Abstract：
Myoclonus is one of the main complications of etomidate anesthesia, which would develop into serious consequences during surgery. The present analysis was performed to evaluate systematically the effect of propofol on preventing etomidate-induced myoclonus in adult patients.
Systematic electronic literature search was performed in the databases PubMed, Cochrane Library, OVID, Wanfang and China National Knowledge Infrastructure (CNKI) from inception to May 20, 2021, without any language restrictions. All randomized controlled trials evaluating the efficacy of propofol on preventing etomidate-induced myoclonus were enrolled. The primary outcome included the incidence and degree of etomidate-induced myoclonus.
1,420 patients (with 602 received etomidate anesthesia and 818 received propofol plus etomidate anesthesia) from 13 studies were eventually included. Whatever the intravenous propofol dose for anesthesia induction 0.8-2 mg/kg (RR:4.04, 95% CI [2.42,6.74] p<0.0001, I2=56.5%), or the dose of propofol for anesthesia induction 0.5-0.8 mg/kg (RR:3.26, 95% CI [2.03,5.22] p<0.0001, I2=0%), or the dose of propofol for anesthesia induction 0.25-0.5mg/kg (RR:1.68, 95% CI [1.1,2.56] p=0.0160, I2=0%), combination of propofol and etomidate could significantly decrease the occurrence of etomidate-related myoclonus (RR=2.99, 95% CI [2.40, 3.71] p<0.0001, I2=43.4%), compared with etomidate alone. In addition, propofol plus etomidate attenuated the incidence of mild (RR:3.40, 95% CI [1.7,6.82] p=0.0010, I2=54.3%), moderate (RR:5.4, 95% CI [3.01, 9.67] p<0.0001, I2=12.6%), severe (RR:4.15, 95% CI [2.11, 8.13] p<0.0001, I2=0%) of etomidate-induced myoclonus without adverse effects except for the increased incidence of pain on injection (RR:0.47, 95% CI [0.26, 0.83] p=0.0100, I2=41.5%) compared with etomidate alone.
The meta-analysis currently generates the evidence of combination of propofol with the dosage of 0.25-2 mg/kg and etomidate can alleviate the occurrence and severity of etomidate-induced myoclonus, with decreased incidence of postoperative nausea and vomiting (PONV) and comparative side effects of hemodynamic and respiratory depression of patients in comparison with etomidate alone.
Systematic electronic literature search was performed in the databases PubMed, Cochrane Library, OVID, Wanfang and China National Knowledge Infrastructure (CNKI) from inception to May 20, 2021, without any language restrictions. All randomized controlled trials evaluating the efficacy of propofol on preventing etomidate-induced myoclonus were enrolled. The primary outcome included the incidence and degree of etomidate-induced myoclonus.
1,420 patients (with 602 received etomidate anesthesia and 818 received propofol plus etomidate anesthesia) from 13 studies were eventually included. Whatever the intravenous propofol dose for anesthesia induction 0.8-2 mg/kg (RR:4.04, 95% CI [2.42,6.74] p<0.0001, I2=56.5%), or the dose of propofol for anesthesia induction 0.5-0.8 mg/kg (RR:3.26, 95% CI [2.03,5.22] p<0.0001, I2=0%), or the dose of propofol for anesthesia induction 0.25-0.5mg/kg (RR:1.68, 95% CI [1.1,2.56] p=0.0160, I2=0%), combination of propofol and etomidate could significantly decrease the occurrence of etomidate-related myoclonus (RR=2.99, 95% CI [2.40, 3.71] p<0.0001, I2=43.4%), compared with etomidate alone. In addition, propofol plus etomidate attenuated the incidence of mild (RR:3.40, 95% CI [1.7,6.82] p=0.0010, I2=54.3%), moderate (RR:5.4, 95% CI [3.01, 9.67] p<0.0001, I2=12.6%), severe (RR:4.15, 95% CI [2.11, 8.13] p<0.0001, I2=0%) of etomidate-induced myoclonus without adverse effects except for the increased incidence of pain on injection (RR:0.47, 95% CI [0.26, 0.83] p=0.0100, I2=41.5%) compared with etomidate alone.
The meta-analysis currently generates the evidence of combination of propofol with the dosage of 0.25-2 mg/kg and etomidate can alleviate the occurrence and severity of etomidate-induced myoclonus, with decreased incidence of postoperative nausea and vomiting (PONV) and comparative side effects of hemodynamic and respiratory depression of patients in comparison with etomidate alone.
