Comparison of propofol monotherapy and propofol combination therapy for sedation during gastrointestinal endoscopy: A systematic review and meta‐analysis

Yoon, Sang Won; Choi, Geun Joo; Lee, Oh Haeng; Yoon, Il Jae; Kang, Hyun; Baek, Chong Wha; Jung, Yong Hun; Woo, Young Cheol

doi:10.1111/den.13050

Cited by 25 publications

(20 citation statements)

References 37 publications

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“…7 However, determining the individualized target concentration is an urgent clinical problem that needs to be solved. 7,9,10 In a previous clinical study, a close correlation between the disappearance of the eyelash reflex and the effect-site concentration was found upon insertion of the gastroscope into the pharynx. 11 Therefore, this study mainly aimed to observe the correlation between the disappearance of the eyelash reflex and the gastroscopic operation during anesthesia induction in painless gastroscopy, and explore the rapid individualised assessment of the dose of propofol, as well as the clinical feasibility of its corresponding anesthetic scheme.…”

Section: Introductionmentioning

confidence: 71%

Propofol Target-controlled Infusion in Anesthesia Induction during Painless Gastroscopy

Li¹,

Zhao²,

Su³

2019

J Coll Physicians Surg Pak

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Section: Introductionmentioning

confidence: 71%

Propofol Target-controlled Infusion in Anesthesia Induction during Painless Gastroscopy

Li¹,

Zhao²,

Su³

2019

J Coll Physicians Surg Pak

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“…Midazolam has a long duration of action and slow recovery from anesthesia (6,7). In addition to the injection site pain, propofol also has strong respiratory and circulatory inhibitory effects, thus increasing the incidence of accidental risks such as hypoxemia, hypotension, and cardiac arrest (8,9).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Remimazolam in Endoscopic Sedation—A Systematic Review and Meta-Analysis

Zhu

Wang

et al. 2021

Front. Med.

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Background: The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of remimazolam in clinical endoscopic procedure sedation.Methods: The authors searched the databases of PubMed, Embase, and Cochrane Library for studies published until January 2, 2021, that reported remimazolam sedation for endoscopic procedures. The sedative efficiency and the incidence of adverse events were assessed as outcomes. Cochrane Review Manager Software 5.3 was used to perform the statistical analyses.Results: Seven relevant studies involving a total of 1,996 patients were identified. We conducted a meta-analysis of the different controls used in the studies, that is, the placebo, midazolam, and propofol. The results demonstrated that remimazolam had a strong sedative effect, and its sedative efficiency was significantly higher than that of placebo [OR = 0.01, 95% CI: (0.00, 0.10), I2 = 30%, p <0.00001]. The sedative efficiency of remimazolam was significantly higher than that of midazolam [OR = 0.12, 95% CI: (0.08, 0.21), I2 = 0%, p < 0.00001] but lesser than that of propofol [OR = 12.22, 95% CI: (1.58, 94.47), I2 = 0%, p = 0.02]. Regarding the adverse events, remimazolam is associated with a lower incidence of hypotension than placebo and midazolam. Similarly, remimazolam was associated with a lower incidence of hypotension and hypoxemia than propofol.Conclusions: Remimazolam is a safe and effective sedative for patients undergoing endoscopic procedures. The sedative efficiency of remimazolam was significantly higher than that of midazolam but slightly lower than that of propofol. However, the respiration and circulation inhibitory effects of remimazolam were weaker than those of midazolam and propofol.

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“…Dexmedetomidine has also been tried, but only showed a limited role in this setting for its slow onset, tedious preparation of intravenous infusion, and longer recovery time and delayed discharge [10], and even a low-dose dexmedetomidine with propofol has been confirmed to delay discharge readiness and provoke hypotension compared to propofol alone [11]. Propofol has been getting more popular as sedative during colonoscopy for its advantages of fast onset and offset, quick recovery and less perception of procedure pain and discomfort during the colonoscopy with higher patient's satisfaction [12,13]. The majority of colonoscopic procedures are performed in outpatient clinic setting and patients are discharged quickly at the end of recovery, and therefore, propofol is the most optimal drug for the same day surgeries.…”

Section: Introductionmentioning

confidence: 99%

The propofol-sparing effect of intravenous lidocaine in elderly patients undergoing colonoscopy: a randomized, double-blinded, controlled study

Chen

Liu

et al. 2020

BMC Anesthesiol

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Background Propofol provides a prominent sedation effect in colonoscopy. However, anesthesia and sedation induced with propofol in the elderly might result in cardiopulmonary complications, especially when it is combined with opoids in the regimen. This study aimed to test the hypothesis that the addition of intravenous lidocaine to propofol-based sedation could decrease the overall propofol requirement in elderly patients during colonoscopy while the procedural sedation satisfaction and the hemodynamic stability were not compromised. Methods Ninety-two patients undergoing colonoscopy were randomly enrolled into lidocaine+propofol (L + P) group or normal saline+propofol (NS + P) groups. Subjects received intravenous bolus of 1.5 mg/kg lidocaine followed by 4 mg kg− 1 h− 1 lidocaine continuous infusion in L + P group or equivalent volumes of normal saline for boluses and infusion in NS + P group. Anesthesia was induced with 2.5 μg sufentanil followed by injection of 1.2 mg kg− 1 propofol in all patients. A single supplemental bolus of 0.6 mg kg− 1 propofol was administered whenever MOAA/S score > 1 or had body movement during the colonoscopy. The recorded primary endpoints included: the total amount of propofol administered during entire procedure, the supplemental amount of propofol after induction, and the frequencies of boluses of supplemental propofol. Results A total of 79 patients were included in the final analysis. Compared with NS + P group, the total amounts of propofol (induction plus supplemental) were no significant differences in L + P group; however, the required supplemental propofol was less (69.9 ± 39.2 mg vs. 51.5 ± 38.6 mg) (P = 0.039); the average frequencies of boluses of supplemental propofol given after induction were lower (2.1 ± 1.1 vs. 1.4 ± 0.9) (P = 0.003); the calculated “unit propofol” infusion rate was lower (0.18 ± 0.05 vs. 0.14 ± 0.04 mg kg− 1 min− 1) (P = 0.002). Conclusions The addition of intravenous lidocaine to propofol-based sedation resulted in a remarked reduction of supplemental propofol in the elderly during colonoscopy. Trial registration The present clinical trial was registered at http://www.chictr.org.cn on 11th March 2019 (registration No. ChiCTR1900021818).

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Comparison of propofol monotherapy and propofol combination therapy for sedation during gastrointestinal endoscopy: A systematic review and meta‐analysis

Abstract: PCT showed comparable efficacy and safety to PMT with respect to respiratory complications, hypotension and arrhythmia, recovery time, procedure duration, patient satisfaction, and doctor satisfaction. However, the average dose of propofol used was higher in PMT.

Cited by 25 publications

References 37 publications

Propofol Target-controlled Infusion in Anesthesia Induction during Painless Gastroscopy

Propofol Target-controlled Infusion in Anesthesia Induction during Painless Gastroscopy

Efficacy and Safety of Remimazolam in Endoscopic Sedation—A Systematic Review and Meta-Analysis

The propofol-sparing effect of intravenous lidocaine in elderly patients undergoing colonoscopy: a randomized, double-blinded, controlled study

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