Propofol combined with traditional sedative agents versus propofol- alone sedation for gastrointestinal endoscopy: a meta-analysis

Wang, Daorong; Wang, Sen; Chen, Jie; Xu, Yaxiang; Chen, Chaowu; Long, Ai-Hua; Zhu, Zhaoqin; Li, Jun; Deng, Denghao; Chen, Juan; Tang, Dong; Wang, Lu

doi:10.3109/00365521.2012.737360

Cited by 37 publications

(25 citation statements)

References 25 publications

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“…Cardiopulmonary adverse events, such as hypoxia, hypotension, arrhythmia, and apnea, are concerns regarding propofol sedation in cirrhotic patients because propofol exhibits greater suppressive cardiopulmonary effects than midazolam does. A previous meta-analysis compared using propofol combined with other sedative agents to sedate patients undergoing GIE with sedation using propofol alone, and determined that administering a higher dose of propofol did not increase the risk of cardiopulmonary adverse events [ 33 ]; this observation is consistent with our findings that propofol sedation does not increase the risk of bradycardia, hypotension, or hypoxemia compared with midazolam sedation. Sedatives used for UGIE can be administered by anesthesiologists, gastroenterologists, and trained registered nurses.…”

Section: Discussionsupporting

confidence: 90%

Propofol versus Midazolam for Upper Gastrointestinal Endoscopy in Cirrhotic Patients: A Meta-Analysis of Randomized Controlled Trials

Tsai

Lin

et al. 2015

PLoS ONE

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BackgroundSedation during gastrointestinal endoscopy is often achieved using propofol or midazolam in general population. However, impaired protein synthesis, altered drug metabolism, and compromised hepatic blood flow in patients with liver cirrhosis might affect the pharmacokinetics of sedatives, placing cirrhotic patients undergoing endoscopy at a greater risk of adverse events. The objective of this study was to assess comparative efficacies and safety of propofol and midazolam in cirrhotic patients undergoing endoscopy.MethodsRandomized, controlled trials comparing propofol with midazolam in cirrhotic patients undergoing gastrointestinal endoscopy were selected. We performed the meta-analysis, using a random-effect model, the Review Manager, Version 5.2, statistical software package (Cochrane Collaboration, Oxford, UK) according to the PRISMA guidelines.ResultsFive studies between 2003 and 2012, including 433 patients, were included. Propofol provided a shorter time to sedation (weight mean difference: -2.76 min, 95% confidence interval: -3.00 to -2.51) and a shorter recovery time (weight mean difference -6.17 min, 95% confidence interval: -6.81 to -5.54) than midazolam did. No intergroup difference in the incidence of hypotension, bradycardia, or hypoxemia was observed. Midazolam was associated with the deterioration of psychometric scores for a longer period than propofol.ConclusionThis meta-analysis suggests that Propofol sedation for endoscopy provides more rapid sedation and recovery than midazolam does. The risk of sedation-related side effects for propofol does not differ significantly from that of midazolam. The efficacy of propofol in cirrhotic patients undergoing endoscopy is superior to those of midazolam.

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Section: Discussionsupporting

confidence: 90%

Propofol versus Midazolam for Upper Gastrointestinal Endoscopy in Cirrhotic Patients: A Meta-Analysis of Randomized Controlled Trials

Tsai

Lin

et al. 2015

PLoS ONE

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“…This study revealed that propofol TCI combined with midazolam/fentanyl versus propofol TCI alone reduced propofol dosage, produced less hypotension and shortened recovery time and discharge time. When propofol was administrated with intermittent bolus method, many reports showed that propofol combined with traditional sedation agents during GI endoscopy could significantly reduce the total dose of propofol compared with propofol‐alone sedation [17,21–23]. Hsieh et al [23] compared intermittent bolus propofol alone and propofol in combination with meperidine and found that the combination regimen is better in improving tolerance and recovery for sedated colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Theoretically, TCI provides a more precise control of propofol concentration than the intermittent bolus methods, which result in many peaks and troughs of propofol level. Only limited reports have investigated propofol TCI in sedated GI endoscopy [13–15]; instead, propofol was administrated by intermittent bolus methods in most nonanesthesiologist practices [16,17].…”

