Clinical Observation Of Butorphanol Combined With Etomidate For Sedation And Analgesia In Elderly Patients Undergoing Painless Gastrointestinal Endoscopy

Objective: To observe the clinical effect of different doses of butorphanol combined with etomidate on sedation and analgesia in elderly patients undergoing painless gastrointestinal endoscopy.Methods: 120 elderly patients who underwent painless gastrointestinal endoscopy in our hospital from November 2021 to August 2022 were randomly divided into four groups(n=30): low-dose butorphanol group(Group A),high-dose butorphanol group(Group B),sufentanil group(Group C)and blank control group(Group D).Group A and group B were given 10μg/kg 、 20μg/kg of butorphanol intravenously,then0.2mg/kg of etomidate was given intravenously after 3 minutes.In group C,0.1μg/kg of sufentanil was given intravenously,then 0.2mg/kg of etomidate was given intravenously 3 minutes later.In group D,1ml of saline was given intravenously,and0.2mg/kg of etomidate was given intravenously after 3min.After the eyelash reflex of the patient disappears,use the Richmond Agitation-Sedation Scale to evaluate the sedation degree of the patient.When the RASS≤-2,put the endoscope into the patient to start the examination.When the RASS score of the patient is more than-2 points or body movement reaction occurs due to pain,stop the operation and add 3 mg of etomidate each time.Observe and record the heart rate(HR)and mean arterial pressure(MAP)before anesthesia induction(T1),after the disappearance of eyelash reflex(T2),when gastroscopy passes through the pharynx(T3),at the end of gastroscopy(T4),when enteroscopy passes through the liver curvature(T5),and at the end of enteroscopy(T6).Record the inspection time and the total amount of etomidate.Record the occurrence and intensity of myoclonus and the occurrence of adverse events during the examination(including bradycardia,hypotension,hypoxemia and body movements that affect the operation).The incidence of postoperative nausea and vomiting,the score of the revised Wong-Baker faces pain scale revision(FPS-R)and the time of departure were recorded.Results: At the time of T2,there was no significant difference in HR and MAP between the four groups(P>0.05).Among them,the HR and MAP of group A at T3 and T5 time points were higher than those of group B and group C,the difference was statistically significant(P<0.05).The total dosage of etomidate in group A was more than that in group B and group C,but less than that in group D,with a statistically significant difference(P<0.05).There was no statistically significant difference in FPS-R scores between group A and group B after operation(P>0.05),and it was lower than that of group C and group D(P<0.05).The incidence of myoclonus in group B was significantly lower than that in group A,C and D(P<0.05).There was no statistically significant difference in the incidence of adverse events among groups A,B and C(P>0.05),and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of postoperative nausea and vomiting among the four groups(P>0.05).There was statistically significant difference in the time of leaving hospital among the four groups(P<0.05).The time of leaving hospital in Group A,Group B and Group C was shorter than that in Group D(P<0.05).Conclusion: This study found that 20μg/kg of butorphanol was injected intravenously3 minutes before anesthesia induction compounding with etomidate has a stable anesthesia process,complete analgesia and good safety in the painless gastrointestinal endoscopy sedation and analgesia of elderly patients with ASA gradeⅡ～Ⅲ,which has clinical application value.