{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:22:49Z","timestamp":1787840569702,"version":"build-2784847793"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Etomidate is the preferred induction agent in haemodynamically unstable patients. Preventing etomidate-induced myoclonus (EIM) is important. The objective of this study was to compare the efficacy of three techniques of etomidate administration in preventing EIM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This randomised, controlled study included 296 patients. General anaesthesia (GA) was induced with etomidate as per the randomly allocated groups: control (C), priming (P), slow (S), and priming with slow injection (T). The incidence, time of onset, and grade of myoclonus were noted. The grade of pain on injection and the effect on various haemodynamic parameters were noted. The Kruskal-Wallis, Fisher\u2019s exact, and Chi-square tests were used for statistical analysis.\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05 was considered to be statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The study shows that the incidence of myoclonus was highest amongst Group C (73.0%), followed by Group P (52.7%), Group S (48.6%), and Group T (37.8%) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001). Priming with a slow technique was most effective in preventing EIM and lowering the intensity of myoclonus. The incidence of grade 3 myoclonus was 5 (6.76%) in Group T when compared to 39 (52.7%) in Group C (mean difference [MD] =36.96, 95% CI: 7.45, 55.94;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>We observed that the priming and slow injection techniques were similar in reducing the incidence of EIM. However, the combination of priming and slow technique was the most effective.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ija.ija_948_24","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T08:00:30Z","timestamp":1739779230000},"page":"282-288","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["To compare the efficacy of three techniques in reducing etomidate-induced myoclonus - A randomised controlled trial"],"prefix":"10.4103","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5049-1475","authenticated-orcid":false,"given":"Ridhi","family":"Rao","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6311-3446","authenticated-orcid":false,"given":"Geetha","family":"Rajappa","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Ramaiah Medical College and Hospitals, New BEL Road, MSRIT Post, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7791-7664","authenticated-orcid":false,"given":"B K","family":"Sandhya","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Ramaiah Medical College and Hospitals, New BEL Road, MSRIT Post, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8206-1578","authenticated-orcid":false,"given":"H S","family":"Srinidhi","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Ramaiah Medical College and Hospitals, New BEL Road, MSRIT Post, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9689-0266","authenticated-orcid":false,"given":"Teja","family":"Pagadala","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Ramaiah Medical College and Hospitals, New BEL Road, MSRIT Post, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3269-9475","authenticated-orcid":false,"given":"S","family":"Likitha","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Ramaiah Medical College and Hospitals, New BEL Road, MSRIT Post, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"key":"R1-20250217","doi-asserted-by":"crossref","first-page":"460","DOI":"10.4103\/1687-7934.139597","article-title":"Efficacy of lignocaine versus midazolam in controlling etomidate-induced myoclonus: A randomized placebo-controlled study","volume":"7","author":"Singh","year":"2014","journal-title":"Ain-Shams J Anaesthesiol"},{"key":"R2-20250217","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1136\/emj.2008.067801","article-title":"Rapid sequence induction in the emergency department: Induction drug and outcome of patients admitted to the intensive care unit","volume":"26","author":"Baird","year":"2009","journal-title":"Emerg Med J"},{"key":"R3-20250217","doi-asserted-by":"crossref","first-page":"e35333","DOI":"10.5812\/aapm.35333","article-title":"Comparison of the effects of low-dose midazolam, magnesium sulfate, remifentanil and low-dose etomidate on prevention of etomidate-induced myoclonus in orthopedic surgeries","volume":"6","author":"Sedighinejad","year":"2016","journal-title":"Anesth Pain Med"},{"key":"R4-20250217","doi-asserted-by":"crossref","first-page":"305","DOI":"10.4097\/kja.d.18.27168","article-title":"Comparison of priming versus slow injection for reducing etomidate-induced myoclonus: A randomized controlled study","volume":"71","author":"Mullick","year":"2018","journal-title":"Korean J Anesthesiol"},{"key":"R5-20250217","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1017\/S1481803500014044","article-title":"Etomidate for rapid sequence intubation in the emergency department: Is adrenal suppression a concern?","volume":"8","author":"Zed","year":"2006","journal-title":"CJEM"},{"key":"R6-20250217","first-page":"13","article-title":"Overview, history, and classification of myoclonus","volume":"89","author":"Fahn","year":"2002","journal-title":"Adv Neurol"},{"key":"R7-20250217","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1177\/147323000803600103","article-title":"A comparison of midazolam with remifentanil for the prevention of myoclonic movements following etomidate injection","volume":"36","author":"Hwang","year":"2008","journal-title":"J Int Med Res"},{"key":"R8-20250217","doi-asserted-by":"crossref","first-page":"305","DOI":"10.4097\/kjae.2008.55.3.305","article-title":"The effect of injection rate on etomidate-induced myoclonus","volume":"55","author":"Do","year":"2008","journal-title":"Korean J