Luo HR, Chen AD, Lin JF, Ye P, Chen YJ, Lin MX, Chen PZ, Chen XH, Zheng XC. Effect of etomidate added to propofol target-controlled infusion in bidirectional endoscopy: A randomized clinical trial. World J Gastrointest Endosc 2025; 17(2): 100722 [DOI: 10.4253/wjge.v17.i2.100722]
Corresponding Author of This Article
Xiao-Hui Chen, MD, Chief Physician, Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, No. 134 East Street, Fuzhou 350000, Fujian Province, China. chenxh@fjmu.edu.cn
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Randomized Clinical Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hui-Rong Luo, Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou 350000, Fujian Province, China
An-Di Chen, Jing-Fang Lin, Peng Ye, Ying-Jie Chen, Ming-Xue Lin, Pin-Zhong Chen, Xiao-Hui Chen, Xiao-Chun Zheng, Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian Province, China
Author contributions: Luo HR contributed to study conception, design, data collection and write the manuscript; Chen AD contributed to data collection and write the manuscript; Lin JF contributed to implementation of clinical anesthesia and the revision of the manuscript; Ye P, Chen YJ, Lin MX and Chen PZ contributed to data collection; Chen XH contributed to study design, supervised the work, performed the analysis, contributed data and analysis tools; Zheng XC contributed to study design, revised the manuscript; All authors made critical revisions and approved the final version to be published. Luo HR and Chen AD contributed equally to this work as co-first authors; Chen XH and Zheng XC contributed equally to this work as co-corresponding authors. The reasons for designating Chen XH and Zheng XC as co-corresponding authors are that Zheng XC is responsible for coordination and quality control; Chen XH is responsible for design of the project.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Boards of Fujian Provincial Hospital of Fujian Medical University (Approval No. K2021-05-036).
Clinical trial registration statement: This study is registered at https://www.chictr.org.cn/searchproj.html. The registration identification number is ChiCTR2100044884.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Hui Chen, MD, Chief Physician, Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, No. 134 East Street, Fuzhou 350000, Fujian Province, China. chenxh@fjmu.edu.cn
Received: August 28, 2024 Revised: January 6, 2025 Accepted: January 18, 2025 Published online: February 16, 2025 Processing time: 169 Days and 11.3 Hours
Abstract
BACKGROUND
Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation; 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.
AIM
To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional 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 mg/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 after induction than the other groups (P group: 78 mmHg, 0.1EP group: 82 mmHg, 0.15EP group: 88 mmHg; P < 0.05). Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups (P group: 260.6 mg, 0.1EP group: 228.1 mg, 0.15EP group: 201.2 mg; P < 0.05). The induction time was longer in the P group than in the other groups (P group: 1.9 ± 0.7 minutes, 0.1EP group: 1.2 ± 0.4 minutes, 0.15EP group: 1.1 ± 0.3 minutes; P < 0.01). The recovery time was shorter in the 0.15EP group than in the other groups (P group: 4.8 ± 2.1 minutes, 0.1EP group: 4.5 ± 1.6 minutes, 0.15EP group: 3.9 ± 1.4 minutes; P < 0.01). The incidence of hypotension (P group: 36.4%, 0.1EP group: 29.1%, 0.15EP group: 11.8%; P < 0.01) 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).
CONCLUSION
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.
Core Tip: This randomized controlled trial compared the effect of different dose etomidate added to propofol target-controlled infusion (TCI) sedation in 330 patients during same-visit bidirectional endoscopy. Adding 0.15 mg/kg etomidate to propofol TCI during endoscopy reduces incidence of hypotension, injection pain, and respiratory depression while improving satisfaction among patients, endoscopists, and anesthesiologists. There was no difference in the adverse events among three groups.
