The Comparison of Etomidate and Propofol Anesthesia in Patients Undergoing Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis

Introduction: Etomidate and propofol played an important role in the sedation of patients undergoing gastrointestinal endoscopy. We conducted a systematic review and meta-analysis to compare their efficacy and safety. Materials and Methods: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials assessing the effect of etomidate versus propofol for the anesthesia of patients undergoing gastrointestinal endoscopy were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were anesthesia duration and recovery time. Meta-analysis was performed using random-effect model. Results: Six randomized controlled trials involving 1115 patients were included in the meta-analysis. Overall, compared with propofol, etomidate resulted in comparable anesthesia duration [standard mean difference (Std. MD)=−0.03; 95% confidence interval (CI), −0.16 to 0.10; P =0.66], recovery time (Std. MD=0.25; 95% CI, −0.42 to 0.92; P =0.47), mean arterial pressure at intubation (Std. MD=0.44; 95% CI, −0.26 to 1.15; P =0.21), heart pulse at intubation (Std. MD=0.93; 95% CI, −0.69 to 2.55; P =0.26), SPO 2 at intubation (Std. MD=−0.52; 95% CI, −1.04 to 0.01; P =0.05), patient satisfaction [odds risk (OR)=0.42; 95% CI, 0.11-1.66; P =0.22], hypotension (OR=0.14; 95% CI, 0.02-1.22; P =0.07), changes of heart rate (OR=0.97; 95% CI, 0.61-1.53; P =0.88), nausea-vomiting (OR=2.02; 95% CI, 0.73-5.57; P =0.17), and the reduction in apnea or hyoxemia (OR=0.39; 95% CI, 0.24-0.64; P =0.0002), and injection pain (OR=0.03; 95% CI, 0.01-0.08; P <0.00001), but the increase in myoclonus (OR=8.54; 95% CI, 3.14-23.20; P <0.0001). Conclusions: Between etomidate and propofol, no significant difference was revealed regarding anesthesia duration, recovery time, mean arterial pressure at intubation, heart pulse at intubation, SPO 2 at intubation, patient satisfaction, hypotension, changes of heart rate and nausea-vomiting. Compared with propofol, etomidate showed reduced apnea or hyoxemia, and injection pain, but with an increased myoclonus.