Gut and Liver https://doi.org/10.5009/gnl18514 Using Etomidate/Midazolam for Screening Colonoscopies Results in More Stable Hemodynamic Responses in Patients of All Ages
Author Information
Jung Min Lee 1, 2, Geeho Min 2, Bora Keum 2, Jae Min Lee 2, Seung Han Kim 2, Hyuk Soon Choi 2, Eun Sun Kim 2, Yeon Seok Seo 2, Yoon Tae Jeen 2, Hoon Jai Chun 2, Hong Sik Lee 2, Soon Ho Um 2 and Chang Duck Kim 2
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Wonkwang University Sanbon Medical Center, Gunpo, Korea, and 2Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea

Bora Keum
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute ofDigestive Disease and Nutrition, Korea University Anam Hospital, 126-1 Anamdong 5-ga,Seongbuk-gu, Seoul 136-705, Korea
Tel: +82-2-920-6555, Fax: +82-2-953-1943, E-mail: borakeum@hanmail.net
© The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. All rights reserved.

Abstract
Background/Aims: Recent studies have demonstrated that etomidate is a safe sedative drug withnoninferior sedative effects. In our recent study, we revealed that etomidate/midazolam was morehemodynamically stable than propofol/midazolam in elderly patients undergoing colonoscopies. Weaimed to investigate whether compared with propofol/midazolam, etomidate/midazolam causes fewercardiopulmonary adverse events with noninferior efficacy for screening colonoscopies in patients ofall ages. Methods: In this single-center, randomized, double-blind study, we prospectively enrolled200 patients. The patients were divided into etomidate and propofol groups. The primary outcomewas the occurrence of cardiopulmonary adverse events. The secondary outcomes were the proportionof patients with fluctuations in vital signs (oxygen desaturation and transient hypotension), adverseevents interrupting the procedure, and sedation-related outcomes. Results: Adverse cardiopulmonaryevents were more common in the propofol group than the etomidate group (65.0% vs 51.0%,respectively; p=0.045). Forty-six patients (46.0%) in the propofol group and 29 (29.0%) in theetomidate group experienced fluctuations in their vital signs (p=0.013). The proportions of patientsexperiencing adverse events that interrupted the procedure, including myoclonus, were notsignificantly different between the two groups (etomidate: 20.0% vs propofol: 11.0%; p=0.079). Bothgroups had similar sedation-related outcomes. Multivariate analysis revealed that compared with thepropofol groups, the etomidate group had a significantly lower risk of fluctuations in vital signs (oddsratio, 0.427; 95% confidence interval, 0.230 to 0.792; p=0.007). Conclusions: Compared with usingpropofol/midazolam, using etomidate/midazolam for screening colonoscopies results in more stablehemodynamic responses in patients of all ages; therefore, we recommend using etomidate/midazolamfor colonoscopies in patients with cardiovascluar risk factors.
Keywords: Etomidate; Colonoscopy; Propofol; Midazolam; Sedation
Abstract
Background/Aims: Recent studies have demonstrated that etomidate is a safe sedative drug withnoninferior sedative effects. In our recent study, we revealed that etomidate/midazolam was morehemodynamically stable than propofol/midazolam in elderly patients undergoing colonoscopies. Weaimed to investigate whether compared with propofol/midazolam, etomidate/midazolam causes fewercardiopulmonary adverse events with noninferior efficacy for screening colonoscopies in patients ofall ages. Methods: In this single-center, randomized, double-blind study, we prospectively enrolled200 patients. The patients were divided into etomidate and propofol groups. The primary outcomewas the occurrence of cardiopulmonary adverse events. The secondary outcomes were the proportionof patients with fluctuations in vital signs (oxygen desaturation and transient hypotension), adverseevents interrupting the procedure, and sedation-related outcomes. Results: Adverse cardiopulmonaryevents were more common in the propofol group than the etomidate group (65.0% vs 51.0%,respectively; p=0.045). Forty-six patients (46.0%) in the propofol group and 29 (29.0%) in theetomidate group experienced fluctuations in their vital signs (p=0.013). The proportions of patientsexperiencing adverse events that interrupted the procedure, including myoclonus, were notsignificantly different between the two groups (etomidate: 20.0% vs propofol: 11.0%; p=0.079). Bothgroups had similar sedation-related outcomes. Multivariate analysis revealed that compared with thepropofol groups, the etomidate group had a significantly lower risk of fluctuations in vital signs (oddsratio, 0.427; 95% confidence interval, 0.230 to 0.792; p=0.007). Conclusions: Compared with usingpropofol/midazolam, using etomidate/midazolam for screening colonoscopies results in more stablehemodynamic responses in patients of all ages; therefore, we recommend using etomidate/midazolamfor colonoscopies in patients with cardiovascluar risk factors.
Keywords: Etomidate; Colonoscopy; Propofol; Midazolam; Sedation
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