Etomidate and Propofol: Which Would be Safe from the Hemodynamic Viewpoint in Colonoscopy Exams?

Main Article Content

Adriana Rolim Campos Emilyanne Gonzaga Arnaud André Arnaud

Abstract

Justification


Most patients who undergo colonoscopy are over 55 years old, with comorbidities and who use cardio-depressant drugs. In addition, exam preparation includes the use of osmotic diuretics, causing osmotic diarrhea leading many patients to some degree of dehydration. Considering all these factors and knowing that the drug selected for sedation also acts by depressing the cardiovascular system, this study proposes to evaluate the action of two hypnotic drugs (etomidate and propofol) routinely used for sedation..


Methods


In two private clinics, 105 participants (18 to 90 years old), ASA I and ASA II (American Society of Anaesthesiologist score) were selected. Participants were divided into two groups: fentanyl 1 mcg / kg + midazolam 0.03 mg / kg + etomidate 0.3 mg / kg (n = 52) and fentanyl 1 mcg / kg + midazolam 0.03 mg / kg + propofol 2 mg / kg (n = 53). Participants were monitored with cardioscope, pulse oximeter and tensiometer. Blood pressure, heart rate and oxygen saturation parameters were observed before, during and after the exam.


Results


Most participants were ASA II (63%) and female (74%). In subjects who received propofol group significant reductions in the systolic (p <0.05) and diastolic (p <0.05) blood pressures and significantly increased heart rate (p <0.05) compared to the group receiving etomidate. There was no difference in hemodynamic variation between male and female participants. There was no difference in satisfaction of endoscopists and patients regarding medications used for sedation.


Conclusion


The hypnotic drug etomidate was safer from the hemodynamic point of view for sedation in colonoscopy exams.

Article Details

How to Cite
CAMPOS, Adriana Rolim; ARNAUD, Emilyanne Gonzaga; ARNAUD, André. Etomidate and Propofol: Which Would be Safe from the Hemodynamic Viewpoint in Colonoscopy Exams?. Medical Research Archives, [S.l.], v. 8, n. 11, dec. 2020. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2270>. Date accessed: 28 nov. 2022. doi: https://doi.org/10.18103/mra.v8i11.2270.
Section
Research Articles

References

1. Lopes G, Stern MC, Temin S, Sharara AL, Cervantes A, Costas-Chavarri A. et al. Early detection for colorectal cancer: ASCO resource-stratified guideline. Journal of Oncology Practice, 2019; 15(5): 287-289.
2. Reisine T, Pasternak G. Opioid analgesics and antagonists. In: Hardman JG, Limbird LE, Molinoff PB, Ruddon RW, Gilman AG. (Ed.). Goodman and Gilman’s: the pharmacological basis of therapeutic. 9th ed. New York: McGraw-Hill Companies, 2017. p. 521–549.
3. Thomson A, Andrew G, Jones BD. Optimal sedation for gastrointestinal endoscopy: review and recommendations. Journal of Gastroenterology and Hepatology, 2010; 25(3): 469–478.
4. Reeves JG, Glass PS, Lubersky DA, Mcevoy MD, Martinez-Ruiz R. Intravenous anaesthetics. In: Miller RD, Eriksson L, Fleisher Lee, Wiener-Kronish J, Young W. (ed.). Miller’s anaesthesia. 7th ed. USA/Churchil, 2015.
5. Langley MS, Heel RC. Propofol: A review of its pharmacodynamic and pharmacokinetic properties and use as an intravenous anesthetic properties and use as an intravenous anesthetic. Drugs, 1988; 35: 334-372.
6. Manica J. Anestesiologia. 4nd ed. Porto Alegre: Artmed, 2018.
7. Brüssel T, Theissen JL, Vigfusson G, Lunkenheimer PP, Van Aken H, Lawin P. Hemodynamic and cardiodynamic effects of propofol and etomidate: negative inotropic properties of propofol. Anesthesia & Analgesia, 1989; 69(1): 35-40.
8. Yeung JK, Zed PJ. A review of etomidate for rapid sequence intubation in the emergency department. Canadian Journal of Emergency Medicine, 2002; 3: 194–1982.
9. Lee JM, Min G, Lee JM, Kim SH, Choi HS, Kim ES, Keum B, Jeen YT, Chun HJ, Lee HS, Kim CD, Park JJ, Lee BJ, Choi SJ, Kim W. Efficacy and safety of etomidate-midazolam for screening colonoscopy in the elderly. Medicine, 2018; 97 (20): e10635.
10. Gäßler M, Ruppert M, Lefering R, Bouillon B, Wafaisade A, TraumaRegister DGU. Pre-hospital emergent intubation in trauma patients: the influence of etomidate on mortality, morbidity and healthcare resource utilization. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2019; 27(1): 61.
11. Gross JB, Bailey PL, Connis RT, Coté CJ, Davis FG, Epstein BS, Gilbertson L, Nickinovich DG, Zerwas JM, Zuccaro G. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology, 2002; 96(4): 1004–1017.
12. Lichtenstein DR, Jagannath S, Baron TH, Anderson MA, Banerjee S, Dominitz JA, Fanelli RD, Gan IS, Harrison E, Ikenberry SO, Shen B, Stewart L, Khan K, Vargo JJ. Sedation and anesthesia in GI endoscopy. Gastrointestinal Endoscopy, 2008; 68(5): 815–826.
13. Lee JM, Min G, Lee JM, Kim SH, Choi HS, Kim ES, Keum B, Jeen YT, Chun HJ, Lee HS, Kim CD, Park J-J, Lee BJ, Choi SJ, Kim W. Efficacy and safety of etomidate-midazolam for screening colonoscopy in the elderly. Medicine, 2018; 97(20): e10635.
14. Sankar A, Johnson S.R., Beattie W.S, Tait G, D. N. Wijeysundera D.N, Myles P.S, Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. British Journal of Anesthesia, 2014;113(3):424–432.
15. Rossoni MD, Sartos MC, Rossoni AMO, Bonardi RA, Souza Filho ZA. Comparação entre as soluções orais de mannitol a 10% e bifosfato de sódio no prepare mecânico do colon. Rev. Col. Bras. Cir., 2008; 35(5): 323-328.
16. Hassan C, Bretthauer M, Kaminski MF, Polkowski M, Rembacken B, Saunders B, Benamouzig R, Holme G, Green S, Kulper T, Marmo R, Omar M, Petruzziello L, Spada C, Zullo A, Dumonceau JM, European Society of Gastrointestinal Endoscopy. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy, 2013; 45(2): 142-150.
17. Weil MH (1988) Defining hemodynamic instability. In: Braunwald E (ed) Heart Disease. WB Saunders, Philadelphia, pp 561–568
18. Forman SA. Clinical and molecular pharmacology of etomidate. Anesthesiology, 2011; 114(3): 695-707.
19. Erdoes G, Basciani R, Eberle B. Etomidate: a review of robust evidence for its use in various clinical scenarios. Acta Anaesthesiologica Scandinavica, 2014; 58(4): 380-389.
20. NCA. Estimativa 2018: incidência de Câncer no Brasil. Instituto
21. Nacional de Câncer José Alencar Gomes da Silva. Coordenação de Prevenção e Vigilância. Rio de Janeiro: INCA, 2018.