Abstract

Propofol has been the most popular drug for induction of general anaesthesia for the past three decades due to its favourable pharmacokinetic and pharmacodynamic profile but its associated haemodynamic complications like bradycardia and hypotension are a matter of concern. On the other hand etomidate provides excellent cardio stabilityas an intra-venous induction agent but its association with myoclonusis undesirable among anaesthetists, many drugs have been tested for prevention of etomidate induced myoclonus with mixed results, keeping this background in mind we decided to test the effectiveness of 0.2mg/kg intravenous nalbuphine as a pre-treatment medication for myoclonus prevention caused by Etomidate. Aims: Primary objective of this study is to evaluate the efficacy of nalbuphine pretreatmentin prevention of etomidate induced myoclonus, Secondary objective of this study is toevaluate the safety profile of nalbuphine. Material and Methods: This prospective, randomized, double blind, placebo controlled study was conducted in a tertiary hospital associated with Index Medical College, 60consenting patients undergoing routine surgeries under general anaesthesia were randomly allocated to one of the two groups 10ml of normal saline was administered intravenously to group Iand 0.2mg/kg of nalbuphine in 10ml of normal saline was administered to group II intravenously, 150 seconds before injecting iv Etomidate 0.3mg/kg, administered over 20 seconds, patients were assessed for incidence and severity of myoclonus over next two minutes and side effects were observed for 24 hours, Students t test, chi square test were applied as required and a P value of <0.05 was considered statistically significant. Result: A statistically significant, decreased incidence as well as severity of myoclonus both during the 1 st and 2nd minuteswas observed with nalbuphine pretreatment compared with the control group (P < 0.005). Whereas the incidence of minor side effects like hypotension, bradycardia, sedation, nausea and vomitingwere observed to be similar in both groups. Conclusion: Both groups were similar with regards to demographic characteristics, the incidence (73.33% in group I vs. 20% in group II) and severity (1.23 at 1 minutes and 0.5 at 2 minutes in group I vs 0.17 at one minute and 0.23 at 2 minutes in group II), of myoclonus was significantly reduced in nalbuphine pre-treatment group compared to placebo group, without any significant increase in side effects

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