Song Jin-Chao, Lu Zhi-Jie, Jiao Ying-Fu, Yang Bin, Gao Hao, Zhang Jinmin, Yu Wei-Feng
1. Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
2. Department of Anesthesiology, Shanghai first people's hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Int J Med Sci. 2015 Jul 3;12(7):559-65. doi: 10.7150/ijms.11521. eCollection 2015.
Propofol may result in hypotension and respiratory depression, while etomidate is considered to be a safe induction agent for haemodynamically unstable patients because of its low risk of hypotension. We hypothesized that etomidate anesthesia during ERCP caused more stable haemodynamic responses compared with propofol. The primary endpoint was to compare the haemodynamic effects of etomidate vs. propofol in ERCP cases. The secondary endpoint was overall survival.
A total of 80 patients undergoing ERCP were randomly assigned to an etomidate or propofol group. Patients in the etomidate group received etomidate induction and maintenance during ERCP, and patients in the propofol group received propofol induction and maintenance. Cardiovascular parameters and procedure-related time were measured and recorded during ERCP.
The average percent change to baseline in MBP was -8.4±7.8 and -14.4±9.4 with P = 0.002, and in HR was 1.8±16.6 and 2.4±16.3 with P = 0.874 in the etomidate group and the propofol group, respectively. MBP values in the etomidate group decreased significantly less than those in the propofol group (P<0.05). The ERCP duration and recovery time in both groups was similar. There was no significant difference in the survival rates between groups ( p = 0.942).
Etomidate anesthesia during ERCP caused more stable haemodynamic responses compared with propofol.
丙泊酚可能导致低血压和呼吸抑制,而依托咪酯因低血压风险低,被认为是血流动力学不稳定患者的安全诱导药物。我们假设在ERCP期间,依托咪酯麻醉比丙泊酚能引起更稳定的血流动力学反应。主要终点是比较依托咪酯与丙泊酚在ERCP病例中的血流动力学效应。次要终点是总体生存率。
共有80例接受ERCP的患者被随机分配到依托咪酯组或丙泊酚组。依托咪酯组患者在ERCP期间接受依托咪酯诱导和维持,丙泊酚组患者接受丙泊酚诱导和维持。在ERCP期间测量并记录心血管参数和与手术相关的时间。
依托咪酯组和丙泊酚组平均动脉压(MBP)相对于基线的变化百分比分别为-8.4±7.8和-14.4±9.4,P = 0.002;心率(HR)变化分别为1.8±16.6和2.4±16.3,P = 0.874。依托咪酯组的MBP值下降明显少于丙泊酚组(P<0.05)。两组的ERCP持续时间和恢复时间相似。两组之间的生存率无显著差异(p = 0.942)。
与丙泊酚相比,ERCP期间依托咪酯麻醉引起的血流动力学反应更稳定。