Comparative Study Of Recovery Quality After Etomidate-or Propofol-based Anesthesia In Painless Gastrointestinal Endoscopy

Background:Propofol alone or in combination with opioids has been widely used in the sedation or anesthesia of digestive endoscopy.Considering the high cardiopulmonary adverse events of propofol,and the unique advantages of etomidate in respiratory circulating system,many scholars have studied the application of etomidate on gastrointestinal endoscopic anesthesia in recent years,and it has shown that etomidate is more safe than propofol during gastrointestinal endoscopy.Some researchers also calculated physician and patient satisfaction,indicating that etomidate has higher physician satisfaction is higher than propofol.However,there are some controversy in patient’s satisfaction.Considering the adverse reactions of etomidate,such as myoclonus and inhibition of cortical function and other adverse reactions,which may have a certain effect on recovery after anesthesia.At present,there is still a lack of clinical research evidences on patient’s comfort and satisfaction after using etomidate as anesthesia induction.A single VAS score is often used in evaluations of satisfaction,there is a lack of more comprehensive evaluation scale to compare the recovery of propofol and etomidate anesthesia.The QOR-15 evaluation scale has been widely used in clinical practice,as a scale for assessing postoperative recovery,the quality of recovery is more specific and in-depth.At present,no one has applied this scale to gastrointestinal endoscopy anesthesia.Objective:Using QOR-15 scale to observe the recovery quality after etomidate-or propofol-based anesthesia in painless gastrointestinal endoscopy.Method:This study is a prospective,randomized,controlled,non-inferiority clinical study.From June 2019 to January 2020,104 patients who underwent painless gastrointestinal examination on the digestive endoscope center of our hospital were selected.They were randomly assigned to group E（etomidate group,n=52 cases）and group P（propofol group,n=52 cases）.The subjects of the two groups were given intravenous fentanyl 0.8μg/kg at first.After 3 minutes,they were given intravenous etomidate or propofol（both at 1 ml/5 s）according to the assigned groups.A single additional 20-30 mg of propofol was maintained for anesthesia if necessary.The primary outcome measure was the QOR-15 scores of the two groups at 24 hours after anesthesia recovery.The secondary outcome measure was the incidence of nausea and vomiting after awakening;QOR-15 score at 24 hours before anesthesia;incidence and grade intensity of myoclonus;examination,wake-up and exit time;additional doses of propofol;and cardiopulmonary adverse events were also analyzed.Result:There was no significant difference in demographic data between the two groups.The difference of total QOR-15 score between the two groups was-3.48,and the 97.5%confidence interval was[-4.1 to+∞],which was in the range of[-10 to+∞],indicating that etomidate was not inferior to propofol in terms of the quality of recovery.（p<0.001）.In terms of communication with others and emotions（tension,anxiety,sadness and depression）,the propofol group had a higher scores,and the difference is statistically significant compared with the etomidate group（p<0.05）.There were no statistical differences on remaining aspects between the two groups.Although the incidence of myoclonus in the propofol group（P group）was lower than that in etomidate group within 2 minutes after induction,the difference was not statistically significant（p=0.065）.The incidence of adverse events such as severe hypotension,SpO₂<95%,SpO₂<90%,jaw lift and mask oxygenation during the anesthesia period in the etomidate group（E group）were lower than those in the propofol group（p<0.05）.The MBP measured at 3 min and 5 min after induction of anesthesia was significantly lower in group P than in group E,and the difference was statistically significant（p<0.05）.There was no statistically significant difference between the two groups in terms of examination,wake-up,time to exit,and additional propofol doses（p>0.05）.Conclusion:Anesthetic method of etomidate combined with propofol is not inferior to the method of propofol alone on recovery quality.Although the etomidate-induction group performed poorly on post-resuscitation mood and communication,it was safer during the anaesthesia period.