Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study

Meng, Qingtao; Cao, Chen; Liu, Huimin; Xia, Zhongyuan; Li, Wei; Tang, Ling‐Hua; Chen, Rong; Jiang, Meng; Wu, Yang; Leng, Yan; Lee, Chris C.

doi:10.3892/etm.2016.3475

Cited by 31 publications

(30 citation statements)

References 25 publications

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“…[ 35 ] In addition, another study showed that a combination of etomidate and propofol improved hemodynamic stability and minimal respiratory depression during gastroscopy in the elderly. [ 36 ] However, there is no study on etomidate for colonoscopy in the elderly. For these reasons, we designed a comparison study in which etomidate can be used alternatively even in elderly patients during screening colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

Lee

Min²,

Lee³

et al. 2018

Medicine

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Background and aims:Recent studies have shown that etomidate is associated with fewer serious adverse events than propofol and has a noninferior sedative effect. We investigated whether etomidate–midazolam is associated with fewer cardiopulmonary adverse events and has noninferior efficacy compared to propofol–midazolam for screening colonoscopy in the elderly.Methods:A prospective, single-center, double-blinded, randomized controlled trial was performed. Patients aged over 65 years who were scheduled to undergo screening colonoscopy were randomized to receive either etomidate or propofol based on midazolam. The primary outcome was all cardiopulmonary adverse events. The secondary outcomes were vital sign fluctuation (VSF), adverse events disturbing the procedure, and sedation-related outcomes.Results:The incidence of cardiopulmonary adverse events was higher in the propofol group (72.6%) than in the etomidate group (54.8%) (P = .040). VSF was detected in 17 (27.4%) and 31 (50.0%) patients in the etomidate and propofol groups, respectively (P = .010). The incidence rate of adverse events disturbing the procedure was significantly higher in the etomidate group (25.8%) than in the propofol group (8.1%) (P = .008). Moreover, the incidence rate of myoclonus was significantly higher in the etomidate group (16.1%) than in the propofol group (1.6%) (P = .004). There was no statistical significance between the 2 groups with respect to sedation times and sedation-related outcomes including patients’ and endoscopist's satisfaction. In the multivariate analysis, the etomidate group had significantly low odds ratio (OR) associated with VSF (OR: 0.407, confidence interval: 0.179–0.926, P = .032).Conclusions:We recommend using etomidate–midazolam in patients with high ASA score or vulnerable to risk factors; propofol–midazolam may be used as a guideline in patients with low ASA score.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

Lee

Min²,

Lee³

et al. 2018

Medicine

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“…The maintenance of MAP was better with sevoflurane compared with propofol. Although the difference may be of limited significance for healthy patients, the relative hypotension associated with propofol may be detrimental in elderly patients and patients with coronary artery disease (32)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

Sevoflurane may be more beneficial than propofol in patients receiving endoscopic variceal ligation and endoscopic variceal sclerotherapy: A randomized, double-blind study

Tang

Liu

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to evaluate the safety and efficacy of various general anesthesia regimens during endoscopic variceal ligation (EVL) and endoscopic variceal sclerotherapy (EVS). A total of 123 patients with American Society of Anesthesiologists physical status III and IV, aged 40-70 years, undergoing general anesthesia for EVL and EVS were randomly divided into two groups: Sevoflurane anesthesia (group S; n=60) and propofol anesthesia (group P; n=60). Vital signs, particularly heart rate (HR) and mean arterial pressure (MAP), were monitored. The designated time points were as follows: 5 min before induction (T0), and 1, 5, 10, 15, 20, 25 and 30 min after intubation (T1, T2, T3, T4, T5, T6 and T7, respectively). Time intervals were recorded, including recovery time and extubation time. Following surgery, the observer recorded the Ramsay sedation scale (RSS) score and the visual analogue scale (VAS) score. Adverse reactions were noted. Results demonstrated that there were significant differences in MAP between the two groups at T2, T3, T5, T6 and T7 (P<0.05). There was a significant difference in HR between the two groups at T2, T3 and T4 (P<0.05). Recovery time and extubation time in group P were significantly longer than those in group S (P<0.05; 18.38±2.25 min vs. 14.57±1.04 min and 21.70±2.70 min vs. 15.83±0.88 min, respectively). The rate of ephedrine injected was 58.3% (35/60 patients) in group P vs. 28.3% (17/60 patients) in group S (P<0.05). There was a significant difference in the RSS score between the two groups 5 min after extubation (P<0.05). VRS scores demonstrated that anesthetists and patients were significantly more satisfied with the procedure in group S than in group P (P<0.01). In conclusion, the superiority and special clinical value of inhalational anesthesia has been demonstrated during EVL and EVS attributed to stable hemodynamics and high quality of anesthesia recovery in the present study.

