title: Etomidate-remifentanil is more suitable for monitored anesthesia care during gastroscopy in older patients than propofol-remifentanil.
abstract: BACKGROUND
  This prospective and randomized study was designed to compare safety, potential complications, and patient and examiner satisfaction of 2 anesthetic combinations - etomidate-remifentanil and propofol-remifentanil - in elderly patients undergoing diagnostic gastroscopy.
  
  
  METHODS
  A group of 720 patients, aged 60-80 years, scheduled for diagnostic gastroscopy under sedation were prospectively randomized. After 0.4-0.6 μg kg⁻¹ of remifentanil was infused, etomidate or propofol was administered. Patients in the etomidate group received doses of etomidate at 0.1-0.15 mg kg⁻¹ followed by 4-6 mg. Patients in the propofol group received doses of propofol at 1-2 mg kg⁻¹ followed by 20-40 mg. Physiological indexes were evaluated for the 715 of 720 patients that completed the treatment. The onset time, duration time, and discharge time were recorded. Physicians, anesthetists, and patients were surveyed to assess their satisfaction.
  
  
  RESULTS
  Systolic pressure and diastolic pressure decreased significantly after the procedure in the propofol group (P<0.001). The average heart rate was significantly lower in the propofol group (P<0.05). No periods of desaturation (SpO₂ <95%) were observed in either group. The onset time was earlier in the etomidate group (P=0.00). All adverse events, with the exception of myoclonus, were greater in the propofol group, and physician and patient satisfaction in both groups was similar.
  
  
  CONCLUSIONS
  Etomidate-remifentanil administration for sedation and analgesia during gastroscopy resulted in more stable hemodynamic responses and less adverse events in older patients.
authors.affiliation: Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland).
authors.forename: Xiao-Chun
authors.initials: XC
authors.lastname: Shen
authors.affiliation: Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland).
authors.forename: Xing
authors.initials: X
authors.lastname: Ao
authors.affiliation: Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland).
authors.forename: Yan
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland).
authors.forename: Li
authors.initials: L
authors.lastname: Lan
authors.affiliation: Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland).
authors.forename: Xin-Man
authors.initials: XM
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland).
authors.forename: Wen-Jing
authors.initials: WJ
authors.lastname: Sun
authors.affiliation: Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland).
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China (mainland).
authors.forename: Chun-Hui
authors.initials: CH
authors.lastname: Lan
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000758:Anesthesia / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005045:Etomidate / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D005773:Gastroscopy / Q000379:methods*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015742:Propofol / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D000077208:Remifentanil; D013997:Time Factors
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol; D005045:Etomidate