Safety and efficacy of combined use of propofol and etomidate for sedation during gastroscopy: Systematic review and meta-analysis

Lingyuan Chen, Xueyan Liang, Xinmei Tan, Haibin Wen, Junsong Jiang, Yan Li, Lingyuan Chen, Xueyan Liang, Xinmei Tan, Haibin Wen, Junsong Jiang, Yan Li

Abstract

Background: Sedation with etomidate or propofol alone during gastroscopy has many side effects. A systematic review and meta-analysis were conducted to evaluate the safety and efficacy of the combined use of propofol and etomidate for sedation during gastroscopy.

Methods: PubMed, Embase, Medline (via Ovid SP), Cochrane library databases, CINAHL (via EBSCO), China Biology Medicine disc (CBMdisc), Wanfang, VIP, and China National Knowledge Infrastructure (CNKI) databases were systematically searched. We included randomized controlled trials (RCTs) comparing the combined use of propofol and etomidate vs etomidate or propofol alone for sedation during gastroscopy. Data were pooled using the random-effects models or fixed-effect model based on heterogeneity.

Results: Fifteen studies with 2973 participants were included in the analysis. Compared to propofol alone, the combined use of propofol and etomidate possibly increased recovery time (SMD = 0.14, 95% CI = 0.04-0.24; P = .005), and the risk for myoclonus (OR = 3.07, 95% CI = 1.73-5.44; P < .001), injection pain, and nausea and vomiting. Furthermore, compared to propofol alone, the combination of propofol and etomidate produced an apparent beneficial effect for mean arterial pressure (MAP) after anesthesia (SMD = 1.32, 95% CI = 0.38-2.26; P = .006), SPO2 after anesthesia (SMD = 0.99, 95% CI = 0.43-1.55; P < .001), apnea or hypoxemia (OR = 0.16, 95% CI = 0.08-0.33; P < .001), injection pain, and body movement. Further, compared to etomidate alone, the combination of propofol and etomidate reduced the risk for myoclonus (OR = 0.15, 95% CI = 0.11-0.22; P < .001), body movement, and nausea and vomiting.

Conclusion: The combination of propofol and etomidate might increase recovery time vs that associated with propofol, but it had fewer side effects on circulation and respiration in patients undergoing gastroscopy. The combined use of propofol and etomidate can improve and produce an apparent beneficial effect on the adverse effects of propofol or etomidate alone, and it was safer and more effective than propofol or etomidate alone.

Conflict of interest statement

The authors have indicated that they have no conflicts of interest regarding the content of this article.

Figures

Figure 1
Figure 1
Selection process for the studies included in the meta-analysis.
Figure 2
Figure 2
Methodological quality assessment of the risk of bias for each included study. (A) Risk of bias summary; (B) risk of bias graph.
Figure 3
Figure 3
Meta-analysis of the of recovery time (min). (A) Recovery time of patients received co-administration of propofol and etomidate vs propofol alone, fixed-effect model; (B) recovery time of patients received co-administration of propofol and etomidate vs etomidate alone, random-effect model.
Figure 4
Figure 4
Meta-analysis of the MAP (mmHg). (A) MAP after the patients received co-administration of propofol and etomidate vs propofol alone, random-effect model; (B) MAP after the patients received co-administration of propofol and etomidate vs etomidate alone, fixed-effect model.
Figure 5
Figure 5
Meta-analysis of SPO2 (%). (A) SPO2 after the patients received co-administration of propofol and etomidate vs propofol alone, random-effect model; (B) SPO2 after the patients received co-administration of propofol and etomidate vs etomidate alone, fixed-effect model.
Figure 6
Figure 6
Meta-analysis of apnea or hypoxemia. (A) Co-administration of propofol and etomidate vs propofol alone, fixed-effect model; (B) co-administration of propofol and etomidate vs etomidate alone, fixed-effect model.
Figure 7
Figure 7
Meta-analysis of the myoclonus. (A) Co-administration of propofol and etomidate vs propofol alone, fixed-effect model; (B) co-administration of propofol and etomidate vs etomidate alone, fixed-effect model.

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