Pharmacological interventions for reducing the incidence of myoclonus in patients receiving etomidate for induction of general anesthesia: an umbrella review
The objective of this umbrella review was to examine various pharmacologic interventions for their potential to reduce etomidate-induced myoclonus. A secondary objective was to compare the relative effectiveness of those medications in reducing the incidence of myoclonus when etomidate is utilized f...
Saved in:
Published in | JBI evidence synthesis Vol. 22; no. 1; p. 66 |
---|---|
Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.01.2024
|
Subjects | |
Online Access | Get more information |
Cover
Loading…
Abstract | The objective of this umbrella review was to examine various pharmacologic interventions for their potential to reduce etomidate-induced myoclonus. A secondary objective was to compare the relative effectiveness of those medications in reducing the incidence of myoclonus when etomidate is utilized for the induction of general anesthesia.
Etomidate is the drug of choice when inducing general anesthesia in hemodynamically unstable patients. However, its use is limited among the general surgical population due to its ability to cause adrenal suppression, vomiting, and myoclonus. Myoclonus can lead to damage of muscle fibers, myalgias, and patient discomfort, and can also be detrimental in patients with low cardiac reserve. Several systematic reviews have reported on the effectiveness of various intravenous medications in reducing mild, moderate, and severe myoclonus; however, a more thorough examination of their influence was lacking.
This review included systematic reviews and meta-analyses of randomized controlled trials involving the use of pharmacologic interventions to reduce etomidate-induced myoclonus. Reviews in English and conducted after 1965 were considered for inclusion.
A comprehensive search of 11 databases was conducted to identify published and unpublished reviews up to March 2022. Critical appraisal was conducted by 2 independent reviewers using the standardized JBI appraisal tool. Quantitative findings were summarized according to the dose, timing of administration, and relative risk using a data matrix, and were synthesized in tabular format with supporting narrative text. Results were organized by severity of myoclonus (overall, mild, moderate, and severe) and by type of intervention.
Eight systematic reviews were included in this umbrella review, which included 48 relevant studies, after removal of duplicates (3909 participants included in the primary studies). Five of the systematic reviews examined the effectiveness of various types of opioids in the prevention of myoclonus, and 3 systematic reviews examined the effectiveness of non-opioid interventions, such as lidocaine, midazolam, and dexmedetomidine. Seven reviews searched at least 4 databases for pertinent studies and specifically indicated that blinded reviewers appraised the articles. All reviews used a published and validated appraisal instrument. The overall quality of all included reviews was judged to be moderate to high. The absolute risk reduction indicating the effectiveness of the prophylactic medications ranged from 47% to 81% for mild, 52% to 92% for moderate, and 61% to 96% for severe myoclonus. Opioids demonstrated the most consistent and substantial effect on the reduction in myoclonus.
All pharmacologic interventions identified in this review demonstrated a statistically significant reduction in the incidence of myoclonus. Future studies and reviews should focus on elucidating the particular dose range and timing that is most effective. Anesthesia providers should consider a pre-treatment dose of one of the medications described in this umbrella review as a means to reduce myoclonus and the untoward effects of that condition. |
---|---|
AbstractList | The objective of this umbrella review was to examine various pharmacologic interventions for their potential to reduce etomidate-induced myoclonus. A secondary objective was to compare the relative effectiveness of those medications in reducing the incidence of myoclonus when etomidate is utilized for the induction of general anesthesia.
Etomidate is the drug of choice when inducing general anesthesia in hemodynamically unstable patients. However, its use is limited among the general surgical population due to its ability to cause adrenal suppression, vomiting, and myoclonus. Myoclonus can lead to damage of muscle fibers, myalgias, and patient discomfort, and can also be detrimental in patients with low cardiac reserve. Several systematic reviews have reported on the effectiveness of various intravenous medications in reducing mild, moderate, and severe myoclonus; however, a more thorough examination of their influence was lacking.
This review included systematic reviews and meta-analyses of randomized controlled trials involving the use of pharmacologic interventions to reduce etomidate-induced myoclonus. Reviews in English and conducted after 1965 were considered for inclusion.
A comprehensive search of 11 databases was conducted to identify published and unpublished reviews up to March 2022. Critical appraisal was conducted by 2 independent reviewers using the standardized JBI appraisal tool. Quantitative findings were summarized according to the dose, timing of administration, and relative risk using a data matrix, and were synthesized in tabular format with supporting narrative text. Results were organized by severity of myoclonus (overall, mild, moderate, and severe) and by type of intervention.
