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External Cephalic Version: Is it an Effective and Safe Procedure?
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Etomidate versus propofol sedation for electrical external cardioversion: a meta-analysis.

Geun Joo Choi1, Hyun Kang1, Chong Wha Baek1

  • 1a Department of Anesthesiology and Pain Medicine , Chung-Ang University College of Medicine , Seoul , Republic of Korea.

Current Medical Research and Opinion
|September 4, 2018
PubMed
Summary

Etomidate and propofol show similar efficacy for electrical cardioversion. Propofol sedation increases hypotension and respiratory depression risk, while etomidate sedation is linked to higher myoclonus and nausea rates.

Keywords:
Electrical cardioversionEtomidateMeta-analysisPropofolSedation

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Area of Science:

  • Anesthesiology
  • Cardiology

Background:

  • Electrical cardioversion requires effective sedation for patient comfort and procedural success.
  • Etomidate and propofol are commonly used anesthetic agents for procedural sedation.
  • Comparing their safety and efficacy profiles is crucial for clinical decision-making.

Purpose of the Study:

  • To conduct a meta-analysis comparing the efficacy and safety of etomidate versus propofol for sedation during electrical cardioversion.
  • To evaluate key efficacy parameters such as induction/recovery time, success rate, and energy requirements.
  • To assess adverse events including respiratory and cardiovascular complications, myoclonus, and gastrointestinal disturbances.

Main Methods:

  • A systematic literature search was performed across multiple databases (MEDLINE, EMBASE, Cochrane, Google Scholar, etc.).
  • Randomized controlled trials (RCTs) comparing etomidate and propofol for cardioversion in adult patients were included.
  • Data on induction/recovery time, success rate, shock parameters, and adverse events were extracted and analyzed.

Main Results:

  • Nine RCTs involving 430 patients were analyzed; efficacy measures were comparable between etomidate and propofol.
  • Propofol sedation was associated with significantly higher rates of hypotension (RR=0.11, CI=0.02-0.74) and respiratory depression (RR=0.50, CI=0.32-0.77).
  • Etomidate sedation showed significantly higher incidences of myoclonus (RR=8.89, CI=4.59-17.23) and nausea/vomiting (RR=5.13, CI=1.72-15.31).

Conclusions:

  • Both etomidate and propofol demonstrate comparable efficacy for electrical cardioversion.
  • Propofol carries a higher risk of hypotension and respiratory depression, though positive pressure ventilation needs were similar.
  • Etomidate is associated with a greater likelihood of myoclonus and nausea or vomiting.