Application of Propofol Target-Controlled Infusion Combined with Etomidate in Painless Gastrointestinal Endoscopy: A Prospective, Randomized Controlled Study

Abstract

Background Propofol has been widely used in painless gastrointestinal endoscopy; however, it frequently leads to cardiovascular adverse events and respiratory depression. Propofol target-controlled infusion (TCI) can provide safe sedation but may require higher dosages of propofol. On the contrary, etomidate offers hemodynamic stability. This study aimed to investigate the efficacy and safety of propofol TCI combined with etomidate in painless gastrointestinal endoscopy. Methods A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups: P, 0.1EP, and 0.15EP. Patients in the P group received propofol TCI only, with an initial effect-site concentration of the propofol TCI system of 3.0 µg/mL. Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection, respectively, followed by propofol TCI. Results Patients in the 0.15EP group had higher mean blood pressure (MBP) after induction than the other groups (P < 0.05). Propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups (P < 0.05). The induction time was longer in the P group than in the other groups (P < 0.01). The recovery time was shorter in the 0.15EP group than in the other groups (P < 0.01). The incidence of hypotension and injection pain was lower in the 0.15EP group than in the other groups (P < 0.05). Furthermore, the incidence of respiratory depression was lower in the 0.15EP group than in the P group (P < 0.05). Additionally, the satisfaction of the patient, endoscopist, and anesthesiologist was higher in the 0.15EP group than in the other groups (P < 0.05). Conclusions Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption, which is followed by fewer cardiovascular adverse events and respiratory depression, along with higher patient, endoscopist, and anesthesiologist satisfaction. Thus, this anesthesia strategy is suitable for painless gastrointestinal endoscopy.