The Use of Propofol as a Sedative Agent in Gastrointestinal Endoscopy: A Meta-Analysis

Abstract

ObjectivesTo assess the efficacy and safety of propofol sedation for gastrointestinal endoscopy, we conducted a meta-analysis of randomized controlled trials (RCTs) comparing propofol with traditional sedative agents.MethodsRCTs comparing the effects of propofol and traditional sedative agents during gastrointestinal endoscopy were found on MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE. Cardiopulmonary complications (i.e., hypoxia, hypotension, arrhythmia, and apnea) and sedation profiles were assessed.ResultsTwenty-two original RCTs investigating a total of 1,798 patients, of whom 912 received propofol only and 886 received traditional sedative agents only, met the inclusion criteria. Propofol use was associated with shorter recovery (13 studies, 1,165 patients; WMD –19.75; 95% CI –27.65, 11.86) and discharge times (seven studies, 471 patients; WMD –29.48; 95% CI –44.13, –14.83), higher post-anesthesia recovery scores (four studies, 503 patients; WMD 2.03; 95% CI 1.59, 2.46), better sedation (nine studies, 592 patients; OR 4.78; 95% CI 2.56, 8.93), and greater patient cooperation (six studies, 709 patients; WMD 1.27; 95% CI 0.53, 2.02), as well as more local pain on injection (six studies, 547 patients; OR 10.19; 95% CI 3.93, 26.39). Effects of propofol on cardiopulmonary complications, procedure duration, amnesia, pain during endoscopy, and patient satisfaction were not found to be significantly different from those of traditional sedative agents.ConclusionsPropofol is safe and effective for gastrointestinal endoscopy procedures and is associated with shorter recovery and discharge periods, higher post-anesthesia recovery scores, better sedation, and greater patient cooperation than traditional sedation, without an increase in cardiopulmonary complications. Care should be taken when extrapolating our results to specific practice settings and high-risk patient subgroups.

Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study

“…An induction dose of propofol results in a 25-30% incidence of apnea and a 25-40% reduction in systolic blood pressure (9,10). The high incidence of apnea, lasting longer than 30 sec, exposes patients to the potential risks of brain damage, which is the leading cause of morbidity in anesthesia-related events (17). In the present study, elderly patients induced with propofol experienced a 42% incidence of apnea, and 88% of patients experienced a significant (>30%) reduction in systolic blood pressure.…”

“…Propofol is a potent hypnotic agent that can cause life-threatening side effects, including the loss of protective airway reflexes and respiratory depression (17,21). In the present study, it was observed that 8% of elderly patients in group P required short-term positive pressure ventilation, while 2% of elderly patients in the other three groups required this intervention.…”

Does Propofol Sedation Increase the Cecal Intubation Rate in Colonoscopy?

“…However, a meta-analysis showed that propofol was safely used even in high-risk patients. [13] In our series, bradycardia was observed to develop in a patient during the procedure. However, we could not detect whether this is due to propofol.…”

Propofol for gastrointestinal endoscopy

“…3 A 2013 meta-analysis of 22 RCTs found that propofol provides a shorter recovery time and better sedation than traditional sedative agents, without causing an increase in cardiopulmonary complications. 7 Furthermore, two 2014 meta-analyses revealed the clear benefits of better sedation and shorter recovery in patients who underwent advanced endoscopic procedures such as endoscopic retrograde cholangiopancreatography and endoscopic submucosal dissection. These benefits were achieved without an increased risk of cardiopulmonary complications.…”