Comparative efficacy and safety of 20 intravenous pharmaceutical intervention for prevention of etomidate-induced myoclonus: a systematic review and Bayesian network meta-analysis.

Summary

Across 48 RCTs (n=4,768), granisetron and oxycodone ranked highest for preventing etomidate-induced myoclonus (OR≈0.01 vs placebo), including for moderate-to-severe events. Opioids overall had higher adverse event rates, though no severe AEs were reported. Sufentanil and remifentanil also performed well.

Key Findings

• 48 RCTs (n=4,768) compared 20 IV interventions plus saline/placebo.
• Granisetron (OR 0.01, 95% CI 0.00–0.06) and oxycodone (OR 0.01, 95% CI 0.00–0.05) most effectively reduced overall EIM; top SUCRA ranks (94.4% and 89.7%).
• Sufentanil (76.5% SUCRA) and remifentanil (74.8%) also ranked highly.
• Opioids increased adverse events compared with controls; no severe AEs reported.

Clinical Implications

Consider granisetron or oxycodone as leading options to reduce etomidate-induced myoclonus, balancing efficacy with the higher AE profile of opioids and individual patient risk.

Limitations

• Certainty graded moderate-to-low for top agents; heterogeneity in dosing and outcome definitions.
• Potential publication bias and limited head-to-head trials for some comparisons.

Future Directions

Head-to-head RCTs comparing granisetron vs leading opioids with standardized dosing and safety endpoints; cost-effectiveness and patient-centered outcomes.