A Comparative Analysis of the Effects of Etomidate and Propofol for Inducing Sedation in Pediatric Patients Undergoing Upper Gastrointestinal Endoscopy
Iranian Journal of Pediatric Surgery,
Vol. 10 No. 1 (2024),
4 April 2024
,
Page 27-38
https://doi.org/10.22037/irjps.v10i1.44586
Abstract
Introduction: Gastrointestinal endoscopy is a prevalent diagnostic and therapeutic procedure employed for both children and adults. Since Etomidate is a short acting intravenous drug with hemodynamic stability and also it is the choice for sedation and anesthesia among patients afflicted with cardiovascular conditions, we decided to compare the benefits and drawbacks of the mentioned drugs in children undergoing endoscopy.
Materials and Methods: For conducting the research, 90 pediatric participants, aged from 1 to 15 years, with ASA I and II class requiring upper gastrointestinal endoscopy (admitted to Mofid Children Hospital) were randomly selected. For 45 patients, intravenous anesthetic drug Propofol (Group P) was administered for sedation required during endoscopy, while in the remaining 45 patients, Etomidate (Group E) was used, and hemodynamic fluctuations, apnea occurrence frequency, sedation recovery length, and nausea and vomiting after sedation were monitored and compared between the two groups. Finally, the data were analyzed using SPSS v.18 software, and t-test and chi-square statistical tests.
Results: The average age of the patients was 7.8 ± 7.9 years. The recovery following anesthesia in Group P was 8.3 ± 4.3 minutes, while in Group E, it was 7 ± 3.2 minutes (p=0.373). The reduction in SPO2 levels in Group P was 7.1 ± 3.9%, and in Group E, it was 1.4 ± 0.6% (p=0.01). The variations in heart rate (HR) were 3.9 ± 7.1 in Group P and 0.6 ± 1.4 in Group E (p=0.01). Changes in blood pressure (BP) were 10.1 ± 7.9 mmHg in Group P and 2.7 ± 1.3 mmHg in Group E (p = 0.235). The incidence of apnea was 26.7% (12 individuals) in Group P and 46.7% (21 individuals) in Group E (p=0.02). The occurrence of nausea and vomiting was 4.4% (2 individuals) in Group P and 20% (9 individuals) in Group E (p=0.01).
Conclusion: The result of the findings suggests that the patients receiving Etomidate experienced lower saturation drop, and quicker awakening compared to the group of patients receiving Propofol, while the occurrence of apnea, nausea, and vomiting were higher
- Keywords: Pediatric Endoscopy, Propofol, Etomidate, Intravenous Sedation
- Pediatric Endoscopy
- Propofol
- Etomidate
- Intravenous Sedation
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References
Cao H, Wang B, Zhang Z, et al: Distribution trends of gastric polyps: an endoscopy database analysis of 24 121 northern Chinese patients. Journal of gastroenterology and hepatology. 2012;27(7):1175-80.
Soweid AM, Yaghi SR, Jamali FR, et al: Posterior lingual lidocaine: a novel method to improve tolerance in upper gastrointestinal endoscopy. World Journal of Gastroenterology: WJG. 2011;17(47):5191.
Ye L, Xiao X, Zhu L: The comparison of Etomidate and Propofol anesthesia in patients undergoing gastrointestinal endoscopy: a systematic review and meta-analysis. Surgical laparoscopy, endoscopy & percutaneous techniques. 2017;27(1):1-7.
Shen X-C, Ao X, Cao Y, et al: Etomidate-remifentanil is more suitable for monitored anesthesia care during gastroscopy in older patients than propofol-remifentanil. Medical science monitor: international medical journal of experimental and clinical research. 2015; 21:1.
Cha JM, Jeun JW, Pack KM, et al: Risk of sedation for diagnostic esophagogastroduodenoscopy in obstructive sleep apnea patients. World Journal of Gastroenterology: WJG. 2013;19(29):4745.
