Clinical Observation Of Etomidate Combined With Propofol And Remifentanil In Painless Gastroscopy

Objective: To compare comfort and safety of etomidate combined with propofol and remifentanil for painless gastroscopy in outpatients.Methods: 150 patients for painless gastroscopy examination were randomly divided into 3 groups(each group with 50 patients): Group I propofol + remifentanil group,group II etomidate + remifentanil group and group III etomidate + propofol + remifentanil group.Before examination,all these patients fasted more than 8H and stopped drinking for more than 4H.After entering the digestive endoscope examinatingroom: The right upper limb venous was opened,heart rate,blood pressure and blood oxygen saturation was monitored.Then patient slept on left lateral position with oxygen inhalation 3-5L/min.Remifentanil 0.2ug/kg was injected firstly intravenously;After 30-45 s,Group I was given 2mg/kg propofol;Group II was given 0.2-0.25mg/kg etomidate;Group III was given 0.1mg/kg etomidate and 1mg.kg-1 propofol respectively.During examination,30-50 mg of propofol or 3-5mg of etomidate was added if needed.During the process,all groups were observed and examined after the eyelash reflex disappeared.(1)Systolic pressure,diastolic pressure,mean arterial pressure,heart rate and blood oxygen saturation were recorded before,during and after operation.(2)The incidence of hypotension(systolic < 80 mm Hg),bradycardia(HR < 50 BPM),hypoxemia(Sp O2 < 90%),muscle tremors,injection pain and body movement were also recorded.(3)The time of induction,inspecting,recovery was recorded.(4)Postoperative complications such as nausea,vomiting,dizziness and the intraoperative awareness and other adverse reactions were all recorded.(5)As well as VAS score after operation.Result:Compared with before inspection,systolic pressure,diastolic pressure,mean arterial pressure,heart rate and blood oxygen saturation decreased in the three groups(P< 0.05).The incidence of muscle tremors in group II was greater than that in the other two groups(P< 0.05).The incidence of injection pain in group I was greater than that in the other two groups(P< 0.05).The decrease of blood pressure in group I was greater than that of the other two groups(P< 0.05)and the heart rate decreased,while the heart rate increased after the examination.The recovery time of the three groups was basically the same,with no significant difference.Conclusion: Etomidate combined with propofol and remifentanil is effective for painless gastroscopy,The hemodynamics were stable and the adverse reactions were less.Its safety and comfort are better than those of etomidate combined with remifentanil or propofol combined with remifentanil which was used alone.It is more suitable for extensive use in the hospital.