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Drug Design, Development and Therapy 2023Remimazolam tosilate (RT) is a new ultrashort-acting γ-aminobutyric acid subtype A (GABA) agonist, with the characteristics of rapid onset and offset, minimal... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Remimazolam tosilate (RT) is a new ultrashort-acting γ-aminobutyric acid subtype A (GABA) agonist, with the characteristics of rapid onset and offset, minimal cardiorespiratory depression. Currently, few studies have compared the effect of RT and etomidate on hemodynamics during anesthesia induction. Here, we aimed to compare the hemodynamic effects of different doses of RT and etomidate for anesthesia induction in patients undergoing cardiac surgeries.
METHODS
Patients were recruited from January to September 2022 in this single-center, prospective, randomized, double-blind trial. A total of 117 patients undergoing selective valve replacement surgery were randomly divided into low-dose RT (0.2 mg/kg) group (group LR), high-dose RT (0.3 mg/kg) group (group HR), or etomidate (1.5 mg/kg) group (group E), respectively. The primary outcome was hemodynamic fluctuations (mean arterial pressure fluctuation value [∆MAP]; heart rate fluctuation value [∆HR]) during anesthesia induction. Secondary outcomes included the incidence of adverse drug reactions (injection pain and myoclonus) and adverse cardiovascular events, vital signs at different time points and the cumulative doses of vasoactive drugs.
RESULTS
The hemodynamic fluctuations (∆MAP) in group LR and group E were significantly lower than that in group HR. In addition, the incidence of hypotension and the cumulative norepinephrine doses in group E and group LR were also significantly lower than that in group HR. Furthermore, the incidence of injection pain and myoclonus in group LR and group HR were less frequently recorded compared with group E. There were no significant differences in terms of ∆HR, tachycardia, hypertension, severe bradycardia, vital signs at different time points, lactic acid and blood glucose between both groups.
CONCLUSION
Compared with etomidate, low-dose RT (0.2mg/kg) can not only provide stable hemodynamic parameters but also cause fewer adverse reactions when used for anesthesia induction in patients with cardiac disease.
Topics: Humans; Etomidate; Anesthetics, Intravenous; Myoclonus; Prospective Studies; Hemodynamics; Cardiac Surgical Procedures; Pain; Propofol
PubMed: 36789096
DOI: 10.2147/DDDT.S401969 -
Neurology India 2022
Topics: Humans; Myoclonus; Hypoxia, Brain
PubMed: 36352643
DOI: 10.4103/0028-3886.359171 -
Wiener Klinische Wochenschrift Sep 2021In addition to respiratory symptoms, many patients with coronavirus disease 2019 (COVID-19) present with neurological complications. Several case reports and small case...
BACKGROUND
In addition to respiratory symptoms, many patients with coronavirus disease 2019 (COVID-19) present with neurological complications. Several case reports and small case series described myoclonus in five patients suffering from the disease. The purpose of this article is to report on five critically ill patients with COVID-19-associated myoclonus.
MATERIAL AND METHODS
The clinical courses and test results of patients treated in the study center ICU and those of partner hospitals are described. Imaging, laboratory tests and electrophysiological test results are reviewed and discussed.
RESULTS
In severe cases of COVID-19 myoclonus can manifest about 3 weeks after initial onset of symptoms. Sedation is sometimes effective for symptom control but impedes respiratory weaning. No viral particles or structural lesions explaining this phenomenon were found in this cohort.
CONCLUSION
Myoclonus in patients with severe COVID-19 may be due to an inflammatory process, hypoxia or GABAergic impairment. Most patients received treatment with antiepileptic or anti-inflammatory agents and improved clinically.
Topics: COVID-19; Critical Illness; Humans; Intensive Care Units; Myoclonus; SARS-CoV-2
PubMed: 34129096
DOI: 10.1007/s00508-021-01890-3 -
Movement Disorders : Official Journal... Aug 2018The clinical demarcation of the syndrome progressive myoclonus ataxia is unclear, leading to a lack of recognition and difficult differentiation from other neurological...
BACKGROUND
The clinical demarcation of the syndrome progressive myoclonus ataxia is unclear, leading to a lack of recognition and difficult differentiation from other neurological syndromes.
OBJECTIVES
The objective of this study was to apply a refined definition of progressive myoclonus ataxia and describe the clinical characteristics in patients with progressive myoclonus ataxia and with isolated cortical myoclonus.