Amornyotin S: Sedation-related complications in gastrointestinal endoscopy. World journal of gastrointestinal endoscopy. 2013;5(11):527.
Olofsen E, Boom M, Nieuwenhuijs D, et al: Modeling the non-steady state respiratory effects of remifentanil in awake and propofol-sedated healthy volunteers. Anesthesiology. 2010;112(6):1382-95.
Hsu WH, Wang SS, Shih HY, et al: Low effect‐site concentration of Propofol target‐controlled infusion reduces the risk of hypotension during endoscopy in a T aiwanese population. Journal of digestive diseases. 2013;14(3):147-52.
El-Shmaa N, El-Baradey G: The efficacy of Etomidate-fentanyl versus dexmedetomidine-ketamine for procedural sedation and analgesia during upper endoscopy and biopsy: a prospective, randomized study. J Anesth Clin Res. 2014;5(480):2.
Meng QT, Cao C, Liu HM, et al: Safety and efficacy of Etomidate and Propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study. Experimental and therapeutic medicine. 2016;12(3):1515-24.
Song J-C, Lu Z-J, Jiao Y-F, et al: Etomidate anesthesia during ERCP caused more stable haemodynamic responses compared with propofol: a randomized clinical trial. International journal of medical sciences. 2015;12(7):559.
Miner JR, Danahy M, Moch A, et al: Randomized clinical trial of Etomidate versus Propofol for procedural sedation in the emergency department. Annals of emergency medicine. 2007;49(1):15-22.
Jackson Jr WL: Should we use Etomidate as an induction agent for endotracheal intubation in patients with septic shock? a critical appraisal. Chest. 2005;127(3):1031-8.
Bendel S, Ruokonen E, Pölönen P, et al: Propofol causes more hypotension than Etomidate in patients with severe aortic stenosis: a double‐blind, randomized study comparing Propofol and Etomidate. Acta anaesthesiologica scandinavica. 2007;51(3):284-9.
Du Y, Chen Y-J, He B, et al: The effects of single-dose Etomidate versus Propofol on cortisol levels in pediatric patients undergoing urologic surgery: a randomized controlled trial. Anesthesia & Analgesia. 2015;121(6):1580-5.
Falk J, Zed PJ: Etomidate for procedural sedation in the emergency department. Annals of Pharmacotherapy. 2004;38(7-8):1272-7.
Han SJ, Lee TH, Yang JK, et al: Etomidate sedation for advanced endoscopic procedures. Digestive diseases and sciences. 2019;64(1):144-51.
Kaushal RP, Vatal A, Pathak R: Effect of Etomidate and Propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass. Annals of cardiac anaesthesia. 2015;18(2):172.
Zhou X, Li B-X, Chen L-M, et al: Etomidate plus Propofol versus Propofol alone for sedation during gastroscopy: a randomized prospective clinical trial. Surgical endoscopy. 2016;30(11):5108-16.
Bisht S, Gopal S: Etomidate versus Propofol as induction agent in patients undergoing Endoscopic Retrograde Cholangiopancreaticogram (ERCP). Indian Journal of Clinical Anaesthesia. 2017;4(1):122-7.
Mandt MJ, Roback MG, Bajaj L, et al: Etomidate for short pediatric procedures in the emergency department. Pediatric emergency care. 2012;28(9):898-904.
Mahajan C, Dash HH: Procedural sedation and analgesia in pediatric patients. Journal of pediatric neurosciences. 2014;9(1):1.
Chen L, Liang X, Tan X, et al: Safety and efficacy of combined use of Propofol and Etomidate for sedation during gastroscopy: systematic review and meta-analysis. Medicine. 2019 May;98(20).
Liu X, Duan L, Yu Z, et al: Propofol and Etomidate Alone or Combined for Sedation during Gastroscopy: A Meta-Analysis. Latin American Journal of Pharmacy. 2021 Jan 1;40(7):1600-9.
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