Effect Of Sufentanil Combined With Butorphanol On Etomidate-induced Myoclonus During Anesthesia Induction

With the progress of medical level,the development of economic level and the increase of patients' demand for comfort,general anesthesia is used more and more in elective surgery.In order to improve the safety of general anesthesia,how to effectively prevent the adverse reaction caused by general anesthetic drugs has become a very important question.Etomidate is a kind of Imidazole derivatives.It is a kind of sedative and hypnotic anesthetic widely used in clinic at present.its anesthetic effect is strong,the effect is rapid,has little effect on circulatory system,and make the anesthesia induction comfortable and stable.However,intravenous injection of etomidate can produce adverse reactions such as pain at injection site and muscle tremor,and the incidence of injection pain is obviously reduced after the dosage form is changed from aqueous agent to emulsion,but the incidence of myoclonus is still as high as 50% to 80%.At present,the mechanism and inducing factors are not clear.This adverse reaction can significantly increase the risk of aspiration,increase the energy consumption of the body,and produce the consequences of increased blood potassium and muscle soreness.Increasing intraocular pressure and intracranial pressure is extremely dangerous for some patients with ophthalmic and cardiovascular and cerebrovascular diseases.At present,the combination of sedative and analgesic drugs are often used to reduce this adverse reaction to reduce the risk of anesthesia.Sufentanil is an opioid receptor agonist,which mainly produces analgesic effect by activating u receptor.Sufentanil is widely used in clinical anesthesia because of its strong analgesic effect,fast action,long action time and little effect on circulation system.Clinical studies have shown that Sufentanil pretreatment can significantly reduce the incidence of myoclonus induced by etomidate,the inhibitory effect is significant and dose-dependent,but intravenous injection of sufentanil can easily cause adverse reactions such as respiratory inhibition,chest wall stiffness,cough reaction and so on.Sufentanil can increase the risk associated with anesthesia.Butorphanol produces analgesic effect mainly by activating ? receptor.The intensity of action on the three receptors of ?:u:e are 25:4:1.Studies have shown that butorphanol has inhibition on cough response induced by sufentanil and myoclonus induced by etomidate.In this paper,butorphanol was used to partially replace sufentanil in the induction of general anesthesia,and the inhibitory effects of several schemes of butorphanol combined with sufentanil on muscle tremor induced by etomidate were observed and compared to provide reference for clinical use.Objective:To observe and compare the effect of three sufentanil combined with butorphanol schemes on etomidate-induced myoclonus during anesthesia induction.Combined with the effects on respiration and circulatory system,the suitable compound dose was selected to provide reference for clinical use.Methods:One hundred and twenty patients,aged 20?60,who received general anesthesia and the duration of the operation is within three hours and graded into grade I-II by American Society of Anesthesiologists(ASA)were randomly divided into group A,group B and group C.Group A received received butorphanol 10 ?g/kg in advance and then sufentanil 0.3 ?g/kg 3 minutes later,and group B received butorphanol 20 ?g/kg in advance and then sufentanil 0.2 ?g/kg 3 minutes later,and group C received butorphanol 30 ?g/kg in advance and then sufentanil 0.1 ?g/kg 3 minutes later.All patients were treated with etomidate 0.3 mg/kg 1 minute later(injection time 10-15 s).After two-minutes continuous observation,tracheal intubation was performed.The incidence of cough reaction and all levels of myoclonus were recorded and the value of mean arterial pressure(MAP)and heart rate(HR)was recorded at the following time points: before administration,immediately before tracheal intubation and immediately after tracheal intubation.The incidence of nausea and vomiting within 6 hours after operation were recorded.Results:1.The incidence of grade 1 muscle tremor in group A was 5.0%;The incidence of grade 1 muscle tremor in group B was 5.0%,and the incidence of grade 3 muscle tremor was 2.5%;The incidence of grade 1 muscle tremor in group C was 7.5%,and the incidence of grade 2 muscle tremor was 2.5%,the difference in the incidence of myoclonus among the three groups had no statistical significance(P>0.05).2.The incidence of cough reaction caused by sufentanil and the incidence of nausea and vomiting within six hours after operation had no statistical significance(P>0.05).3.There were no significant difference in HR and MAP among the three groups at T0 and T1.The HR at T2 in the group A was lower than group B and group C,the difference had statistical significance(P <0.05), and the MAP at T2 in group C was higher than group A,the difference had statistical significance(P <0.05).Conclusion:The three schemes of butorphanol combined with sufentanil had strong inhibitory effects on myoclonus induced by etomidate,and the inhibitory effect was the same.Sufentanil combined with butorphanol was more stable and safe for etomidate anesthesia induction.The combination of butorphanol 10 ug/kg with sufentanil 0.3 ug/kg scheme compared with the other two is a more suitable measurement to maintain hemodynamic stability of general anesthesia induction..