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Safety and Efficacy of Etomidate And Washington University School of Medicine Digital Commons@Becker Open Access Publications 2016 Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study Qing-Tao Meng Wuhan University Chen Cao The Third Hospital of Wuhan Hui-Min Liu Wuhan University Zhong-Yuan Xia Wuhan University Wei Li Wuhan University See next page for additional authors Follow this and additional works at: https://digitalcommons.wustl.edu/open_access_pubs Recommended Citation Meng, Qing-Tao; Cao, Chen; Liu, Hui-Min; Xia, Zhong-Yuan; Li, Wei; Tang, Ling-Hua; Chen, Rong; Jiang, Meng; Wu, Yang; Leng, Yan; and Lee, Chris C., ,"Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study." Experimental and Therapeutic Medicine.12,3. 1515-1524. (2016). https://digitalcommons.wustl.edu/open_access_pubs/5193 This Open Access Publication is brought to you for free and open access by Digital Commons@Becker. It has been accepted for inclusion in Open Access Publications by an authorized administrator of Digital Commons@Becker. For more information, please contact [email protected]. Authors Qing-Tao Meng, Chen Cao, Hui-Min Liu, Zhong-Yuan Xia, Wei Li, Ling-Hua Tang, Rong Chen, Meng Jiang, Yang Wu, Yan Leng, and Chris C. Lee This open access publication is available at Digital Commons@Becker: https://digitalcommons.wustl.edu/open_access_pubs/5193 EXPERIMENTAL AND THERAPEUTIC MEDICINE 12: 1515-1524, 2016 Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double‑blind randomized clinical study QING-TAO MENG1*, CHEN CAO2*, HUI-MIN LIU1*, ZHONG-YUAN XIA1, WEI LI1, LING-HUA TANG1, RONG CHEN1, MENG JIANG1, YANG WU1, YAN LENG1 and CHRIS C. LEE3 1Department of Anesthesiology, Renmin Hospital of Wuhan University; 2The Medical Department, The Third Hospital of Wuhan, Wuhan, Hubei 430060, P.R. China; 3Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA Received January 30, 2016; Accepted June 6, 2016 DOI: 10.3892/etm.2016.3475 Abstract. The aim of the present study is to compare the (P>0.05). The present study demonstrates that anesthesia for safety, efficacy and cost effectiveness of anesthetic regimens gastroscopy in elderly patients can be safely and effectively by compound, using etomidate and propofol in elderly patients accomplished using a drug regimen that combines propofol undergoing gastroscopy. A total of 200 volunteers (65‑79 years with etomidate. The combined use of propofol and etomidate of age) scheduled for gastroscopy under anesthesia were has unique characteristics which improve hemodynamic randomly divided into the following groups: P, propofol stability, cause minimal respiratory depression and less side (1.5‑2.0 mg/kg); E, etomidate (0.15‑0.2 mg/kg); P+E, propofol effects, provide rapid return to full activity and result in high (0.75‑1 mg/kg) followed by etomidate (0.075‑0.1 mg/kg); levels of satisfaction. and E+P, etomidate (0.075‑0.01 mg/kg) followed by propofol (0.75‑1 mg/kg). Vital signs and bispectral index were moni- Introduction tored at different time points. Complications, induction and examination time, anesthesia duration, and recovery and Gastroscopy is a well‑established, highly effective diagnostic discharge time were recorded. At the end of the procedure, and therapeutic procedure. The frequency of this procedure the satisfaction of patients, endoscopists and the anesthetist in the elderly is increasing rapidly as the general population were evaluated. The recovery (6.1±1.2 h) and discharge times ages (1,2). Although it is a non‑traumatic invasive proce- (24.8±2.8 h) in group E were significantly longer compared dure, it often causes significant discomfort in the majority with groups P, P+E and E+P (P<0.05). The occurrence of of patients. With the collaboration of the anesthesia and injection pain in group P+E was significantly higher compared digestive system departments, gastroscopy under anesthesia with the other three groups (P<0.05). In addition, the incidence minimizes the risk of physical injury occurring during of myoclonus and post‑operative nausea and vomiting were examination, and provides the endoscopist with a suitable significantly higher in group P+E compared with the other environment for a thorough examination. This has been three groups (P<0.05). There was no statistical difference reported to be safe in high risk patients, including elderly, among the four groups with regards to the patients' immediate, frail and seriously ill patients (3,4). Despite the benefits of post‑procedure satisfaction (P>0.05). Furthermore, there was using anesthesia for gastroscopy, it has significant draw- no difference in the satisfaction of anesthesia, as evaluated backs. Anesthesia