Clinical Application Of Etomidate With Different Target Concentration And Propofol In Elderly Patients During ERCP Operation

Objective:To test the value of EC₅₀ and its 95%reliable interval of propofol inhibiting sympathetic response of gastroendoscope when compositing etomidate in different target concentration;By observing the hemodynamic indexes,levels of stress hormones and the adverse reactions occurred,using etomidate as the quantitative targets,to find out the suitable ratio of concentration for etomidate and propofol target controlled induction.Methods:The ninety ASAⅠorⅡelderly patients of both sexes aged 65-80 years who would undergo ERCP,were randomized into three groups（n=30 each）.Group E₁-E₃was with different concentration etomidate:Target controlled infusion of propofol in target chamber was performed with target controlled infusion of etomidate at0.1ug/ml（E1）,0.2ug/ml（E2）and 0.3ug/ml（E3）.The sequence of anesthesia induction is IV sufentanil 0.1ug/kg,anisodamine 10mg,tropisetron 5mg and target controlled infusing propofol,when BIS<60 and Ce of propofol reaches presupposed plasma concentration,making insert gastroendoscope.By"up and down"method to target controlled infusing propofol,according to the pre-experiment,the initial Ce of propofol of three groups’elderly patients is 3.0ug/ml,and ratio of two close target concentrations was 1:1.1.According to the intercalation reaction,the target concentration of the effect chamber of propofol is determined:if the insertion mirror has a reaction,the target concentration of the next propofol effect chamber target concentration is increased by a concentration gradient,and the target concentration of the next propofol response chamber is reduced by a concentration gradient if the insertion mirror is not reacted.During the study,when there are seven consecutive negative inflection points,stop the experiment,and then record the value of EC₅₀ and its 95%reliable interval of propofol of negative reaction when inserting gastroendoscope.The values of T1,T2,1min（T3）,3min（T4）,5min（T5）after digestive endoscopy,heart rate（HR）,oxygen saturation（SPO2）,mean arterial pressure（MAP）,and bispectral index of electroencephalogram（MAP）were recorded at the time of insertion of digestive endoscopy（T3）,3min（T4）,5min（T5）,and open eyes（T6）.At the time of T1 and T4,the left elbow vein blood sample 2ml was taken into the procoagulant tube,and the content of cortisol（COR）and norepinephrine（NE）was measured by radioimmunoassay.The number of adverse reactions,such as the operation time,the opening time,the time of opening to the room and the respiratory inhibition,injection pain and muscle array tremor were recorded.Results:1.There was no significant difference in sex composition ratio,age,height,weight and ASA grade between the three groups（p>0.05）;there’s no statistically significant difference of the operation time,eye-opening time and time of leaving operating room（p>0.05）.2.The EC₅₀0 and 95%CI of propofol with inhibiting the sympathetic response of gastroendoscope in the three groups.The EC₅₀ and 95%CI of propofol with inhibiting the sympathetic response of gastroendoscope in the three groups are:group E1 is 3.23（2.91-3.61）ug/ml;group E2 is 2.89（2.68-3.14）ug/ml;group E3 is 2.72（2.31-3.01）ug/ml.In group E1 to E3,with the increase of target concentration of etomidate effect,the stress response of digestive endoscopy was inhibited,and the EC50 of propofol gradually decreased,Compared with Group E1,the EC50 of propofol with inhibiting the sympathetic response of gastroendoscope in the group E2,E3 decreased significantly（p<0.05）,Patients in group E2 and group E3 suppressed digestive endoscopy stress response.There was no significant difference in EC50 between propofol and propofol（p>0.05）.3.Comparison of hemodynamic parameters and the BIS between the three groups.Comparison within the groups:There’s no statistically significant difference of MAP,HR,SPO₂,BIS at TI in three groups（p>0.05）,the value of MAP and BIS of three groups have reduced at T2,T3,T4,T5 compared with T1（p<0.05）.Comparison between groups:compared with group E1,the value of MAP at T2,T3 have mildly reduced of group E2,E3（p<0.05）,at T2,T3,there is no statistically significant difference between group E2 and E3（p>0.05）.At T4,T5,there is no statistically significant difference in three groups（p<0.05）,at the other time point,the value of BIS,SPO₂,HR is in normal range and with no statistically significant difference in each groups（p>0.05）.4.Comparison of stress response cortisol（COR）and norepinephrine（NE）in three groups of patientsAt T1,there’s no statistically significant difference of the value of COR,NE in three groups（p>0.05）.Compared with TI,the value of COR,NE at T4 have increased in group E1,E2,E3（p<0.05）.Compared with group E3,the value of COR,NE have slightly increased at T4 in groupE1,E2（p<0.05）.5.Comparison of adverse reactions in three groupsCompared with group E1,the occurrence rate of hypotension,respiratory depression,intravenous injection pain has obviously reduced in group E2,E3（p<0.05）,and there is no statistically significant difference of the occurrence rate of hypotension,respiratory depression,intravenous injection pain between group E2 and E3（p>0.05）.The occurrence rate of myoclonia and PONV in groupE3 is obviously higher than the other two groups（p<0.05）.With the Ce of propofol increasing,the occurrence rate of myoclonia and PONV increase in three groups.Conclusion:Within a certain range,with the increase of target concentration of etomidate,the median effective concentration of propofol to inhibit digestive endoscopy stress gradually decreased.0.2ug/ml etomidate and 2.89（2.68-3.14）ug/ml propofol combined with target controlled infusion can effectively inhibit the stress response of digestive endoscopy,and it causes less adverse reactions,and it effectively inhibits the sympathetic response of gastroendoscope,so it is suitable for clinical choice.