Effect of etomidate combined with propofol on pulmonary complications and quality of recovery after laparoscopic abdominal surgery in elderly patients: a clinical, randomized, controlled study

Purpose To observe the effect of etomidate combined with propofol on pulmonary complications and quality of recovery after laparoscopic abdominal surgery in elderly patients. Methods Ninety patients undergoing elective laparoscopic abdominal surgery, aged 65 ~ 87 years, American society of anesthesiologists (ASA) physical status II or III, were randomly allocated into three groups: propofol group (group P), etomidate group (group E) and etomidate combined with propofol group (group EP), 30 patients in each group. Group P received 2.5 mg/kg propofol for anesthesia induction, followed by 6 ~ 8 mg·kg ^− 1 ·h ^− 1 propofol to maintain anesthesia. Group E received 0.3 mg/kg etomidate for anesthesia induction, followed by 0.4 ~ 0.7 mg·kg ^− 1 ·h ^− 1 etomidate to maintain anesthesia. Group EP received 0.2 mg/kg etomidate combined with 1 mg/kg propofol for anesthesia induction, followed by 0.2 ~ 0.4 mg·kg ^− 1 ·h ^− 1 etomidate combined with 4 ~ 6 mg·kg ^− 1 ·h ^− 1 propofol to maintain anesthesia. The incidence of postoperative pulmonary complications (PPCs) was recorded as the primary indicator. Secondary indicators included mean arterial pressure (MAP) and heart rate (HR) before anesthesia induction (T0), after tracheal intubation (T1), 30min after anesthesia induction (T2), and at the end of surgery (T3), the levels of IL-6 and TNF-α before anesthesia induction (T0), at the end of surgery (T3), and 24 hours after surgery (T4), awakening time, time to tracheal extubation, postoperative nausea and vomiting (PONV) and quality of recovery-15 (QoR-15) scale scores 1 day before and after surgery. Results The incidence of PPCs in group EP and group E was significantly lower than that in group P ( P  < 0.05). Compare with T0, the MAP and HR at T2 and T3 were more stable in group EP ( P  < 0.05). The levels of IL-6 and TNF-α in groups EP and E were lower than those in group P at T3 and T4 ( P  < 0.05). Compared with group E, the incidence of PONV was significantly lower in group EP and group P ( P  < 0.05). The QoR-15 scale scores in group EP were higher than that in group P and group E ( P  < 0.05). Conclusion Combination of etomidate and propofol for anesthesia can reduce the incidence of PPCs, alleviate inflammatory response, achieved better hemodynamic stability, reduce the incidence of PONV and improve the postoperative recovery quality in elderly patients undergoing laparoscopic abdominal surgery. Trial registration ChiCTR2200065117.