METHODS
A retro- and prospective analysis was performed in our tertiary referral center between 1994 and 2014. Inclusion criteria for progressive myoclonus ataxia patients were the presence of myoclonus and ataxia with or without infrequent (all types, treatment responsive) epileptic seizures. Inclusion criteria for isolated cortical myoclonus was the presence of isolated cortical myoclonus. Clinical and electrophysiological characteristics data were systematically scored.
RESULTS
A total of 14 progressive myoclonus ataxia patients (males, 7; females, 7), median age 14.5 years, and 8 isolated cortical myoclonus patients (males, 2; females, 6), median age 23.5 years, were identified. In 93% of the progressive myoclonus ataxia patients, ataxia started first (median 2 years) followed by myoclonus (4 years) and finally infrequent epilepsy (9.3 years), with a progressive course in 93%. In 64% of the progressive myoclonus ataxia patients, a genetic underlying etiology was identified, including 3 not earlier reported causative progressive myoclonus ataxia genes. In isolated cortical myoclonus patients, myoclonus started at (median) 12 years with progression over time in 63% and a single epileptic seizure in 1 patient. No genetic causes were identified.
CONCLUSION
Using a refined definition, we could create a rather homogenous progressive myoclonus ataxia group. Patients with isolated cortical myoclonus have a different course and do not appear to evolve in progressive myoclonus ataxia. The refined progressive myoclonus ataxia definition is a successful first step toward creating a separate syndrome for both clinical practice and future genetic research. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
Topics: Adolescent; Adult; Cerebellar Ataxia; Child; Cognitive Dysfunction; Cohort Studies; Disease Progression; Electrophysiology; Female; Humans; Male; Myoclonus; Myography; Young Adult
PubMed: 30145808
DOI: 10.1002/mds.27412 -
Anaesthesia Dec 2016
Topics: Female; Humans; Motor Cortex; Myoclonus; Reflex
PubMed: 27870185
DOI: 10.1111/anae.13725 -
BMJ Case Reports Jul 2021Postinfectious generalised myoclonus has been reported after many viral and bacterial infections in the past. Recently, some case reports have described it in the...
Postinfectious generalised myoclonus has been reported after many viral and bacterial infections in the past. Recently, some case reports have described it in the context of COVID-19 infection. Most patients described in these case reports are either critically ill and intubated or have concurrent respiratory symptoms. Herein, we present a case of a 79-year-old man, who was recovering from a recent COVID-19 infection, presented with isolated generalised myoclonus. The patient was treated with levetiracetam, a short course (10 days) of dexamethasone, and required extensive rehabilitation. Outpatient follow-up at 2 months suggested complete resolution of symptoms and levetiracetam was subsequently discontinued. This case highlights that generalised myoclonus can occur as a delayed complication of COVID-19 infection.
Topics: Aged; COVID-19; Humans; Levetiracetam; Male; Myoclonus; SARS-CoV-2
PubMed: 34301706
DOI: 10.1136/bcr-2021-243780 -
Neurology India 2022
Topics: Heart Arrest; Humans; Myoclonus; Syndrome
PubMed: 35263872
DOI: 10.4103/0028-3886.338676 -
The Primary Care Companion For CNS... Jun 2022
Topics: Antipsychotic Agents; Dose-Response Relationship, Drug; Humans; Myoclonus; Quetiapine Fumarate
PubMed: 35687883
DOI: 10.4088/PCC.21cr02907 -
Journal of Neurology, Neurosurgery, and... Oct 1981Two cases of spinal myoclonus are described; in both patients myoclonus was responsive to stimuli and absent during sleep. The first patient was considered to have viral...
Two cases of spinal myoclonus are described; in both patients myoclonus was responsive to stimuli and absent during sleep. The first patient was considered to have viral neuronitis and the condition resolved spontaneously. The second patient had spinal cord ischaemia; there was electro-physiological evidence of abnormal alpha motor neurone activity and histological study of the spinal cord revealed a severe reduction in small and intermediate neurones. This supports the theory that spinal myoclonus may result from abnormal activity of alpha motor neurones released from control by spinal internuncial neurones.
Topics: Adult; Aged; Cell Count; Electromyography; Female; Humans; Male; Myoclonus; Spinal Cord; Spinal Cord Diseases; Syndrome
PubMed: 7310406
DOI: 10.1136/jnnp.44.10.884 -
Journal of Neurology, Neurosurgery, and... Feb 1966
Topics: Adult; Electromyography; Facial Muscles; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Myoclonus
PubMed: 5910576
DOI: 10.1136/jnnp.29.1.35