Anesthesiol"},{"key":"R9-20250217","doi-asserted-by":"crossref","first-page":"262","DOI":"10.12659\/MSM.889833","article-title":"Prevention of etomidate-induced myoclonus: Which is superior: Fentanyl, midazolam, or a combination? A Retrospective comparative study","volume":"20","author":"Isitemiz","year":"2014","journal-title":"Med Sci Monit"},{"key":"R10-20250217","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1213\/00000539-198908000-00022","article-title":"Etomidate myoclonus and the open globe","volume":"69","author":"Berry","year":"1989","journal-title":"Anesth Analg"},{"key":"R11-20250217","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.annfar.2006.07.079","article-title":"Prevention of myoclonus after etomidate using a priming dose","volume":"25","author":"Aissaoui","year":"2006","journal-title":"Ann Fr Anesth Reanim"},{"key":"R12-20250217","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/00000542-199901000-00017","article-title":"Reducing myoclonus after etomidate","volume":"90","author":"Doenicke","year":"1999","journal-title":"Anesthesiology"},{"key":"R13-20250217","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1093\/bja\/48.3.199","article-title":"Effect of dose and premedication on induction complications with etomidate","volume":"48","author":"Holdcroft","year":"1976","journal-title":"Br J Anaesth"},{"key":"R14-20250217","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1177\/0310057X0303100103","article-title":"Midazolam pretreatment reduces etomidate-induced myoclonic movements","volume":"31","author":"Schwarzkopf","year":"2003","journal-title":"Anaesth Intensive Care"},{"key":"R15-20250217","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1590\/1414-431x20144100","article-title":"Prevention of etomidate-induced myoclonus during anesthetic induction by pretreatment with dexmedetomidine","volume":"48","author":"Luan","year":"2015","journal-title":"Braz J Med Biol Res"},{"key":"R16-20250217","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1213\/00000539-199411000-00020","article-title":"A comparison of two formulations for etomidate, 2-hydroxypropyl-beta-cyclodextrin (HPCD) and propylene glycol","volume":"79","author":"Doenicke","year":"1994","journal-title":"Anesth Analg"},{"key":"R17-20250217","first-page":"357","article-title":"Cerebral function under etomidate, a new non-barbiturate IV hypnotic (author\u2019s transl)","volume":"22","author":"Doenicke","year":"1973","journal-title":"Anaesthesist"},{"key":"R19-20250217","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1002\/j.1875-9114.1983.tb03266.x","article-title":"Etomidate: A new intravenous anesthetic induction agent","volume":"3","author":"Giese","year":"1983","journal-title":"Pharmacotherapy"},{"key":"R20-20250217","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1093\/bja\/83.3.464","article-title":"Solvent for etomidate may cause pain and adverse effects","volume":"83","author":"Doenicke","year":"1999","journal-title":"Br J Anaesth"},{"key":"R21-20250217","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1093\/bja\/ael187","article-title":"Etomidate-Lipuro is associated with considerably less injection pain in children compared with propofol with added lidocaine","volume":"97","author":"Nyman","year":"2006","journal-title":"Br J Anaesth"},{"key":"R22-20250217","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1053\/j.jvca.2010.02.005","article-title":"Hemodynamic responses to etomidate in pediatric patients with congenital cardiac shunt lesions","volume":"24","author":"Dhawan","year":"2010","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R23-20250217","first-page":"51","article-title":"Hemodynamic stability during induction of anesthesia in elderly patients: Propofol+ketamine versus propofol+etomidate","volume":"5","author":"Hosseinzadeh","year":"2013","journal-title":"J Cardiovasc Thorac Res"},{"key":"R24-20250217","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1213\/01.ane.0000166764.99863.b4","article-title":"Hemodynamic responses to etomidate on induction of anesthesia in pediatric patients","volume":"101","author":"Sarkar","year":"2005","journal-title":"Anesth Analg"},{"key":"R25-20250217","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.bjan.2016.02.010","article-title":"A comparative study between propofol and etomidate in patients under general anesthesia","volume":"66","author":"Aggarwal","year":"2016","journal-title":"Rev Bras Anestesiol"},{"key":"R26-20250217","doi-asserted-by":"crossref","first-page":"180","DOI":"10.4103\/0970-9185.155145","article-title":"Comparison of hemodynamic effects of intravenous etomidate versus propofol during induction and intubation using entropy guided hypnosis levels","volume":"31","author":"Shah","year":"2015","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R27-20250217","first-page":"109","article-title":"Hemodynamic changes following anesthesia induction and LMA insertion with propofol, etomidate, and propofol+etomidate","volume":"5","author":"Hosseinzadeh","year":"2013","journal-title":"J Cardiovasc Thorac Res"},{"key":"R29-20250217","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1097\/00003643-200010000-00007","article-title":"Does etomidate increase postoperative nausea? A double-blind controlled comparison of etomidate in lipid emulsion with propofol for balanced anaesthesia","volume":"17","author":"St","year":"2000","journal-title":"Eur J Anaesthesiol"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_948_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:25:15Z","timestamp":1787837115000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_948_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,17]]},"references-count":27,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_948_24","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,17]]},"assertion":[{"value":"2024-09-16","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-28","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}