mg/kg,fentanyl 3 μg/kg,etomidate 0.3 mg/kg, cisatracurium 0.25 mg/kg, Group Ⅱreceived dezocine 0.2 mg/kg,fentanyl 3 μg/kg,etomidate 0.3 mg/kg, cisatracurium 0.25 mg/kg,Group Ⅲ received normal saline 5 ml,fentanyl 3 μg/kg,etomidate 0.3 mg/kg, cisatracurium 0.25 mg/kg, All the drugs were intravenously injected sequentially. The fentanyl and etomidate should be injected less than 5 seconds.And then the occurrence and severity of myoclonus was observed and recorded in two minutes.At the same time the occurrence of bucking and BP,HR,SPO2 was observed. The severity of myoclonus is divided into 4 grade. Grade 0:No myoclonus, Grade 1: A mild myoclonus was a short movement of a body segment(a finger or a shoulder),Grade 2:A moderate myoclonus was slight movement of two different muscles or muscle groups of the body(face and leg). Grade 2:Severe myoclonus was intense clonic movement in two or more muscle groups(fast abduction of a limb). Results1, Baseline characteristics were similar for all patients between the three groups in age, weight,sex,ASA classification(P> 0.05)2,There were some changes of each groups’ HR,MAP, and SPO2, but the difference is not significant(P>0.05).3,The occurrence and severity of myoclonus. Group Ⅰ:grade 0,38 cases. grade 1,2 cases. grade 2 and grade 3 are all 0 cases. The incidence rate was 5.0%. GroupⅡ:grade 0,39 cases. grade 1,1 cases. grade 2 and grade 3 are all 0 cases. The incidence rate was 2.5%. Group Ⅲ:grade 0,19 cases. grade 1,17 cases. grade 2,1 case and grade 3,3 cases. The incidence rate was 52.5%. The occurrence and severity of group Ⅰand Ⅱ were significantly higher than group Ⅲ(P<0.05).Group Ⅰwere similar with group Ⅱ(P>0.05).4,The occurrence of bucking. Group Ⅰand Group Ⅱ with no occurrence of bucking but Group Ⅲ had 21 cases of bucking patients. The incidence rate was significantly higher than group Ⅰand Group Ⅱ. ConclusionsDuring the induction of general anesthesia, the added use of dezocine can not only reduce the occurrence of bucking but also the the combined use of fentanyl and dezocine can significantly reduce the etomidate-induced myoclonus occurrence。This will make the induction more stable and safe. The two different dose of 0.1 mg/kg and 0.2 mg/kg dezocine have the same effect on the occurrence of bucking and myoclonus。...