Abstract：
BACKGROUND: Propofol is increasingly being used for sedation in gastrointestinal endoscopy; however, owing to its side effects, an alternative drug is needed. We aimed to compare the safety, satisfaction, and efficacy outcomes of etomidate versus propofol in patients undergoing gastrointestinal endoscopy, including advanced endoscopic procedures.
METHODS: We systematically searched Embase, PubMed, Cochrane Central Register of Controlled Trials, CINAHL (via EBSCO), China National Knowledge Infrastructure, and Web of Science (1946-April 2020) databases for randomized controlled trials of gastrointestinal endoscopy (upper gastrointestinal endoscopy, colonoscopy, and advanced endoscopy) using etomidate or propofol as sedatives. We pooled odds ratios (ORs) for the safety profile and patient and anesthesiologist satisfaction using mixed-effects conditional logistic models and standardized mean differences for efficiency outcomes using random-effects models.
RESULTS: Twenty-four studies involving 3875 patients were included. Compared with propofol, etomidate resulted in significantly reduced apnea (OR: 0.22; 95% confidence interval [CI]: 0.13-0.37; P < .001), hypoxemia (OR: 0.43; 95% CI: 0.35-0.54; P < .001), hypotension (OR: 0.20; 95% CI: 0.11-0.36; P < .001), and bradycardia (OR: 0.52; 95% CI: 0.30-0.91; P = .02) but led to increased myoclonus (OR: 8.54; 95% CI: 5.20-14.01; P < .001) and lowered anesthesiologist satisfaction (OR: 0.60; 95% CI: 0.39-0.91; P = .02).
CONCLUSIONS: Etomidate may be a good alternative to propofol for gastrointestinal endoscopy, especially advanced endoscopy. Etomidate appears to be safe as an inducer for hemodynamically unstable patients or older adult patients undergoing gastrointestinal endoscopy.
METHODS: We systematically searched Embase, PubMed, Cochrane Central Register of Controlled Trials, CINAHL (via EBSCO), China National Knowledge Infrastructure, and Web of Science (1946-April 2020) databases for randomized controlled trials of gastrointestinal endoscopy (upper gastrointestinal endoscopy, colonoscopy, and advanced endoscopy) using etomidate or propofol as sedatives. We pooled odds ratios (ORs) for the safety profile and patient and anesthesiologist satisfaction using mixed-effects conditional logistic models and standardized mean differences for efficiency outcomes using random-effects models.
RESULTS: Twenty-four studies involving 3875 patients were included. Compared with propofol, etomidate resulted in significantly reduced apnea (OR: 0.22; 95% confidence interval [CI]: 0.13-0.37; P < .001), hypoxemia (OR: 0.43; 95% CI: 0.35-0.54; P < .001), hypotension (OR: 0.20; 95% CI: 0.11-0.36; P < .001), and bradycardia (OR: 0.52; 95% CI: 0.30-0.91; P = .02) but led to increased myoclonus (OR: 8.54; 95% CI: 5.20-14.01; P < .001) and lowered anesthesiologist satisfaction (OR: 0.60; 95% CI: 0.39-0.91; P = .02).
CONCLUSIONS: Etomidate may be a good alternative to propofol for gastrointestinal endoscopy, especially advanced endoscopy. Etomidate appears to be safe as an inducer for hemodynamically unstable patients or older adult patients undergoing gastrointestinal endoscopy.
摘要：
背景：丙泊酚越来越多地用于胃肠内窥镜检查的镇静；然而，由于它的副作用，需要一种替代药物。我们的目的是比较安全性，满意,在接受胃肠内镜检查的患者中，依托咪酯与丙泊酚的疗效结果，包括先进的内窥镜手术。
方法：我们系统地搜索了Embase，PubMed,Cochrane中央控制试验登记册,CINAHL（通过EBSCO），中国国家知识基础设施，和WebofScience(1946-2020年4月)胃肠内镜随机对照试验数据库(上消化道内镜，结肠镜检查,和高级内窥镜检查）使用依托咪酯或异丙酚作为镇静剂。我们使用混合效应条件逻辑模型汇总了安全性和患者和麻醉师满意度的优势比（OR），并使用随机效应模型汇总了效率结果的标准化平均差异。
结果：纳入了涉及3875名患者的24项研究。与异丙酚相比，依托咪酯导致呼吸暂停显着减少（OR：0.22;95％置信区间[CI]：0.13-0.37;P<.001），低氧血症(OR:0.43;95%CI:0.35-0.54;P<.001),低血压(OR:0.20;95%CI:0.11-0.36;P<.001),和心动过缓（OR：0.52；95％CI：0.30-0.91；P=.02），但导致肌阵挛性增加（OR：8.54；95％CI：5.20-14.01；P<.001）和麻醉医师满意度降低（OR：0.60；95％CI：0.39-0.91；P=.02）。
结论：依托咪酯可能是用于胃肠镜检查的异丙酚的良好替代品，尤其是先进的内窥镜检查.依托咪酯作为血液动力学不稳定患者或接受胃肠内镜检查的老年患者的诱导剂似乎是安全的。
方法：我们系统地搜索了Embase，
结果：纳入了涉及3875名患者的24项研究。
结论：依托咪酯可能是用于胃肠镜检查的异丙酚的良好替代品，
