a Department of Anesthesiology and Pain Medicine , Chung-Ang University College of Medicine , Seoul , Republic of Korea.
b Department of Plastic Surgery , National Police Hospital , Seoul , Korea.
Curr Med Res Opin. 2018 Nov;34(11):2023-2029. doi: 10.1080/03007995.2018.1519501. Epub 2018 Sep 20.
To compare the efficacy and safety of etomidate vs propofol sedation for electrical cardioversion.
The authors searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials, Google Scholar, Koreamed, and KMBASE databases to identify all randomized controlled trials that compared etomidate and propofol sedation for cardioversion in adult patients. Induction and recovery time, success rate, number of shocks, and cumulative energy were evaluated. Adverse effects, including respiratory and cardiovascular complications, myoclonus, and nausea and vomiting, were also assessed.
A total of nine studies, involving a total of 430 patients, were included. Induction and recovery time, success rate, number of shocks, and cumulative energy were similar. The incidences of hypotension and respiratory depression were significantly higher in the propofol group than in the etomidate group (risk ratio [RR] = 0.11, 95% confidence interval (CI) = 0.02-0.74, I = 0%; RR = 0.50, 95% CI = 0.32-0.77, I = 47%, respectively). The incidences of myoclonus and nausea or vomiting were significantly higher in the etomidate group than in the propofol group (RR = 8.89, 95% CI = 4.59-17.23, I = 9%; RR = 5.13, 95% CI = 1.72-15.31, I = 31%, respectively).
Issues affecting efficacy, including induction and recovery time, success rate, number of shocks, and cumulative energy, were comparable between etomidate and propofol sedation. Regarding safety issues, propofol sedation resulted in hypotension and respiratory depression more frequently; however, initiation of positive pressure ventilation was comparable. Etomidate sedation caused myoclonus and nausea or vomiting more frequently.
比较依托咪酯与丙泊酚镇静用于电复律的疗效和安全性。
作者检索了 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册数据库、Google Scholar、韩国医学数据库（Koreamed）和 KMBASE 数据库，以确定所有比较成年患者电复律时依托咪酯和丙泊酚镇静的随机对照试验。评估诱导和恢复时间、成功率、电击次数和累积能量。还评估了不良反应，包括呼吸和心血管并发症、肌阵挛、恶心和呕吐。
共纳入 9 项研究，共 430 例患者。诱导和恢复时间、成功率、电击次数和累积能量相似。丙泊酚组低血压和呼吸抑制的发生率明显高于依托咪酯组（风险比 [RR] = 0.11，95%置信区间 [CI] = 0.02-0.74，I = 0%；RR = 0.50，95%CI = 0.32-0.77，I = 47%）。依托咪酯组肌阵挛和恶心或呕吐的发生率明显高于丙泊酚组（RR = 8.89，95%CI = 4.59-17.23，I = 9%；RR = 5.13，95%CI = 1.72-15.31，I = 31%）。
影响疗效的问题，包括诱导和恢复时间、成功率、电击次数和累积能量，在依托咪酯和丙泊酚镇静之间是可比的。关于安全问题，丙泊酚镇静更频繁地导致低血压和呼吸抑制；然而，开始正压通气是可比的。依托咪酯镇静更频繁地引起肌阵挛和恶心或呕吐。
