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Abstract

Background: A steady cardiovascular profile and little respiratory depression are among its most noteworthy therapeutic characteristics. These characteristics make etomidateparticularly helpful in the management of anesthesia in patients with hemodynamic instability, such as those with shock, hypovolemia, or significant cardiac comorbidities. Because of this, etomidate is still often utilized in both emergency and elective surgical situations, particularly where preserving circulatory stability during induction is crucial. This study aims to fill this knowledge gap by evaluating the effectiveness of these pre-treatment strategies and providing information that will guide clinical practice, improve patient outcomes, and optimize perioperative care for this high-risk patient population.
Material and Methods:  This prospective, randomised, double-blind study was conducted on 90 surgical patients allocated to 45 in each group. Group A patients received intravenous (IV) fentanyl 2 μg/kg and 5 mL saline. Group B patients received IV fentanyl 2 μg/kg and midazolam 0.03 mg/kg. The study drugs were administered intravenously over 30 s. Five minutes after study drug administration; etomidate 0.3 mg kg−1 was administered over 60 s. Patients were observed for 1 min for occurrence and severity of EIM.
Results: The incidence of myoclonus was markedly lower in Group B (15.6%) versus Group A (48.9%), with a significant reduction in higher severity grades. Patients experiencing myoclonus showed elevated haemodynamic responses, including increased heart rate and blood pressure, emphasizing the clinical importance of preventing myoclonus during anesthesia induction.  
Conclusion: According to these findings, preparation with fentanyl-midazolam provides a more secure and safe induction method, enhancing patient outcomes in high-risk surgical situations.