The comparison of the effect of pretreatment with low dose of midazolam, low dose of etomidate, remifentanyl and sulfate magnesium on reduction or prevention of myoclonus after etomidate induction in orthopedic surgery

The purpose of this study is comparison of the effect of pretreatment with low dose of Midazolam, low dose of Etomidate, Remifentanyl, and Magnesium sulphate on reduction or prevention of Myoclonous (Some type of jerky movement of muscle) after Etomidate induction in orthopedic surgery. Inclusion criteria: ASA ( American Society of Anesthesiologists) I, II; age between 18 to 59 years old. Exclusion criteria: patients with Neurological problems; allergy; those who have received sedative or analgesic drugs in the 24 hours ago. Patients in randomized blocks are divided into four groups: Midazolam (M) 0.015 mg/kg (M.S) 30 mg/kg, Magnesium sulphate3 Remifentanyl (R)1 micg/kg Etomidate 0.03 mg/kg (E) intravenously. All drugs are injected intravenously. In the operation room, patients are monitored for standard electrocardiography, heart rate, pulse oximetry and non-invasive blood pressure. Induction of the anesthesia is the same way in all groups by using of 0.3 mg/kg etomidate intravenously After etomidate injection for 90 seconds, the presence and severity of myoclonus is checked. Assessment of myoclonus after injection of Etomidate is performed by another anesthesiologist who is blinded to the study procedure. Myoclonus is divided to 4 grades: 0: without myoclonus; 1: movement just in wrist; 2: movement in arm, elbow and shoulder and 3: movement in whole of the body.

Guilan University of Medical Sciences