Eight systematic reviews were included in this umbrella review, which included 48 relevant studies, after removal of duplicates (3909 participants included in the primary studies). Five of the systematic reviews examined the effectiveness of various types of opioids in the prevention of myoclonus, and 3 systematic reviews examined the effectiveness of non-opioid interventions, such as lidocaine, midazolam, and dexmedetomidine. Seven reviews searched at least 4 databases for pertinent studies and specifically indicated that blinded reviewers appraised the articles. All reviews used a published and validated appraisal instrument. The overall quality of all included reviews was judged to be moderate to high. The absolute risk reduction indicating the effectiveness of the prophylactic medications ranged from 47% to 81% for mild, 52% to 92% for moderate, and 61% to 96% for severe myoclonus. Opioids demonstrated the most consistent and substantial effect on the reduction in myoclonus.
All pharmacologic interventions identified in this review demonstrated a statistically significant reduction in the incidence of myoclonus. Future studies and reviews should focus on elucidating the particular dose range and timing that is most effective. Anesthesia providers should consider a pre-treatment dose of one of the medications described in this umbrella review as a means to reduce myoclonus and the untoward effects of that condition. |
Author | Crull, Allison Graves, Melissa Greenwood, Jennifer Ledvina, Michael |
Author_xml | – sequence: 1 givenname: Jennifer surname: Greenwood fullname: Greenwood, Jennifer organization: RFU Center for Interprofessional Evidence Based Practice: A JBI Centre of Excellence, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA – sequence: 2 givenname: Allison surname: Crull fullname: Crull, Allison organization: Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA – sequence: 3 givenname: Melissa surname: Graves fullname: Graves, Melissa organization: Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA – sequence: 4 givenname: Michael surname: Ledvina fullname: Ledvina, Michael organization: Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37560913$$D View this record in MEDLINE/PubMed |
BookMark | eNo1kE1OwzAQRi0EoqV0zQ75AgHbSWOHHVQFiiqBBKwr2xm3Rold2UlQD8NdcflZzWjme2-kOUPHzjtA6IKSK0opK66f7paL14yxjJC8IkdozEpRZSIXdISmMX4QQtiMUkGqUzTK-awkFc3H6OtlK0MrtW_8xmrZYOs6CAO4znoXsfEBB6h7bd0Gd1tIa21rcBqwN7jde91418c0xjvZ2YTFlNdghwMAnW9tLTv48ViXPAftAd2Ag5DOSQcxeaOVN6nHfasCNI1MksHC5zk6MbKJMP2rE_R-v3ibP2ar54fl_HaVaVbxLjO85tIYymY1FSWVQLhQioIuKqaIKkqeq4KRSrOc57zUjIORhShT3lCuCZugy1_vrlct1OtdsK0M-_X_n9g3805vaw |
CitedBy_id | crossref_primary_10_11124_JBIES_23_00543 |
ContentType | Journal Article |
Copyright | Copyright © 2023 JBI. |
Copyright_xml | – notice: Copyright © 2023 JBI. |
DBID | CGR CUY CVF ECM EIF NPM |
DOI | 10.11124/JBIES-22-00390 |
DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed |
DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) |
DatabaseTitleList | MEDLINE |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
DeliveryMethod | no_fulltext_linktorsrc |
EISSN | 2689-8381 |
ExternalDocumentID | 37560913 |
Genre | Journal Article Review |
