Effect of Etomidate vs Propofol for Total Intravenous Anesthesia on Major Postoperative Complications in Older Patients

作者：Zhihong Lu, Hong Zheng, Zhijun Chen, Shiyuan Xu, Shibiao Chen, Weidong Mi, Tianlong Wang, Xiaoqing Chai, Qulian Guo, Haiyan Zhou, Yonghao Yu, Xiaochun Zheng, Jiaqiang Zhang, Yanqiu Ai, Buwei Yu, Hongguang Bao, Hui Zheng, Wenqi Huang, Anshi Wu, Xiaoming Deng, Hong Ma, Weiqing Ma, Liyuan Tao, Xue Yang, Junbao Zhang, Tingting Liu, Haiping Ma, Wei Liang, Xiang Wang, Yang Zhang, Wei Du, Ting Ma, Yanhu Xie, Yongqiu Xie, Na Li, Yong Yang, Ting Zheng, Chunyan Zhang, Yanling Zhao, Rong Dong, Chen Zhang, Guo‐Hua Zhang, Kuanzhi Liu, Yan Wu, Xiaohua Fan, Wenfei Tan, Na Li, Hailong Dong, Lize Xiong · 发表于：JAMA Surgery · 年份：2022 · DOI：10.1001/jamasurg.2022.3338 · 被引用次数：79 · 研究领域：Anesthesia and Sedative Agents、Cardiac, Anesthesia and Surgical Outcomes、Adrenal Hormones and Disorders

Importance: Older patients may benefit from the hemodynamic stability of etomidate for general anesthesia. However, it remains uncertain whether the potential for adrenocortical suppression with etomidate may increase morbidity. Objective: To test the primary hypothesis that etomidate vs propofol for anesthesia does not increase in-hospital morbidity after abdominal surgery in older patients. Design, Setting, and Participants: This multicenter, parallel-group, noninferiority randomized clinical trial (Etomidate vs Propofol for In-hospital Complications [EPIC]) was conducted between August 15, 2017, and November 20, 2020, at 22 tertiary hospitals in China. Participants were aged 65 to 80 years and were scheduled for elective abdominal surgery. Patients and outcome assessors were blinded to group allocation. Data analysis followed a modified intention-to-treat principle. Interventions: Patients were randomized 1:1 to receive either etomidate or propofol for general anesthesia by target-controlled infusion. Main Outcomes and Measures: Primary outcome was a composite of major in-hospital postoperative complications (with a noninferiority margin of 3%). Secondary outcomes included intraoperative hemodynamic measurements; postoperative adrenocortical hormone levels; self-reported postoperative pain, nausea, and vomiting; and mortality at postoperative months 6 and 12. Results: A total of 1944 participants were randomized, of whom 1917 (98.6%) completed the trial. Patients were rand...