Out on PubMed today is this study from Iran:

Comparison of Premedication with Low-Dose Midazolam Versus Etomidate for Reduction of Etomidate-Induced Myoclonus During General Anesthesia for Electroconvulsive Therapy: A Randomized Clinical Trial. Nazemroaya B, Mousavi SM.
Anesth Pain Med. 2019 Dec 23;9(6):e94388. doi: 10.5812/aapm.94388. eCollection 2019 Dec.
PMID: 32280614

The pdf is here.

Optimizing ECT anesthesia is a very important part of contemporary ECT practice. Etomidate is one of several induction agents commonly used in ECT. Its advantages include low anticonvulsant properties and good hemodynamics. It does cause myoclonus in a substantial proportion of patients soon after injection. It is not clear that this is a major problem, other than possibly being confused with seizure activity.
In this study, pretreatment with low-dose midazolam decreased the incidence and severity (there is a mistake in the abstract, contradicting this) of myoclonus. Seizure duration, not unexpectedly, was also decreased.
This intervention seems largely unnecessary and potentially deleterious to the quality of ECT.


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