Propofol versus traditional sedative agents for advanced endoscopic procedures: A meta‐analysis

Sethi, Saurabh; Wadhwa, Vaibhav; Thaker, Adarsh M.; Chuttani, Ram; Pleskow, Douglas K.; Barnett, Sheila R.; Leffler, Daniel A.; Berzin, Tyler M.; Sethi, Nidhi; Sawhney, Mandeep S.

doi:10.1111/den.12219

Cited by 67 publications

(46 citation statements)

References 45 publications

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“…For instance, the interns were more likely sedation is required to ensure an acceptable procedural environment for patients, reduce intolerance to the procedure, and increase the success rate of endoscopic procedures. Propofol or midazolam is usually used for patient sedation, either alone or in combination with other analgesics [10,11]. Although these analgesics have been proven to be safe, the increased number of endoscopies and the subsequent increase in sedation has raised concerns regarding sedation-related complications and their complication management [12].…”

Section: Resultsmentioning

confidence: 99%

Clinical performance comparison of I-gel insertion by anesthesiology residents versus novice clinicians

Lee¹,

Park²,

Jung³

et al. 2015

Anesth Pain Med

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: I-gel is a recently developed supraglottic airway device with many advantages. Like laryngeal mask airway (LMA), I-gel is an easier and quicker intubation alternative to endotracheal intubation in certain situations. In this study, we assessed the ease of I-gel insertion and compared the clinical performance of anesthetsiology residents (group R) experienced in endotracheal intubation versus that of interns (group I) with little intubation experience. Methods: This prospective and randomized study included 60 patients. The ease of insertion, number of I-gel insertion attempts, presence of air leakage, and postoperative complications such as bleeding, dental trauma, hoarseness, and sore throat were evaluated in each group. Results: Insertion was successful on the initial attempt in 29 of 30 cases in group R. In group I, 24 initial insertions were successful. The mean insertion times were 12.5 ± 4.8 and 27.9 ± 12.5 seconds for group R and group I, respectively (P ＜ 0.001). No significant differences were observed between the two groups regarding postintubational air leakage. Regarding complications, two cases of bleeding, one case of dental trauma, and two cases of sore throat were recorded. No significant differences were observed between the two groups for any of the complications examined. Conclusions: I-gel is a suitable alternative insertion device that enables rapid and easy intubation by physicians who are experienced with endotracheal intubation. Moreover, this device also enables efficient and safe insertion during emergent situations for novice clinicians, even those who have little experience in intubation. (Anesth Pain Med 2015; 10: 312-316)

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Section: Resultsmentioning

confidence: 99%

Clinical performance comparison of I-gel insertion by anesthesiology residents versus novice clinicians

Lee¹,

Park²,

Jung³

et al. 2015

Anesth Pain Med

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“…Two previous meta-analyses demonstrated the advantage of propofol use over traditional sedative agents during advanced endoscopic procedures, which include endoscopic examinations [8,9]. In contrast, high doses of propofol are an independent risk factor for sedation-related complications [10].…”

Section: Discussionmentioning

confidence: 99%

An Effective and Safe Sedation Technique Combining Target-Controlled Infusion Pump with Propofol, Intravenous Pentazocine, and Bispectral Index Monitoring for Peroral Double-Balloon Endoscopy

Okada¹,

Iwamuro²,

Kouno

et al. 2015

Digestion

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Background/Aims: Because peroral double-balloon endoscopy (DBE) is a time-consuming, painful procedure, sedation with analgesics, and/or anesthetics is generally required. The aim of this prospective study was to investigate the safety and efficacy of our sedation protocol for peroral DBE, which consisted of target-controlled infusion (TCI) anesthesia with propofol, an intravenous bolus of pentazocine, and bispectral index (BIS) monitoring. Methods: A total of 34 consecutive patients who underwent DBE by the oral approach were enrolled. Patients were primarily sedated with a continuous infusion of propofol and adjusted in accordance with the BIS levels. The bolus infusion of pentazocine was performed when the propofol infusion was insufficient. The primary outcome measure of this study was to ensure the safety and efficacy of this sedation technique. The secondary purpose was to identify the characteristics of the patient who required the bolus infusion of pentazocine. Results: Five patients (14.7%) required a reduction in the dose of propofol. However, no patient experienced any serious adverse events. All patients (100%) and 80.6% (25/31) of endoscopists answered that the sedation protocol was ‘excellent' or ‘enough' for peroral DBE. Eleven patients (32.3%) required a bolus injection of pentazocine. Age <60 years and a total procedure time of >70 min were significant risk-factors for pentazocine use. Conclusions: A combination of propofol via TCI pump, bolus injection of pentazocine as needed, and BIS monitoring was a safe and effective procedure for peroral DBE. Reasonable satisfaction indices were obtained from both patients and endoscopists. Pentazocine was required for young patients and in cases with longer procedure times.

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“…These benefits were achieved without an increased risk of cardiopulmonary complications. 8,9 A recent prospective study underlined the safety of sedation with propofol alone in comparison to other regimens. The multicenter electronic registry recorded a total of 36,206 endoscopies.…”

Section: Propofol Versus Other Agentsmentioning

confidence: 99%

Propofol for gastrointestinal endoscopy

Nishizawa

Suzuki

2018

UEG Journal

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Most gastrointestinal endoscopic procedures are now performed with sedation. Moderate sedation using benzodiazepines and opioids continues to be widely used, but propofol sedation is becoming more popular because its unique pharmacokinetic properties make endoscopy almost painless, with a very predictable and rapid recovery process. There is controversy as to whether propofol should be administered only by anesthesia professionals. According to published values, endoscopist-directed propofol has a lower mortality rate than endoscopist-delivered benzodiazepines and opioids, and a comparable rate to general anesthesia by anesthesiologists. Rapid recovery has a major impact on patient satisfaction, post-procedure education and the general flow of the endoscopy unit. According to estimates, the absolute economic benefit of endoscopist-directed propofol implementation in a screening setting is probably substantial, with 10-year savings of $3.2 billion in the USA. Guidelines concerning the use of propofol emphasize the need for adequate training and certification in sedation by non-anesthetists.

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Propofol versus traditional sedative agents for advanced endoscopic procedures: A meta‐analysis

Abstract: Propofol for advanced endoscopic procedures is associated with shorter recovery time, better sedation and amnesia level without an increased risk of cardiopulmonary complications. Overall patient cooperation was also improved with propofol sedation.

Cited by 67 publications

References 45 publications

Clinical performance comparison of I-gel insertion by anesthesiology residents versus novice clinicians

Clinical performance comparison of I-gel insertion by anesthesiology residents versus novice clinicians

An Effective and Safe Sedation Technique Combining Target-Controlled Infusion Pump with Propofol, Intravenous Pentazocine, and Bispectral Index Monitoring for Peroral Double-Balloon Endoscopy

Propofol for gastrointestinal endoscopy

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