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Meta-Analysis
. 2008 Oct 8;2008(4):CD006268.
doi: 10.1002/14651858.CD006268.pub2.

Propofol for sedation during colonoscopy

Harminder Singh  1 , William Poluha, Mary Cheung, Nicole Choptain, Ken I Baron, Shayne P Taback
Affiliations
Meta-Analysis

Propofol for sedation during colonoscopy

Harminder Singh et al. Cochrane Database Syst Rev. .

Abstract

Background: Propofol is increasingly used for sedation during colonoscopy, with many recent reports of randomized controlled trials (RCTs) and large non-randomized case series.

Objectives: The primary objective was to identify, analyze and summarize RCTs comparing the relative effectiveness, patient acceptance and safety of propofol for colonoscopy, to traditional sedatives (narcotics and/or benzodiazepines).The secondary objective was to synthesize the studies comparing propofol administration by anesthesiologists to that by non-anesthesiologists for sedation during colonoscopy.

Search strategy: We searched Medline, Cancerlit, EMBASE, CINAHL, LILACS, Biological Abstracts, Web of Science and the Cochrane Controlled Trials Registry database between January 1980 and June 2007; and conference proceeding abstracts for DDW, EUGW and ACG between 1990 and June 2007. There were no language restrictions.

Selection criteria: Randomized controlled trials comparing use of propofol and traditional agents or administration of propofol by anesthesiologists to that by non-anesthesiologists for sedation during colonoscopy.

Data collection and analysis: Two reviewers independently extracted the data. The data were pooled using the Cochrane Collaborations' methodology and statistical software RevMan 4.2.10.

Main results: Twenty studies met the inclusion criteria for the primary objective. Most studies included only healthy out-patients. Recovery and discharge times were shorter with use of propofol. There was higher patient satisfaction with use of propofol (OR for dissatisfaction 0.35, 95% CI 0.23, 0.53). There was no difference in procedure time, cecal intubation rate or complications. There was no difference in pain control with non- patient controlled sedation (PCS) use of propofol as compared to the traditional agents (OR 0.90; 95% CI 0.58, 1.39). Although there was higher patient satisfaction (OR for dissatisfaction 0.42, 95% CI 0.20, 0.89), the pain control was inferior with use of PCS use of propofol as compared to the use of traditional agents (OR 3.09; 95% CI 2.15, 4.46).There was only one study comparing administration of propofol by anesthesiologists to that by non-anesthesiologists for sedation during colonoscopy, with no difference in procedure time or patient satisfaction.

Authors' conclusions: Propofol for sedation during colonoscopy for generally healthy individuals can lead to faster recovery and discharge times, increased patient satisfaction without an increase in side-effects. More studies with standardized end-points are needed to compare propofol administration by anesthesiologists to that by non-anesthesiologists.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 1 Recovery time.
1.3
1.3. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 3 Discharge time.
1.4
1.4. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 4 Procedure duration.
1.5
1.5. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 5 Cecal intubation.
1.6
1.6. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 6 Patient Dissatisfication (dichotomous data).
1.7
1.7. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 7 Patient Satisfication (continuous data).
1.8
1.8. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 8 Patient Dissatisfication (combined).
1.9
1.9. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 9 Pain Control (continuous outcome).
1.10
1.10. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 10 Pain Control (dichotomous outcome).
1.11
1.11. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 11 Pain Control (combined).
1.12
1.12. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 12 Hypoxia.
1.13
1.13. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 13 Apnea.
1.14
1.14. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 14 Respiratory depression requiring intervention.
1.15
1.15. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 15 Arrhythmias.
1.16
1.16. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 16 Hypotension.
1.17
1.17. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 17 Blood pressure drop or lowest blood pressure during the procedure.
1.18
1.18. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 18 Colonic perforations.
1.19
1.19. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 19 Sedation (failure to sedate).
1.20
1.20. Analysis
Comparison 1 Propofol Versus Traditional Agents, Outcome 20 Sedation.
See this image and copyright information in PMC

Comment in

  • Preparation, sedation, and monitoring.
    Yu D, Hookey LC. Yu D, et al. Endoscopy. 2010 Jan;42(1):77-80. doi: 10.1055/s-0029-1215350. Epub 2010 Jan 11. Endoscopy. 2010. PMID: 20066595 No abstract available.

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