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Etomidate versus propofol sedation for complex upper endoscopic procedures: a prospective double-blinded randomized
Mi Gang Kim1, Se Woo Park1, Jae Hyun Kim1
1Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Korea.
Gastrointestinal Endoscopy
|March 13, 2017
Summary
Etomidate sedation for endoscopic procedures showed fewer respiratory events and better efficacy than propofol. However, etomidate was linked to more myoclonus and higher blood pressure, impacting patient safety during sedation.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Gastroenterology
- Pharmacology
Background:
- Propofol-induced deep sedation is effective but frequently causes cardiopulmonary adverse events.
- Etomidate offers hemodynamic and respiratory stability, particularly beneficial for high-risk patients.
- Endoscopic procedures necessitate safe and effective sedation strategies.
Purpose of the Study:
- To compare the safety and efficacy of etomidate versus propofol for sedation during endoscopic retrograde cholangiopancreatography (ERCP) procedures.
- To evaluate cardiopulmonary adverse events, respiratory depression, and overall physician satisfaction between the two anesthetic agents.
Main Methods:
- A randomized, blinded study involving 128 patients undergoing endoscopic ultrasound (EUS).
- Patients were randomized to receive either etomidate or propofol for sedation, administered by a registered nurse.
- The primary outcome measured was the proportion of patients experiencing any cardiopulmonary adverse events.
Main Results:
- Overall cardiopulmonary adverse events did not differ significantly between etomidate and propofol groups (34.38% vs. 51.56%, P = .074).
- Etomidate demonstrated significantly lower incidence of oxygen desaturation (6.25% vs. 31.25%, P = .001) and respiratory depression (7.81% vs. 32.81%, P = .001).
- Myoclonus was more frequent with etomidate (34.37% vs. 12.50%, P = .012), and systolic blood pressure was higher in the etomidate group. Physician satisfaction was greater with etomidate.
Conclusions:
- Etomidate provides better sedative efficacy and fewer respiratory complications compared to propofol during endoscopic procedures.
- Etomidate use is associated with a higher incidence of myoclonus and elevated blood pressure.
- The choice between etomidate and propofol for endoscopic sedation requires balancing efficacy and safety profiles, considering potential adverse events.
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