Dhingra Udit, Mantri Nitin, Pani Soveena, Tempe Deepak K, Arora Mahesh
Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, IND.
Anesthesiology, Vishesh Jupiter Hospital, Indore, IND.
Cureus. 2023 Aug 8;15(8):e43178. doi: 10.7759/cureus.43178. eCollection 2023 Aug.
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.
基于丙泊酚的镇静是内镜逆行胰胆管造影术（ERCP）最常用的方法之一。ERCP期间最常见的并发症是镇静导致的不良心肺事件。依托咪酯比丙泊酚具有更稳定的心血管和呼吸状况，已用于简单的胃肠内镜检查镇静，但尚未用于ERCP的程序镇静研究。本研究的目的是比较依托咪酯和丙泊酚在ERCP手术期间镇静的安全性和可行性。方法：这项单中心随机试验纳入了100例计划进行ERCP的美国麻醉医师协会（ASA）身体状况分级为I至II级的患者。所有患者静脉注射咪达唑仑0.02mg/kg、利多卡因（2%）1mg/kg和芬太尼1μg/kg，然后根据分组分配给予依托咪酯或丙泊酚。主要结局是比较两组在不同时间点的平均动脉压（MAP），次要结局是比较血氧饱和度、诱导和恢复时间以及不良事件。短暂性低血压定义为MAP降至60mmHg以下或低于基线20%。短暂性低氧血症定义为外周血氧饱和度（SpO2）<92%持续超过10秒且需要气道干预。结果：每组纳入50例患者（E组：依托咪酯；P组：丙泊酚）。P组8例（16%）患者发生短暂性低血压，E组2例（4%）患者发生短暂性低血压（P=0.045）。两组基线MAP相当，但在研究期间的三个时间点P组显著更低。P组9例（18%）患者发生短暂性低氧发作，E组无患者发生（p=0.006）。两组的诱导和恢复时间相似。结论：依托咪酯比丙泊酚具有更好的血流动力学和呼吸稳定性，可推荐用于ASA I/II级患者的ERCP期间。
