viernes, 28 de abril de 2017

Etomidato / Etomidate

Abril 24, 2017. No. 2669

Efecto del pretratamiento con midazolam sobre el mioclono inducido por etomidato. Meta-análisis
Effect of pretreatment with midazolam on etomidate-induced myoclonus: A meta-analysis.
Zhou C1,2, Zhu Y2, Liu Z1, Ruan L1.
J Int Med Res. 2017 Apr;45(2):399-406. doi: 10.1177/0300060516682882. Epub 2017 Feb 2.
Objective To investigate the effect of pretreatment with midazolam on myoclonus induced by etomidate injection. Methods A meta-analysis was performed using Review Manager software, version 5.2. Two researchers independently searched PubMed, Cochrane Library, and Embase® databases for randomized controlled trials involving patients who underwent etomidate induced general anaesthesia with or without midazolam pretreatment, published between 1990 and 2016. Outcome measures comprised overall myoclonus incidence rate and incidence rate classified by degree of myoclonus following etomidate injection. Data were assessed using a fixed effects model. Results Five studies, comprising 302 patients, were included for analysis. Overall incidence rate of etomidate injection-induced myoclonus was significantly lower in the pooled midazolam group versus controls (relative risk [RR] 0.34, 95% confidence interval [CI] 0.26, 0.44); Results subgrouped by degree of myoclonus showed significantly lower incidence in midazolam groups versus control groups for mild myoclonus (RR 0.56, 95% CI 0.39, 0.80); moderate myoclonus (RR 0.20, 95% CI 0.10, 0.41); and severe myoclonus (RR 0.12, 95% CI 0.04, 0.39). Conclusion Midazolam can effectively prevent etomidate-inducedmyoclonus, and alleviate the degree of etomidate-induced myoclonus.
KEYWORDS: Midazolam; etomidate; meta-analysis; myoclonus

Corticoides después de etomidato en pacientes graves. Estudio randomizado
Corticosteroid after etomidate in critically ill patients: a randomized controlled trial.
Payen JF, Dupuis C, Trouve-Buisson T et al. Crit Care Med 2012;40:29-35
In this prospective, single-centre, slightly underpowered, double-blind randomised controlled trial (RCT) with intention-to-treat analysis, use of moderate-dose hydrocortisone in etomidate-related adrenal insufficiency was not shown to reduce the proportion of patients with a cardiovascular Sequential Organ Failure Assessment (SOFA) score of 3 or 4.
Level of evidence: 2B (CEBM, low quality RCT)

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