The Comparison of Midazolam and Propofol in Gastrointestinal Endoscopy: A Systematic Review and Meta-analysis

Abstract

When compared with midazolam sedation for gastrointestinal endoscopy, propofol sedation results in higher endoscopist satisfaction scores, but may increase the incidence of hypotension.

Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study.

“…In a meta-analysis, propofol-induced respiratory depression and hypotensive effects were shown to be more common than in single use. In the same article, it was reported that recovery time was shorter and patient cooperation was better when used with opioids or midazolam [11]. However, higher doses of propofol may cause platelet aggregation [12], metabolic acidosis [13], delayed awakening [14], depression of the hypoxic ventilator response, and cardiorespiratory depression.…”

Procedural sedation : Aspects on methods, safety and effectiveness

“…The frequency of desaturation among patients with propofol was highest in the ACS group (Study I). Neither mode of propofol administration (28) nor drug (midazolam or propofol) seemed to influence the risk for desaturation during GI endoscopy (5) or bronchoscopy (78), except for one non-randomised study that showed a decreased incidence for PCS compared with anaesthesiologistadministered sedation (77). Of the complications related to the sedation, respiratory depression represented a third of all minor complications within colonoscopy (13).…”

Changes of Arterial Blood Pressure and Heart Rate During Induction of Anesthesia With Midazolam and Fentanyl. Is Enhanced Basal Cardiac Parasympathetic Tonus a Risk Factor for Cardiovascular Instability?

“…The combination of an opioid and midazolam is the most commonly used sedation regimen in gastrointestinal endoscopy [5][6][7][8]. Midazolam is a benzodiazepine which has been used successfully with other induction agents to reduce the dose of these drugs, a technique called co-induction [9].…”

“…Many studies have examined the hemodynamic changes after administration of midazolam, but in most of them midazolam was administered for sedation [5][6][7]11,20]. Only few studies investigated the hemodynamic changes after induction of anesthesia with midazolam, and it is important to note that in most of these studies midazolam was used as an anesthesia co-induction agent [9,10,12].…”

“…In a recent meta-analysis of five randomized clinical trials involving 552 patients, Zhang R. et al found that sedation during gastrointestinal endoscopy with midazolam was safer than propofol (propofol showed higher incidence of hypotension than midazolam) [7]. Tsai H.C. et al [6] in another meta-analysis of five randomized studies conducted between 2003 and 2012 analyzed the efficacy and safety of midazolam sedation in cirrhotic patient undergoing endoscopy.…”