can delay patient recovery and discharge by the anesthetist and endoscopist, among the four groups time, and increases the risk of cardiopulmonary complica- tions, which are understood to account for ~50% mortality and ~60% morbidity associated with upper gastrointestinal endoscopy (5,6). This risk is increased in elderly patients or those with cardiovascular diseases and upper gastrointestinal Correspondence to: Professor Zhong‑Yuan Xia, Department bleeding (7). Arterial hypoxemia, arrhythmias and myocar- of Anesthesiology, Renmin Hospital of Wuhan University, dial ischemia have been reported following gastroscopy with 238 Jiefang Road, Wuhan, Hubei 430060, P.R. China E‑mail: [email protected] anesthesia (7). Anesthesia strategies for gastroscopy have been explored *Contributed equally for decades. There are numerous reports on the safety profile of propofol used for anesthesia during gastrointestinal Key words: anesthesia, gastroscopy, elderly patients, etomidate, endoscopy (8‑10). Propofol is currently the most frequently propofol used intravenous anesthetic, due to its rapid recovery profile, and is widely used in outpatient surgeries and examina- tions (4,10). The most prominent undesirable effect of propofol 1516 MENG et al: ETOMIDATE AND PROPOFOL USE IN ELDERLY GASTROSCOPY is its marked depression on cardiovascular and respiratory (Baxter International Inc., Deerfield, IL, USA) was infused, parameters, particularly in elderly patients (9‑10). The and routine monitoring consisting of a 5‑lead electrocardi- distinct pharmacological characteristics of etomidate include ography (ECG), non‑invasive blood pressure, pulse oxygen improved hemodynamic stability and minimal respiratory saturation (SpO2) and bispectral index (BIS; Monitor Model depression (11). This results in a wider margin of safety for A‑2000; Aspect Medical Systems, Inc., Norwood, MA, USA). patients with significant risk factors, including patients with The mean of the final 3 vital signs obtained prior to the injec- valvular heart disease and myocardial ischemia, and elderly tion of anesthetics was recorded as the baseline in all patients. patients. However, due to side effects, including myoclonus After lying on the examination table in the left lateral posi- and post‑operative nausea and vomiting (PONV), etomidate is tion, each patient was provided oxygen (5 l/min) via a face rarely used in patients undergoing gastroscopy. mask and instructed to take deep breathes to increase their The aim of the present prospective study is to determine oxygen reserves. the safety, efficacy, cost effectiveness, side effect profile and All patients received intravenous (i.v.) 1 µg/kg fentanyl recovery time of a combination of propofol and etomidate, at 5‑10 sec prior to gastroscopy. Prior to endoscopy, compared with propofol and etomidate alone, as anesthetic patients were randomized to one of four groups using a regimens for gastroscopy. computer‑generated random numbers table, which allocated 50 patients to each group. Patients in the propofol group (P) Materials and methods received i.v. propofol at an induction dose of 1.5‑2.0 mg. kg-1 over a 1 min period using a computer controlled infu- Patients and study design. The current study is a double‑blinded, sion pump (Syringe Infusion Pump Model compact; B. randomized, parallel‑group study, performed in accordance Braun Melsungen AG, Melsungen, Germany), followed by a with the International Conference on Harmonization Good maintenance infusion of 4 mg.kg-1.h-1 during the gastroscopy Clinical Practice guidelines (8). The study was approved by the procedure. Patients in the etomidate group (E) received i.v. Ethics Committee of Renmin Hospital of Wuhan University etomidate at an induction dose of 0.15‑0.2 mg/kg over 1 min (Wuhan, China), and informed consent was obtained from using the same infusion pump, followed by a maintenance all patients. A total of 200 healthy, American Society of infusion of 0.4 µg.kg-1.h-1 during the gastroscopy procedure. Anesthesiologists grade I‑II patients, consisting of 97 males Patients in the propofol and etomidate group (P+E) received and 103 females, aged between 65 and 79 years, who were propofol (0.75‑1 mg/kg) over a 30 sec period and subse- scheduled for gastroscopy with anesthesia, were included in the quently etomidate (0.075‑0.1 mg/kg) over a 30 sec period study. Patients had normal serum chemistry, and normal liver using the same infusion pump, followed by a maintenance and renal function test results. No patients were experiencing infusion of 2 mg.kg-1.h-1 propofol and 0.2 µg.kg-1.h-1 etomi- cardiac or respiratory disease. Exclusion criteria included
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