Application Of Etomidate Combined With Different Doses Of Alfentanil In Painless Ultrasonic Gastroscopy In Elderly Patients

Objective:In this study,etomidate combined with different doses of alfentanil was used for painless ultrasonic gastroscopy in elderly patients,to explore the effectiveness and safety of the drug combination,and toexplore theappropriate doseof alfentanil inthe combination.Methods:After being reviewed and approved by the hospital ethics committee,120 elderly patients who underwent painless ultrasound gastroscopy at the endoscopy center of our hospital from January 2022 to October 2022 were randomly divided into They were randomly divided into group S（etomidate）and group A（alfentanil 5μg/kg+etomidate）and group B（alfentanil 10μg/kg+etomidate）.Before ultrasonic gastroscopy,all patients underwent 12-lead ECG,blood routine test and coagulation function test,and the upper limb vein channel was opened.After entering the room,10mLof oral lidocaine mucilage was given to make the patient lie on the left side,and4～6 L/min nasal catheter was given to inhale oxygen.ECG,blood pressure（BP）and blood oxygen saturation（SpO₂）were monitored,and the mouth pad was placed.Anesthesia method:Group A patients received intravenous injection of alfentanil 5μg/kg,intravenous etomidate 0.10-0.30 mg/kg after 30s;Group B patients were injected with the same volume of alfentanil 10μg/kg,intravenous etomidate 0.10-0.30mg/kg after30s;The patients in group S were given the same volumeof normal saline intravenously and etomidate 0.10-0.30 mg/kg intravenously 30 seconds later.After the completion of administration,the modified observer’s assessment of alertness/sedation（MOAA/S）score will be given.The entry operation will be started after the MOAA/S score is≤2 points.If the sedation depth is not enough or the entry fails,the etomidate 3-5 ml will be added and then the evaluation and entry can be repeated.The MOAA/S score of the sedation depth maintained during the examination is≤2points.If the depth of sedation was not enough,3-5 mL etomidate was added,which could be repeated.The rate of administration was the same among the three groups,all of which were 1ml/s.During the examination,closely monitor the patient’s blood pressure,ECG and SpO₂.When the patient’s blood pressure is 30%lower than the basic blood pressure,5～10 mg of ephedrine shall be given;0.3～0.5 mg atropine was given when the heart rate was lower than 50 beats per minute;When the SpO2 is lower than 90%and the time is longer than 30s,the mask shall be used to pressurize the oxygen supply.If necessary,endotracheal intubation can be used.The total amount of etomidate,the duration of ultrasonic gastroscopy and the time of patients’recovery were recorded in the three groups;The mean arterial pressure（MAP）,heart rate（HR）,respiratory rate（RR）and blood oxygen saturation（SpO₂）were monitored before anesthesia induction（T₁）,immediately after examination（T₂）,5 minutes after induction（T₃）,10 minutes after induction（T₄）and at the end of examination（T₅）;Record the occurrence of adverse events such as respiratory depression,arrhythmia,hypotension,injectionpain,myoclonus,nausea and vomiting.Results:1.There were no significant differences in gender,age,BMI and ASA grading,and the results werenot statisticallysignificant（P>0.05）.2.Comparedwithgroup S,theinspection duration of group Aand group B was slightly reduced,but there was no statistical significance（P>0.05）.Compared with group S,the postoperative recovery timein group Awas shorter（P<0.05）,but the recoverytime of group B was prolonged（P<0.05）;3.Compared with group S,the dose of etomidate required in group A and group B was lower（P<0.05）,andthere was no significant difference between group Aandgroup B（P>0.05）.4.Compared with group S,MAP in groups A and B decreased immediately after administration（T₂）（P<0.05）,and the trend continued to T5（P<0.05）.Compared with group A at each time point,MAP of group B was significantly decreased（P<0.05）.Intra-group comparison at each timepoint:Compared with T₁,MAPat T₂to T₅in all groups was decreased（P<0.05）;5.Compared with group S,there was no statistical difference in the data of group Aat each time point,while the HR of group B was decreased at T₂to T₅time points（P<0.05）.Comparison of time points within each group:Compared with T₁time points,HR at T₂to T₅time points in each group was decreased（P<0.05）;6.RR:Compared with group S,RR in group A was slightly decreased at time points T₂to T₅,but there was no statistical difference（P>0.05）;RR in group B was significantly decreased at time points T2 to T5 compared with group S（P<0.05）.Comparison of time points within each group:Comparedwith T1 timepoints,RR at T₂to T₅time points was decreased in all groups（P<0.05）.7.SpO₂:Compared with group S,SpO₂in group Awas slightly decreased at time points T₂to T₅and in group B at time points T₃to T₅,but there was no statistical difference（P>0.05）,while SpO₂in group B was significantly decreased at immediate administration（T₂）（P<0.05）.Comparison of time points within each group:Compared with T1 time points,SpO₂at T₂to T₅time points in each group was decreased（P<0.05）;8.Adverse reactions:In the statistics of adverse reactions among groups,the proportion of adverse reactions in group S was larger（55.3%）,among which injection pain and muscle spasm accounted for 18.4%and 15.8%,respectively,which had statistical significance compared with groups A and B（P<0.05）.In the other adverse reaction hypotension,the occurrence rate of group B was higher（10.3%）,which was statistically significant compared with group S（P<0.05）.Conclusion:1.Alfentanil combined with etomidate can be safely and effectively used for painless ultrasonic gastroscopy in elderly patients;2.For painless ultrasonic gastroscopy in elderly patients,this study concluded that compared with etomidate combined afentanil 5μg/kg and etomidate combined afentanil 10μg/kg,it had a slight effect on hemodynamics,weaker respiratory inhibition and shorter recovery time,which could reduce the dosage of etomidate and reduce the incidence of injection pain and myoclonus and other adverse reactions,It is worthy ofclinical promotion.