Sedation with a 1:1 mixture of etomidate and propofol for gastroscopy in hypertensive elderly patients

Abstract

We hypothesized that the combined use of etomidate and propofol for endoscopic sedation in elderly hypertensive patients could reduce adverse reactions while providing ideal sedation. To validate our hypothesis, we conducted a prospective, randomized, controlled, double-blinded study. A total of 360 elderly hypertensive patients scheduled for gastroscopy at our hospital were enrolled in the study, of whom 328 completed the trial. The patients were randomly assigned to one of three groups: the propofol group (group P), the etomidate group (group E), or the propofol-etomidate combination group (mixed at a ratio of 1:1, group PE). We collected and analyzed the cardiopulmonary effects and side effects in each group. Regardless of the sedation drug used, the systolic blood pressure, mean blood pressure, and heart rate of involved patients were significantly affected. Oxygen desaturation and injection pain were more common in group P compared to groups E (33.6% vs. 14.8%, 31.8% vs. 2.7%, both P < 0.01) and group PE (33.6% vs. 13.6%, 31.8% vs. 6.4%, both P < 0.01). The incidence of myoclonus in the PE group was lower than that in the E group (10.9% vs. 61.2%, P < 0.01). Our results indeed demonstrated that the combined use of etomidate and propofol appeared to maintain cardiopulmonary stability with minimal side effects in older hypertensive patients scheduled for gastroscopy, which further implied that this sedation strategy could be a safe and pain-free option for managing patients undergoing gastroscopy, particularly those at a higher risk of adverse cardiovascular events.

Keywords: elderly; etomidate; gastroscopy; hypertension; propofol; sedation.

FIGURE 1

Changes in systolic blood pressure. P: Group P; E: Group E; PE: Group PE; SBP: systolic blood pressure; T1: before administration; T2: two minutes after administration; T3: five minutes after administration; T4: removal of gastroscope; T5: awake from anesthesia; T6: recovery from anesthesia. P vs. E, P < 0.001; P vs. PE, P < 0.001; E vs. PE, P < 0.001.

FIGURE 2

Changes in mean blood pressure. P: Group P; E: Group E; PE: Group PE; MAP: mean artery pressure; T1: before administration; T2: two minutes after administration; T3: five minutes after administration; T4: removal of gastroscope; T5: awake from anesthesia; T6: recovery from anesthesia. P vs. E, P < 0.001; P vs. PE, P < 0.001; E vs. PE, P < 0.001.

FIGURE 3

Changes in heart rate. P: Group P; E: Group E; PE: Group PE; HR: heart rate; T1: before administration; T2: two minutes after administration; T3: five minutes after administration; T4: removal of gastroscope; T5: awake from anesthesia; T6: recovery from anesthesia. P vs. E, P = 0.771; P vs. PE, P = 0.730; E vs. PE, P = 0.958.