Propofol And Etomidate Alone Or Combined For Sedation During Gastroscopy: A Meta-Analysis

The propofol and etomidate combination used for sedation during gastroscopy has drawn considerable attention for its efficacy and safety compared to propofol or etomidate alone. However, the results are conflicting. This study aimed to perform a meta-analysis of randomized controlled trials to examine the safety and efficacy of propofol and etomidate combination for subjects during gastroscopy compared to either propofol or etomidate alone. A systematic literature search up to December 2019 was performed and 16 studies were identified with 3093 subjects. They were reporting relationships between propofol and etomidate combination uses and their efficacy and safety (14 compared to propofol, 12 compared to etomidate). We calculated the odds ratio (OR) or mean differences (MD) with 95% confidence intervals (CIs) was calculated to assess the efficacy and safety of propofol and etomidate combination and propofol or etomidate alone using the dichotomous or continuous method with a random or fixed-effect model. Significantly longer recovery time (MD, 0.26; 95% CI, 0.10-0.42, p = 0.001); higher mean arterial pressure (MD, 11.06; 95% CI, 8.66-13.45, p < 0.001); higher pulse oxygen saturation (MD, 2.36; 95% CI, 0.80-3.91, p = 0.003); higher myoclonus (OR, 3.09; 95% CI, 1.72-5.56, p < 0.001), and lower apnea or hypoxemia (OR, 0.16; 95% CI, 0.08-0.33, p < 0.001) were observed related to propofol and etomidate combination compared to propofol alone. However, no significant different was found in mean arterial pressure ( MD, -0.11; 95% CI, -1.66-1.45, p = 0.89); pulse oxygen saturation (MD, 0.08; 95% CI, -0.23-0.40, p = 0.60); and apnea or hypoxemia (OR, 1.18; 95% CI, 0.53-2.59, p = 0.69) between propofol and etomidate combination compared to etomidate alone. Though, there was a significantly lower myoclonus (OR, -0.22; 95% CI, -0.29- -0.16, p < 0.001), and shorter recovery time (MR, -0.30; 95% CI, -0.65-0.05, p = 0.09) between propofol and etomidate combination and etomidate alone. Using etomidate combined with propofol may lower the risk of low mean arterial pressure, low pulse oxygen saturation, high myoclonus, and apnea or hypoxemia of propofol alone; and also may lower the risk of high myoclonus and longer recovery time of etomidate alone. This relationship forces us to recommend the use of etomidate combined with propofol to avoid any complication that could occur with any of them alone.