Etomidate Versus Propofol for Monitored Anesthesia Care During Endoscopic Retrograde Cholangiopancreatography: A Prospective Randomized Controlled Trial.
endoscopy ercp
etomidate
haemodynamic parameters
intravenous sedation
monitored anaesthesia care
propofol based sedation
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
accepted:
08
08
2023
medline:
11
9
2023
pubmed:
11
9
2023
entrez:
11
9
2023
Statut:
epublish
Résumé
Background and objectives Propofol-based sedation is one of the most commonly used methods for endoscopic retrograde cholangiopancreatography (ERCP). The commonest complications during ERCP are in the form of adverse cardiopulmonary events as a result of sedation. Etomidate has a more stable cardiovascular and respiratory profile than propofol and has been used for sedation in simple gastrointestinal endoscopy but has not been studied for procedural sedation in ERCP. The objective of the present study was to compare the safety and feasibility of etomidate and propofol for sedation during ERCP procedures. Methods This single-center, randomized trial included 100 American Society of Anesthesiologists (ASA) physical status class I to II patients who were scheduled for ERCP. All patients received midazolam 0.02 mg/kg, lignocaine (2%) 1 mg/kg, and fentanyl 1 µg/kg intravenously, followed by etomidate or propofol according to the group allocation. The primary outcome was to compare the mean arterial pressure (MAP) at various timepoints between the two groups and secondary outcomes were to compare oxygen saturation, induction and recovery times, and adverse events. Transient hypotension was defined as any decrease in MAP below 60 mmHg or 20% below the baseline. Transient hypoxia was defined as desaturation (saturation of peripheral oxygen (SpO2) <92%) lasting for more than 10 seconds requiring airway intervention. Results Fifty patients were enrolled in each group (Group E: etomidate and Group P: propofol). Transient hypotension occurred in eight (16%) patients in Group P, and two (4%) patients in Group E (P= 0.045). Baseline MAP was comparable between the two groups but was significantly lower in Group P at three timepoints during the study. Nine (18 %) patients in Group P had a transient hypoxic episode, compared to none in Group E (p= 0.006). The induction and recovery times were similar in the two groups. Conclusions Etomidate offers better hemodynamic and respiratory stability than propofol and can be recommended for use during ERCP in ASA I/II patients.
Identifiants
pubmed: 37692744
doi: 10.7759/cureus.43178
pmc: PMC10485560
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e43178Informations de copyright
Copyright © 2023, Dhingra et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Gastrointest Endosc. 2018 Jan;87(1):174-184
pubmed: 28610897
Surg Laparosc Endosc Percutan Tech. 2017 Feb;27(1):1-7
pubmed: 28079763
Anaesthesia. 1999 Sep;54(9):861-7
pubmed: 10460557
Anesth Analg. 1993 Nov;77(5):1008-11
pubmed: 8214699
World J Gastrointest Endosc. 2011 Feb 16;3(2):34-9
pubmed: 21403815
Biomed J. 2016 Apr;39(2):145-9
pubmed: 27372170
Anesth Pain Med. 2016 Apr 02;6(2):e35333
pubmed: 27247915
Anesthesiology. 1992 May;76(5):725-33
pubmed: 1575340
J Cardiothorac Vasc Anesth. 1998 Apr;12(2):182-5
pubmed: 9583551
PLoS One. 2013;8(1):e53311
pubmed: 23308191
Diagn Ther Endosc. 2012;2012:639190
pubmed: 22272061
Clin Gastroenterol Hepatol. 2010 Feb;8(2):137-42
pubmed: 19607937
Anesthesiology. 2011 Mar;114(3):695-707
pubmed: 21263301
Clin Pharmacokinet. 2021 Oct;60(10):1253-1269
pubmed: 34060021
PLoS One. 2015 Sep 24;10(9):e0138422
pubmed: 26402319
Int J Med Sci. 2015 Jul 03;12(7):559-65
pubmed: 26180512
Cochrane Database Syst Rev. 2012 Jun 13;(6):CD007274
pubmed: 22696368
Indian J Pharmacol. 2016 Nov-Dec;48(6):617-623
pubmed: 28066096
J Anesth. 2010 Apr;24(2):300-2
pubmed: 20108006
Anaesth Intensive Care. 2003 Feb;31(1):18-20
pubmed: 12635389
Gastrointest Endosc. 2016 May;83(5):928-33
pubmed: 26364968
Gastrointest Endosc. 2017 Sep;86(3):452-461
pubmed: 28284883