Patient-Controlled Versus Clinician-Controlled Sedation With Propofol: Systematic Review and Meta-analysis With Trial Sequential Analyses

Kreienbühl, Lukas; Elia, Nadia; Pfeil-Beun, Elvire; Walder, Bernhard; Tramèr, Martin R.

doi:10.1213/ane.0000000000003361

Cited by 19 publications

(7 citation statements)

References 31 publications

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“…The body of literature assessing PMPS is markedly smaller than that available for PCPS, where a recent systematic review conducted meta-analyses on clinical trial data for 1103 participants. 31 The ease with which PCPS can be administered (requiring no software or hardware modification to TCI infusion devices) may explain this difference. It is our contention, however, that the pharmacokinetic advantages of TCI propofol delivery (established from its widespread use as an anaesthetist-controlled sedative and agent of general anaesthesia) are such that PMPS, rather than PCPS, should be the focus of future technological development and sedation research.…”

Section: Discussionmentioning

confidence: 99%

Patient-maintained propofol sedation for adult patients undergoing surgical or medical procedures: a scoping review of current evidence and technology

Hewson

Hardman

Bedforth

2021

British Journal of Anaesthesia

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Patient-maintained propofol sedation (PMPS) is the delivery of procedural propofol sedation by target-controlled infusion with the patient exerting an element of control over their target-site propofol concentration. This scoping review aims to establish the extent and nature of current knowledge regarding PMPS from both a clinical and technological perspective, thereby identifying knowledge gaps to guide future research. We searched MEDLINE, EMBASE, and OpenGrey databases, identifying 17 clinical studies for analysis. PMPS is described in the context of healthy volunteers and in orthopaedic, general surgical, dental, and endoscopic clinical settings. All studies used modifications to existing commerciallyavailable infusion devices to achieve prototype systems capable of PMPS. The current literature precludes rigorous generalisable conclusions regarding the safety or comparative clinical effectiveness of PMPS, however cautious acknowledgement of efficacy in specific clinical settings is appropriate. Based on the existing literature, together with new standardised outcome reporting recommendations for sedation research and frameworks designed to assess novel health technologies research, we have made recommendations for future pharmacological, clinical, behavioural, and health economic research on PMPS. We conclude that high-quality experimental clinical trials with relevant comparator groups assessing the impact of PMPS on standardised patient-orientated outcome measures are urgently required.

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Section: Discussionmentioning

confidence: 99%

Patient-maintained propofol sedation for adult patients undergoing surgical or medical procedures: a scoping review of current evidence and technology

Hewson

Hardman

Bedforth

2021

British Journal of Anaesthesia

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“…14 PCS also had no significant impact on propofol dosage in a 2018 meta-analysis comprised of PCS trials in colonoscopy, ERCP, cataract surgery, and extracorporeal shockwave lithotripsy. 15 This finding may be explainable by differences between ERCP and other invasive procedures. ERCP has long procedural length and may involve complex interventions 16 ; hence, clinicians may be inclined to give higher sedative doses during ERCP, particularly during steps such as sphincterotomy and common bile duct cannulation.…”

Section: Discussionmentioning

confidence: 99%

Patient-Controlled Sedation Versus Clinician-Administered Sedation for Endoscopic Retrograde Cholangiopancreatography: A Systematic Review

Hui¹,

Leung

2021

Anesthesia &Amp; Analgesia

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Patient-controlled sedation (PCS) has been explored as a sedation method in endoscopic retrograde cholangiopancreatography (ERCP), yet a comprehensive review article on this topic is lacking. We performed a systematic review to compare PCS against clinician-administered sedation. The primary objectives are to compare the sedative dosage used and the sedation depth, while secondary objectives are to compare sedation failure rates, clinician intervention rates, and patient satisfaction. A systematic literature search was conducted on MEDLINE, EMBASE, and the Cochrane Library Database using the terms “ERCP,” “Sedation,” “Patient-controlled,” and related terms. Randomized controlled trials comparing PCS against clinician-administered sedation in adults undergoing ERCP were included. Articles without English full texts were excluded. Studies were reviewed by 2 independent reviewers. The Cochrane Risk of Bias tool was used for quality assessment of individual included trials. This systematic review is registered in the International Prospective Register of Systematic Reviews (CRD42020198647). A total of 2619 articles were identified from the literature search. A total of 2615 articles were excluded based on the exclusion criteria. Four articles (comprised of 4 independent trials involving 425 patients) were included in analysis. When compared with clinician-administered sedation, PCS in ERCP may lead to lower propofol dosage used and lower sedation depth. The sedation failure rates appear to be higher in PCS, whereas lower rates of airway maneuvers are required. No significant difference was observable for patient satisfaction rates between PCS and clinician-administered sedation. The included studies demonstrated unclear to high risk of bias, particularly in randomization, incomplete outcome data, and outcome measurement. PCS appears to be a feasible option for sedation in ERCP. Nonetheless, large-scale, high-quality trials will be required before PCS can be regularly implemented in ERCP.

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“…PCS allows the patient to self-administer the sedation or analgesia medications for a specific effect, but with a built-in lock-out interval to prevent a possible overdose. PCS has shown encouraging results in preliminary studies, with lighter sedation, less drug consumption, good patient and proceduralist satisfaction, reduction in adverse events requiring interventions, and minimal risk of over sedation [47,48]. Sedasys system (Johnson & Johnson, New Brunswick, NJ), a Computer-Assisted Personalized Sedation system was developed to provide mild to moderate sedation by nonanesthesiologists.…”

Section: Patient-controlled Sedationmentioning

confidence: 99%

Sedation-analgesia techniques for nonoperating room anesthesia: an update

Khorsand¹,

Karamchandani²,

Joshi³

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThere has been a substantial increase in nonoperating room anesthesia procedures over the years along with an increase in the complexity and severity of cases. These procedures pose unique challenges for anesthesia providers requiring meticulous planning and attention to detail. Advancements in the delivery of sedation and analgesia in this setting will help anesthesia providers navigate these challenges and improve patient safety and outcomes. Recent findingsThere has been a renewed interest in the development of newer sedative and analgesic drugs and delivery systems that can safely provide anesthesia care in challenging situations and circumstances. SummaryDelivery of anesthesia care in nonoperating room locations is associated with significant challenges. The advent of sedative and analgesic drugs that can be safely used in situations where monitoring capabilities are limited in conjunction with delivery systems, that can incorporate unique patient characteristics and ensure the safe delivery of these drugs, has the potential to improve patient safety and outcomes. Further research is needed in these areas to develop newer drugs and delivery systems.

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Patient-Controlled Versus Clinician-Controlled Sedation With Propofol: Systematic Review and Meta-analysis With Trial Sequential Analyses

Abstract: PCS with propofol, compared with CCS with propofol, had no impact on the risk of oxygen desaturation, but significantly decreased the risk of rescue interventions for sedation-related adverse events. Further high-quality trials are required to assess the risks and benefits of PCS.

Cited by 19 publications

References 31 publications

Patient-maintained propofol sedation for adult patients undergoing surgical or medical procedures: a scoping review of current evidence and technology

Patient-maintained propofol sedation for adult patients undergoing surgical or medical procedures: a scoping review of current evidence and technology

Patient-Controlled Sedation Versus Clinician-Administered Sedation for Endoscopic Retrograde Cholangiopancreatography: A Systematic Review

Sedation-analgesia techniques for nonoperating room anesthesia: an update

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