A Clinic Study Of Etomidate-lipuro In Painless Gastroscopy

BACKGROUND: With the gradual development of painless gastroscopy, and systemic illness of the patients involved in complex situations. So this asked anesthesiologist chose different anesthetic and methods according to different conditions of patient to minimize the risk and meet gastroscopy, anesthetic can not be too single. Now propofol was often used in the painless gastroscopy in the world and etomidate was seldom studied. Etomidate has rapid onset and rapid recovery properties, it easily maintain stability of the cardiovascular system and has no significant effect on the respiratory system. We designed this study to compare the clinic effects of etomidate-lipuro and propofol in painless gastroscopy and study a better anaesthetic method and anaesthetics in safety,consciousness and complications for painless gastroscopyMETHODS: This is a prospective, randomized and double-blinded clinical trial. 398 ASAⅠ-Ⅱpatients undergoing gastroscopy were randomly assigned to one of the four modes of administration. One minutes before gastroscopy: PF group received 0.1ml/kg of 10μg/ml fentanyl within 5-10 sec, followed by bolus injection of 10mg/ml propofol; EF group received 0.1 ml/kg of 10μg/ml fentanyl within 5-10 sec, followed by bolus injection of 2mg/ml etomidate-lipuro.PFM group received 0.1ml/kg of 10 #g/ml fentanyl and 0.2mg/ml midazolam mixture, followed by 10mg/ml propofol; and EFM group received 0.1ml/kg of 10μg/ml fentanyl and 0.2mg/ml midazolam mixture, followed by 2mg/ml etomidate-lipuro.The doses of propofol or etomidate-lipuro was adapt to clinical needs. No endotracheal intubation or infusion device or pharyngeal topical anesthesia was applied. Atropine(0.005-0.01 mg/kg) and Ephedrine(0.1-0.2mg/kg) were administrated to treat bradycardia and hypotention, respectively. All the quantitative data are presented as mean±standard deviation (SD) and were analyzed by the one-way analysis of variance except the VAS score. The VAS score was analyzed by the variance analysis of the randomized blocks. Nonparametric data were analyzed by the Chi-squared tests. P＜0.05 was considered statistically significant.RESULTS The consciousness recovery in PF and EF groups was faster than that in PFM and EFM groups ,and The consciousness recovery in PF group was the fastest The incidence of myoclonus in EF and EFM groups(26.0% and14.1%) was higher than that in PF and PFM grpups (6.1% and 4.0% ).However,the incidence of hypotension,hypoxemia,apnea and pain in injection site in PF and PFM groups was higher than that in EF and EFM groups. The postoperative incidence of nausea,vomiting and dizziness in EF and EFM groups was higer than that in PF and PFM groups. The anesthetist's VAS score in the EF and EFM groups was higher that in PF and PFM groups,. The endoscopist's VAS score among the four groups had not significant differences.CONCLUSION Etomidate-lipuro could be safely allied in painless gastroscopy with less influence on respiration and circulation comparing with propofol. However, cautions should be taken by the frequent occurrence of myoclonus,nausea,vomit and dizziness with intravenous etomidate-lipuro.