Cardiopulmonary and Neurologic Safety in Patients with Liver Cirrhosis of Etomidate-Based Sedation Compared with Propofol During Upper Endoscopy: A Double-Blind, Randomized Controlled Trial

Background/Aims Etomidate‐based sedation during endoscopy was superior to propofol in terms of the overall hemodynamic and respiratory events in previous reported trials. However, there is a lack of evidence on the safety of etomidate in patients with liver cirrhosis (LC). The aim of this study was to compare efficacy and safety profiles including hepatic encephalopathy of etomidate and propofol for endoscopic sedation in patients with LC. Methods This single‐center, randomized, double‐blind trial included patients with chronic liver disease who had evidence of LC who were undergoing diagnostic or therapeutic endoscopy. Either etomidate or propofol was administered according to group allocation. The primary endpoint was the proportion of patients with any cardiopulmonary adverse events. Also, the trail making test (TMT) A consists of documenting the time required to sequentially connect randomly placed circles which are labeled from 1 to 25 was also assessed. Results Fifty‐three and 56 patients were enrolled in the etomidate and propofol groups, respectively. There were no significant differences between the groups regarding the total procedure time, induction time, awake time, and recovery time. The overall incidence of respiratory and cardiovascular events was not different between the groups. The time for TMT tended to be higher in the propofol group than etomidate group without significant difference (mean±standard deviation, 92.4±116.8 vs 67.1±56.6 seconds; p=0.151). Also, the proportion of patients without any cognitive dysfunction was not different between the groups (etomidate vs propofol, 12 [22.6%] vs 11 [19.6%]; p=0.570). Conclusions Etomidate‐based sedation in patients with LC was noninferior to propofol‐ based sedation in terms of the overall incidence of respiratory, cardiovascular and neurologic adverse events.