The Application Of Propofol Target Controlled Infusion Combined With Etomidate In Painless Gastrointestinal Endoscopy

Object To investigate the efficacy and safety of propofol by target-controlled infusion（TCI）combined with etomidate in painless gastrointestinal endoscopy.Methods A total of 300 patients were randomly divided into the GroupⅠ（propofol TCI group）,GroupⅡ（0.1mg/kg etomidate+propofol TCI）,GroupⅢ（0.15mg/kg etomidate+propofol TCI）.Patients in GroupⅠreceived propofol TCI alone,the initial effect site concentration（Ce）of propofol TCI system was set at 3.0 ug/ml for upper gastrointestinal endoscopy.Ce of propofol TCI was further titrated using 0.5ug/ml step-size patient response.Patients in GroupⅡ,Ⅲreceived intravenous injection（IV）0.1mg/kg or 0.15mg/kg etomidate respectively before propofol TCI.The remaining steps were the same as GroupⅠ.The systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean arterial pressure（MAP）,heart rate（HR）,pulse oximetry（SPO₂）and respiratory rate（RR）were all recorded before induction until recovery.Induction time,CE of loss of consciousness（CeLOC）,induction of propofol dose,total propofol use,gastroscopy time,colonoscopy time,wake time,recovery time,CE of consciousness recovery（CeROC）,immediately intraoperative awareness,intraoperative awareness after 24h and adverse events（hypoxia,hypotension,bradycardia,injection pain,myoclonus,postoperative nausea and vomiting）were all recorded.The satisfaction of patients,endoscopy physicians and anesthesiologists were all recorded.Results The SBP,DBP and MAP of GroupⅢpatients were significantly higher than other groups after induction until recover.GroupⅡpatients had higher DBP and MAP than GroupⅠafter induction until wake.Hypoxia,hypotension,injection pain CeLOC,CeROC,induction of propofol dose and total propofol use of GroupⅢpatients were lower than other groups（P<0.05）.GroupⅡpatients had a lower recovery time than other groups（P<0.05）.The satisfaction of GroupⅢpatients,endoscopy physicians and anesthesiologists were higher than other groups（P<0.05）.Conclusion Three formula of anesthesia management can all be used for painless gastrointestinal endoscopy.However,propofol TCI combined with 0.15mg/kg etomidate for painless gastrointestinal endoscopy has less negative impact on hemodynamics and respiratory system,as well as lower incidence of adverse reactions,and is more suitable for painless gastrointestinal endoscopy.