Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Korea.
Gastrointest Endosc. 2017 Sep;86(3):452-461. doi: 10.1016/j.gie.2017.02.033. Epub 2017 Mar 8.
Although a growing body of evidence demonstrates that propofol-induced deep sedation can be effective and performed safely, cardiopulmonary adverse events have been observed frequently. Etomidate is a new emerging drug that provides hemodynamic and respiratory stability, even in high-risk patient groups. The objective of this study was to compare safety and efficacy profiles of etomidate and propofol for endoscopic sedation.
A total of 128 patients undergoing EUS were randomized to receive either etomidate or propofol blinded administered by a registered nurse. The primary outcome was the proportion of patients with any cardiopulmonary adverse events.
Overall cardiopulmonary adverse events were identified in 22 patients (34.38%) of the etomidate group and 33 patients (51.56%) of the propofol group, without significant difference (P = .074). However, the incidence of oxygen desaturation (4/64 [6.25%] vs 20/64 [31.25%]; P =.001) and respiratory depression (5/64 [7.81%] vs 21/64 [32.81%]; P =.001) was significantly lower in the etomidate group than in the propofol group. The frequency of myoclonus was significantly higher in the etomidate group (22/64 [34.37%]) compared with the propofol group (8/64 [12.50%]) (P =.012). Repeated measure analysis of variance revealed significant effects of sedation group and time on systolic blood pressure (etomidate group greater than propofol group). Physician satisfaction was greater in the etomidate group than in the propofol group.
Etomidate administration resulted in fewer respiratory depression events and had a better sedative efficacy than propofol; however, it was more frequently associated with myoclonus and increased blood pressure during endoscopic procedures. (Clinical trial registration number: KCT0001701.).
虽然越来越多的证据表明异丙酚诱导的深度镇静可以有效且安全地进行，但经常观察到心肺不良事件。依托咪酯是一种新出现的药物，即使在高危患者群体中，也能提供血流动力学和呼吸稳定性。本研究的目的是比较依托咪酯和丙泊酚用于内镜镇静的安全性和疗效。
总共 128 名接受 EUS 的患者被随机分为接受依托咪酯或丙泊酚镇静的组，由注册护士进行盲法给药。主要结局是任何心肺不良事件的患者比例。
依托咪酯组有 22 名（34.38%）患者和丙泊酚组有 33 名（51.56%）患者出现心肺不良事件，但无显著差异（P=.074）。然而，依托咪酯组的氧饱和度下降（4/64 [6.25%] 与 20/64 [31.25%]；P=.001）和呼吸抑制（5/64 [7.81%] 与 21/64 [32.81%]；P=.001）的发生率明显低于丙泊酚组。依托咪酯组肌阵挛的发生率明显高于丙泊酚组（22/64 [34.37%] 与 8/64 [12.50%]）（P=.012）。重复测量方差分析显示镇静组和时间对收缩压有显著影响（依托咪酯组大于丙泊酚组）。依托咪酯组医生满意度高于丙泊酚组。
依托咪酯给药导致呼吸抑制事件较少，镇静效果优于丙泊酚；然而，它更频繁地与内镜检查期间的肌阵挛和血压升高相关。（临床试验注册号：KCT0001701.）。