GroupedDBID | .UL 0R~ 3T~ 53G AAAAV AAHPQ AAIQE AASCR ABASU ABDIG ABILE ABVCZ ACILI ACTHT ACXJB ADEGP ADGGA ADHPY ADTGS AFDTB AFYGQ AHQNM AHWXW AINUH AJEOO AJIOK AJNWD AJZMW ALMA_UNASSIGNED_HOLDINGS ALMTX AMJPA AMKUR AMNEI AOHHW C45 CGR CUY CVF DIWNM EBS ECM EEVPB EIF FCALG GNXGY GQDEL HLJTE HYJ IKREB IYOWL MMDCI MPPUT NPM OBZCC OGKNY OHCKH OKBHI OPUJH OUVZD OVD OVDLW OVDNE OXXIT RLZ TEORI TSPGW |
ID | FETCH-LOGICAL-c297t-f7d7aff125d1861ae078bb1ec492b0b4673b4209c237376c27efa48625df17c02 |
IngestDate | Wed Oct 23 10:15:16 EDT 2024 |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 1 |
Language | English |
License | Copyright © 2023 JBI. |
LinkModel | OpenURL |
MergedId | FETCHMERGED-LOGICAL-c297t-f7d7aff125d1861ae078bb1ec492b0b4673b4209c237376c27efa48625df17c02 |
PMID | 37560913 |
ParticipantIDs | pubmed_primary_37560913 |
PublicationCentury | 2000 |
PublicationDate | 2024-01-01 |
PublicationDateYYYYMMDD | 2024-01-01 |
PublicationDate_xml | – month: 01 year: 2024 text: 2024-01-01 day: 01 |
PublicationDecade | 2020 |
PublicationPlace | United States |
PublicationPlace_xml | – name: United States |
PublicationTitle | JBI evidence synthesis |
PublicationTitleAlternate | JBI Evid Synth |
PublicationYear | 2024 |
SSID | ssj0002511809 |
Score | 2.3040257 |
SecondaryResourceType | review_article |
Snippet | The objective of this umbrella review was to examine various pharmacologic interventions for their potential to reduce etomidate-induced myoclonus. A secondary... |
SourceID | pubmed |
SourceType | Index Database |
StartPage | 66 |
SubjectTerms | Anesthesia, General - adverse effects Etomidate - adverse effects Humans Incidence Lidocaine - adverse effects Myoclonus - chemically induced Myoclonus - epidemiology Myoclonus - prevention & control |
Title | Pharmacological interventions for reducing the incidence of myoclonus in patients receiving etomidate for induction of general anesthesia: an umbrella review |
URI | https://www.ncbi.nlm.nih.gov/pubmed/37560913 |
Volume | 22 |
hasFullText | |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1LbxMxELZSkFAvCMSrvOQDt2hh19msvdxaBCqIVhxaqbfKTxQpyVZtggT_hf_Dz-KzvXYeFARcVis7Hm08n8Yz43kQ8oKJRptGNeCAkkUtnCiEMk2ha-6EqVxbjn2-89Fxc3hafzgbnw0GP9ailpYL9VJ_uzav5H-4ijHw1WfJ_gNnM1EM4B38xRMcxvOvePxpVXc67PVkLYAx1FkYXvrKrCkjyrvVQwvRcKn-tdPTbr6MceSxuqq_QtB2EnwMdtHNJt4dEOjAco9lZv3Sz7FU9VBCTILu1ST094GgWM5gYANXfULMhuJ78H5o-w6mvkxCWJf1-Y3onxRwk69HLpfxbmR_OvWxT6tF8ksUckcWE1f5gPloDf6C3M4K6H0brF7zbdggA1kj2kKMYleXJLAZ-wWYUfrG_i3XHAqs9g2vD6BgF7C9fT5yuf5LbNLFLGBkxKEBtjE79s-zW1W609QO2eHCS9rj3mvkNYJgxpVtX1nKf86rzY_ZJbcSgS3zJqg5J3fI7d4-ofsRbHfJwM7vke9bQKMbQKMACE1Ao2AszUCjnaMZaBimCWg0A41moAU6GWh-aQ80ugLaa7zTBDMaYXafnL57e_LmsOj7ehSatXxROG64dA6qtalEU0kLNVWpyuq6ZapUOLpHqmZlq9mI4_zTjFsna5jeY-Mqrkv2gNyYd3P7iFAL6VJpOZbSV7rkXJRGWwcTv7TcwJTfIw_jbp5fxOIt52mfH_925gnZXWHxKbnpIC3sM6ieC_U88PUnOV-OAg |
link.rule.ids | 786 |
linkProvider | National Library of Medicine |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Pharmacological+interventions+for+reducing+the+incidence+of+myoclonus+in+patients+receiving+etomidate+for+induction+of+general+anesthesia%3A+an+umbrella+review&rft.jtitle=JBI+evidence+synthesis&rft.au=Greenwood%2C+Jennifer&rft.au=Crull%2C+Allison&rft.au=Graves%2C+Melissa&rft.au=Ledvina%2C+Michael&rft.date=2024-01-01&rft.eissn=2689-8381&rft.volume=22&rft.issue=1&rft.spage=66&rft_id=info:doi/10.11124%2FJBIES-22-00390&rft_id=info%3Apmid%2F37560913&rft_id=info%3Apmid%2F37560913&rft.externalDocID=37560913 |