Department of Internal Medicine, Ewha Woman's University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Nasaret International Hospital, Incheon, Korea.
Medicine (Baltimore). 2023 Feb 10;102(6):e32876. doi: 10.1097/MD.0000000000032876.
Propofol is increasingly being used for sedation in gastrointestinal endoscopy; however, owing to its side effects, an alternative drug is needed. We aimed to compare the safety, satisfaction, and efficacy outcomes of etomidate versus propofol in patients undergoing gastrointestinal endoscopy, including advanced endoscopic procedures.
We systematically searched Embase, PubMed, Cochrane Central Register of Controlled Trials, CINAHL (via EBSCO), China National Knowledge Infrastructure, and Web of Science (1946-April 2020) databases for randomized controlled trials of gastrointestinal endoscopy (upper gastrointestinal endoscopy, colonoscopy, and advanced endoscopy) using etomidate or propofol as sedatives. We pooled odds ratios (ORs) for the safety profile and patient and anesthesiologist satisfaction using mixed-effects conditional logistic models and standardized mean differences for efficiency outcomes using random-effects models.
Twenty-four studies involving 3875 patients were included. Compared with propofol, etomidate resulted in significantly reduced apnea (OR: 0.22; 95% confidence interval [CI]: 0.13-0.37; P < .001), hypoxemia (OR: 0.43; 95% CI: 0.35-0.54; P < .001), hypotension (OR: 0.20; 95% CI: 0.11-0.36; P < .001), and bradycardia (OR: 0.52; 95% CI: 0.30-0.91; P = .02) but led to increased myoclonus (OR: 8.54; 95% CI: 5.20-14.01; P < .001) and lowered anesthesiologist satisfaction (OR: 0.60; 95% CI: 0.39-0.91; P = .02).
Etomidate may be a good alternative to propofol for gastrointestinal endoscopy, especially advanced endoscopy. Etomidate appears to be safe as an inducer for hemodynamically unstable patients or older adult patients undergoing gastrointestinal endoscopy.
越来越多的人在胃肠内镜检查中使用丙泊酚进行镇静；然而，由于其副作用，需要一种替代药物。我们旨在比较依托咪酯与丙泊酚在接受胃肠内镜检查（包括先进内镜检查）的患者中的安全性、满意度和疗效结果。
我们系统地检索了 Embase、PubMed、Cochrane 中央对照试验注册库、CINAHL（通过 EBSCO）、中国国家知识基础设施和 Web of Science（1946 年-2020 年 4 月）数据库，以寻找使用依托咪酯或丙泊酚作为镇静剂的胃肠内镜（上消化道内镜、结肠镜检查和先进内镜）的随机对照试验。我们使用混合效应条件逻辑模型汇总安全性特征和患者及麻醉师满意度的优势比（ORs），并使用随机效应模型汇总效率结果的标准化均数差值。
纳入了 24 项涉及 3875 名患者的研究。与丙泊酚相比，依托咪酯可显著减少呼吸暂停（OR：0.22；95%置信区间 [CI]：0.13-0.37；P <.001）、低氧血症（OR：0.43；95% CI：0.35-0.54；P <.001）、低血压（OR：0.20；95% CI：0.11-0.36；P <.001）和心动过缓（OR：0.52；95% CI：0.30-0.91；P =.02），但导致肌阵挛增加（OR：8.54；95% CI：5.20-14.01；P <.001）和麻醉师满意度降低（OR：0.60；95% CI：0.39-0.91；P =.02）。
依托咪酯可能是胃肠内镜检查（尤其是先进内镜检查）的一种良好的丙泊酚替代药物。依托咪酯似乎是不稳定血流动力学患者或接受胃肠内镜检查的老年患者诱导的安全选择。