摘要：
目的：肌阵鸣是依托咪酯麻醉的主要并发症之一，在手术过程中会发展成严重的后果。进行本分析是为了系统地评估异丙酚预防成年患者依托咪酯诱导的肌阵鸣的效果。
方法：在PubMed，科克伦图书馆,OVID,万方和中国国家知识基础设施（CNKI）从成立到2021年5月20日，没有任何语言限制。所有随机对照试验均评价异丙酚预防依托咪酯诱导的肌阵鸣的疗效。主要结果包括依托咪酯诱导的肌阵鸣的发生率和程度。
结果：最终纳入13项研究的1,420例患者（602例接受依托咪酯麻醉，818例接受异丙酚加依托咪酯麻醉）。无论麻醉诱导的静脉丙泊酚剂量为0.8-2mg/kg（RR：4.04，95％CI[2.42,6.74]p<0.0001，I2=56.5％），或麻醉诱导的丙泊酚剂量0.5-0.8mg/kg（RR：3.26，95％CI[2.03,5.22]p<0.0001，I2=0％），或丙泊酚的麻醉诱导剂量0.25-0.5mg/kg（RR：1.68，95％CI[1.1,2.56]p=0.0160，I2=0％），异丙酚和依托咪酯的联合使用可以显着降低依托咪酯相关肌阵挛症的发生（RR=2.99，95％CI[2.40，3.71]p<0.0001，I2=43.4％），与单独使用依托咪酯相比。此外,异丙酚联合依托咪酯降低了轻度的发生率（RR：3.40，95％CI[1.7,6.82]p=0.0010，I2=54.3％），中等(RR：5.4，95%CI[3.01，9.67]p<0.0001，I2=12.6%)，严重(RR:4.15,95%CI[2.11,8.13]p<0.0001,I2=0%)的依托咪酯诱导的肌阵动,除注射时疼痛发生率增加外,无不良反应(RR:0.47,95%CI[0.26,0.83]p=0.0100,I2=41.5%).
结论：目前的荟萃分析得出的证据表明，丙泊酚的剂量为0.25-2mg/kg，依托咪酯的联合使用可以减轻依托咪酯引起的肌阵挛症的发生和严重程度，与单独使用依托咪酯相比，患者术后恶心和呕吐（PONV）的发生率降低，血流动力学和呼吸抑制的副作用也比较低。
方法：在PubMed，科克伦图书馆,OVID,万方和中国国家知识基础设施（CNKI）从成立到2021年5月20日，没有任何语言限制。所有随机对照试验均评价异丙酚预防依托咪酯诱导的肌阵鸣的疗效。主要结果包括依托咪酯诱导的肌阵鸣的发生率和程度。
结果：最终纳入13项研究的1,420例患者（602例接受依托咪酯麻醉，818例接受异丙酚加依托咪酯麻醉）。无论麻醉诱导的静脉丙泊酚剂量为0.8-2mg/kg（RR：4.04，95％CI[2.42,6.74]p<0.0001，I2=56.5％），或麻醉诱导的丙泊酚剂量0.5-0.8mg/kg（RR：3.26，95％CI[2.03,5.22]p<0.0001，I2=0％），或丙泊酚的麻醉诱导剂量0.25-0.5mg/kg（RR：1.68，95％CI[1.1,2.56]p=0.0160，I2=0％），异丙酚和依托咪酯的联合使用可以显着降低依托咪酯相关肌阵挛症的发生（RR=2.99，95％CI[2.40，3.71]p<0.0001，I2=43.4％），与单独使用依托咪酯相比。此外,异丙酚联合依托咪酯降低了轻度的发生率（RR：3.40，95％CI[1.7,6.82]p=0.0010，I2=54.3％），中等(RR：5.4，95%CI[3.01，9.67]p<0.0001，I2=12.6%)，严重(RR:4.15,95%CI[2.11,8.13]p<0.0001,I2=0%)的依托咪酯诱导的肌阵动,除注射时疼痛发生率增加外,无不良反应(RR:0.47,95%CI[0.26,0.83]p=0.0100,I2=41.5%).
结论：目前的荟萃分析得出的证据表明，丙泊酚的剂量为0.25-2mg/kg，依托咪酯的联合使用可以减轻依托咪酯引起的肌阵挛症的发生和严重程度，与单独使用依托咪酯相比，患者术后恶心和呕吐（PONV）的发生率降低，血流动力学和呼吸抑制的副作用也比较低。