Section: Introductionmentioning

confidence: 99%

Propofol target‐controlled infusion for sedated gastrointestinal endoscopy: A comparison of propofol alone versus propofol–fentanyl–midazolam

Hsu

Huang

Chuang

et al. 2015

The Kaohsiung J of Med Scie

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Gastrointestinal (GI) endoscopy is the major technique for diagnosis of GI disease and treatment. Various sedation and analgesia regimens such as midazolam, fentanyl, and propofol can be used during GI endoscopy. The purpose of the study was to compare propofol alone and propofol combination with midazolam and fentanyl in moderate sedation for GI endoscopy. One hundred patients undergoing GI endoscopy were enrolled in this study. All patients received a propofol target-controlled infusion (TCI) to maintain sedation during the procedure. Patients were randomly allocated into either Group P (propofol TCI alone) or Group C (combination of propofol TCI plus midazolam and fentanyl). Dermographic data, anesthetic parameters (sedation regimen, blood pressure, heart rate, and oxygen saturation), procedure parameters (procedure time, colonoscopy, or panendoscopy), propofol consumption, and adverse events (hypoxia, hypotension, and bradycardia) were all recorded. Postprocedural records included recovery time, postoperative adverse events (nausea, vomiting, dizziness, recall, and pain) and satisfaction. The average propofol consumption was 251 ± 83 mg in Group P and 159 ± 73 mg in Group C (p < 0.001). The incidence of transient hypotension was higher in Group P (p = 0.009). The recovery time and discharge time were both shorter in Group C (p < 0.001 and p = 0.006 respectively). Overall, postprocedural adverse events were similar in both groups. The postanesthetic satisfaction was comparable in both groups. TCI of propofol combined with midazolam and fentanyl achieved sedation with fewer hypotension episodes and shorter recovery and discharge time than propofol TCI alone in patients undergoing GI endoscopy.

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“…Although a smaller proportion of patients in the study by Leslie et al received propofol in combination with opioids (fentanyl or alfentanyl), the weight-adjusted doses were similar in both studies (0.78 vs. 0.77 mcg.kg -). In addition, 37% of patients in the aforementioned study also received 2 mg of midazolam during anaesthesia induction, which has been proven to reduce propofol consumption [15,16]. Therefore, the lower administered doses of propofol in the study by Leslie et al could probably be attributed to the addition midazolam and not opioids to the anaesthetic regimen.…”

Section: Discussionmentioning

confidence: 93%

Deep sedation using propofol target-controlled infusion for gastrointestinal endoscopic procedures: a retrospective cohort study*

Guzzo

Fernandez

Novas

et al. 2020

Preprint

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Background: Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine its potentially improved safety over other anaesthetic strategies. Methods: This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age >18 years, American Society of Anesthesiologists physical status classification scores I–III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support. Results: The most frequently encountered adverse event was oxygen desaturation <95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation <90% followed, with incidences of 19.2%, 12.64%, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P=0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P=0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, confidence interval: 95% 2.83 to 36.99) more likely to experience oxygen desaturation <90% events. Conclusions: Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with low rates of adverse events and could be more widely adopted in clinical practice.

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Propofol combined with traditional sedative agents versus propofol- alone sedation for gastrointestinal endoscopy: a meta-analysis

Abstract: PTSA sedation during gastrointestinal endoscopy could significantly reduce the total dose of propofol, but without benefits of lower risk of cardiopulmonary complications compared with propofol-alone sedation.

Cited by 37 publications

References 25 publications

Propofol versus Midazolam for Upper Gastrointestinal Endoscopy in Cirrhotic Patients: A Meta-Analysis of Randomized Controlled Trials

Propofol versus Midazolam for Upper Gastrointestinal Endoscopy in Cirrhotic Patients: A Meta-Analysis of Randomized Controlled Trials

Propofol target‐controlled infusion for sedated gastrointestinal endoscopy: A comparison of propofol alone versus propofol–fentanyl–midazolam

Deep sedation using propofol target-controlled infusion for gastrointestinal endoscopic procedures: a retrospective cohort study*

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