Effect of anesthesia with propofol plus remifentanil vs etomidate plus remifentanil on respiratory function and stress in elderly patients with esophageal leukoplakia treated by gastroscopy

Abstract

BACKGROUND With the development of society and the advancement of science and technology, the patient’s requirements for comfort during gastroscopy are constantly increasing, and more attention has been paid to the possible adverse reactions. More and more patients choose to undergo painless gastroscopy. Elderly patients have vascular tolerance, significant organ function decline, and higher requirements for anesthetic drugs due to age and degenerative changes. Therefore, it is important to choose the correct anesthetic drugs during gastroscopy in elderly patients. AIM To compare the effects of anesthesia with propofol plus remifentanil and etomidate plus remifentanil on respiratory function and stress in elderly patients with esophageal leukoplakia. METHODS A total of 200 elderly patients (aged 62-73 years) with esophageal leukoplakia who underwent painless gastroscopy at the Endoscopy Center of our hospital from April 2018 to October 2018 were enrolled. The patients were randomly divided into either a control group or a study group, with 100 patients in each group. The control group was anesthetized with propofol and remifentanil, and the study group was anesthetized with etomidate and remifentanil. Serum oxygen saturation (SPO2) and stress hormones (adrenocorticotropic hormone, glucocorticoid, and angiotensin) before and at the end of treatment were compared between the two groups. Hemodynamics during treatment, adverse reactions during treatment, and the difference in time to recovery of spontaneous breathing time were also compared. RESULTS Serum levels of stress hormones in the two groups were comparable before treatment. At the end of treatment, serum levels of stress hormones (adrenocorticotropic hormone, glucocorticoid, and angiotensin) in the study group were significantly lower than those in the control group (P < 0.05). Hemodynamics was more stable in the study group (P < 0.05). SPO2 was significantly higher in the study group than in the control group (P < 0.05). The rate of adverse reactions was significantly reduced in the study group (P < 0.05). However, the time to recovery of spontaneous breathing was significantly shorter in the control group than in the study group (P < 0.05). CONCLUSION Compared with anesthesia with propofol plus remifentanil, etomidate plus remifentanil in elderly patients with esophageal leukoplakia can reduce inflammatory factors and stress hormones more significantly, maintain hemodynamics and intraoperative blood oxygenation saturation more stably, and have fewer adverse reactions, but is associated with longer time to recovery of spontaneous breathing.