Propofol vs traditional sedatives for sedation in endoscopy: A systematic review and meta-analysis

Abstract

BACKGROUNDPropofol is commonly used for sedation during endoscopic procedures. Data suggests its superiority to traditional sedatives used in endoscopy including benzodiazepines and opioids with more rapid onset of action and improved post-procedure recovery times for patients. However, Propofol requires administration by trained healthcare providers, has a narrow therapeutic index, lacks an antidote and increases risks of cardio-pulmonary complications.AIMTo compare, through a systematic review of the literature and meta-analysis, sedation with propofol to traditional sedatives with or without propofol during endoscopic procedures.METHODSA literature search was performed using MEDLINE, Scopus, EMBASE, the Cochrane Library, Scopus, LILACS, BVS, Cochrane Central Register of Controlled Trials, and The Cumulative Index to Nursing and Allied Health Literature databases. The last search in the literature was performed on March, 2019 with no restriction regarding the idiom or the year of publication. Only randomized clinical trials with full texts published were included. We divided sedation therapies to the following groups: (1) Propofol versus benzodiazepines and/or opiate sedatives; (2) Propofol versus Propofol with benzodiazepine and/or opioids; and (3) Propofol with adjunctive benzodiazepine and opioid versus benzodiazepine and opioid. The following outcomes were addressed: Adverse events, patient satisfaction with type of sedation, endoscopists satisfaction with sedation administered, dose of propofol administered and time to recovery post procedure. Meta-analysis was performed using RevMan5 software version 5.39.RESULTSA total of 23 clinical trials were included (n = 3854) from the initial search of 6410 articles. For Group I (Propofol vs benzodiazepine and/or opioids): The incidence of bradycardia was not statistically different between both sedation arms (RD: -0.01, 95%CI: −0.03–+0.01, I2: 22%). In 10 studies, the incidence of hypotension was not statistically difference between sedation arms (RD: 0.01, 95%CI: −0.02–+0.04, I2: 0%). Oxygen desaturation was higher in the propofol group but not statistically different between groups (RD: −0.03, 95%CI: −0.06–+0.00, I2: 25%). Patients were more satisfied with their sedation in the benzodiazepine + opioid group compared to those with monotherapy propofol sedation (MD: +0.89, 95%CI: +0.62–+1.17, I2: 39%). The recovery time after the procedure showed high heterogeneity even after outlier withdrawal, there was no statistical difference between both arms (MD: -15.15, 95%CI: −31.85–+1.56, I2: 99%). For Group II (Propofol vs propofol with benzodiazepine and/or opioids): Bradycardia had a tendency to occur in the Propofol group with benzodiazepine and/or opioid-associated (RD: -0.08, 95%CI: −0.13–−0.02, I2: 59%). There was no statistical difference in the incidence of bradycardia (RD: -0.00, 95%CI: −0.08–+0.08, I2: 85%), desaturation (RD: −0.00, 95%CI: −0.03–+0.02, I2: 44%) or recovery time (MD: -2.04, 95%CI: −6.96–+2.88, I2: 97%) between sedation arms. The total dose of pr...

Efficacy and Safety of Non-Anesthesiologist Administration of Propofol Sedation in Endoscopic Ultrasound: A Propensity Score Analysis

“…Although propofol has a favorable safety and efficacy profile in comparison to other sedative regimens [ 30 , 31 ], the lack of an antidote for reversibility and the potential severe adverse events, including cardiopulmonary compromise requiring resuscitation, call for a particular caution in its use. Therefore, several anesthesiology societies and regulatory agencies recommended against the use of propofol in absence of an anesthesia specialist [ 6 , 7 , 8 ].…”

Peroral endoscopic myotomy (POEM) is more cost-effective than laparoscopic Heller myotomy in the short term for achalasia: economic evaluation from a randomized controlled trial

“…Inoue et al 15 introduced the concept of natural orifice transluminal endoscopic surgery (NOTES) 16 17 associated with submucosal dissection 18 and named this technique peroral endoscopic myotomy (POEM). Studies have shown that the short- to mid-term efficacy of POEM is greater than 90 % and that the procedure is associated with less postoperative pain 19 20 21 22 23 24 25 . However, this procedure is frequently associated with some common adverse effects, such as pneumoperitoneum and surgical emphysema 26 .…”

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

“…However, randomised studies have evaluated pharmacological alternatives for procedural sedation and have shown that propofol (Baxter International Inc., Deerfield, IL), compared with the use of traditional agents, has a rapid onset of action, provides predictable sedation depth and recovery times, and improves patient satisfaction rates [ 4 – 6 ]. Nonetheless, and despite its beneficial pharmacokinetic profile, propofol has a narrow therapeutic window and no antidote, highlighting the fact that it should be administered by certified health professionals using precise administration techniques to avoid critical events [ 7 ].…”