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“…With the aging of the general population, the frequency of this procedure in the elderly is increasing rapidly [2,3]. Although it is a non-traumatic invasive procedure, it often results in significant discomfort in the majority of patients, requiring sedation during the thorough examination [4]. Currently, sedation during upper gastrointestinal endoscopy is mainly obtained by using either propofol or a benzodiazepine, sometimes in combination with an analgesic [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Remimazolam tosilate in patients undergoing upper gastrointestinal endoscopy: a multicenter, randomized, dose-exploration, positive-controlled, parallel-group, phase II trial Shao-Hui Chen 1 , Tang-Mi Yuan 1 , Jiao Zhang 1 , Hua Bai 2 , Ming Tian 3 , Chu-Xiong Pan 4 , Hong-Guang Bao 5 , Su Min 6 , Xiao-Ju Jin 7 , Guo-Zhong Chen 8 , Tai-Di Zhong 9 , Yu-Guang Huang 1…”

mentioning

confidence: 99%

Remimazolam tosilate in patients undergoing upper gastrointestinal endoscopy: a multicenter, randomized, dose-exploration, positive-controlled, parallel-group, phase II trial

et al. 2020

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IntroductionTo assess both the safety and efficacy of different doses of remimazolam tosilate (HR7056) in maintaining suitable sedation during upper gastrointestinal endoscopy and the reversibility of HR7056’s sedative effects with flumazenil.Material and methodsA total of 156 patients were enrolled and randomly received propofol (group A), 1 of 3 induction doses of HR7056 (8.0 mg (group B), 7.0 mg (group C), 5.0 mg (group D)), or 5.0 mg of HR7056 plus flumazenil (group E). The primary efficacy endpoint was the successful sedation rate. Adverse events (AEs) were recorded to evaluate safety.ResultsBaseline characteristics of patients were well balanced between five treatment groups. For the dose-exploration part, there were no significant difference in successful sedation rate, rates of hypotension and respiratory depression between the four treatment groups. The sedative recovery time in group A was significantly higher than that in group B. The rate of hypoxemia and pain on injection in group A were both significantly higher than those in groups B, C and D. For the flumazenil reversal part, there was no significant difference in the sedative recovery time between group D and group E. The rates of AEs in groups A, B, C, D, E were 40.00%, 29.03%, 16.13%, 6.45%, 6.67%, respectively. There were no serious AEs.ConclusionsHR7056 was comparable to propofol in safety and efficacy in maintaining sedation during upper gastrointestinal endoscopy. HR7056 5.0/2.5 mg-dose (initial dose 5.0 mg, combined with supplemental doses of 2.5 mg) was capable of inducing rapid sedation without the need for flumazenil reversal.

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Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study

Cited by 31 publications

References 25 publications

Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

Sevoflurane may be more beneficial than propofol in patients receiving endoscopic variceal ligation and endoscopic variceal sclerotherapy: A randomized, double-blind study

Remimazolam tosilate in patients undergoing upper gastrointestinal endoscopy: a multicenter, randomized, dose-exploration, positive-controlled, parallel-group, phase II trial

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