The use of propofol as a sedative agent in gastrointestinal endoscopy: a meta-analysis

Abstract

Objectives: To 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.

Methods: RCTs 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.

Results: Twenty-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.

Conclusions: Propofol 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.

Figure 1. Flow chart of study selection.

Figure 2. Forest plot demonstrating the overall number of complications of PS vs. TS for gastrointestinal endoscopy.

Figure 3. Forest plot demonstrating procedure duration with PS vs. TS for gastrointestinal endoscopy.

Figure 4. Forest plot demonstrating recovery time with PS vs. TS for gastrointestinal endoscopy.

Figure 5. Forest plot demonstrating discharge time with PS vs. TS for gastrointestinal endoscopy.

Figure 6. Forest plot demonstrating PARS with PS vs. TS for gastrointestinal endoscopy.

Figure 7. Forest plot demonstrating sedation level with PS vs. TS for gastrointestinal endoscopy.

Figure 8. Forest plot demonstrating patient cooperation with PS vs. TS for gastrointestinal endoscopy.

Figure 9. Forest plot demonstrating local pain on injection with PS vs. TS for gastrointestinal endoscopy.

Figure 10. Forest plot demonstrating amnesia with PS vs. TS for gastrointestinal endoscopy.

Figure 11. Forest plot demonstrating procedural pain with PS vs. TS for gastrointestinal endoscopy.

Figure 12. Forest plot demonstrating patient satisfaction with PS vs. TS for gastrointestinal endoscopy.

Figure 13. Funnel plot assessing publication bias.

No publication bias was noted. SE, standard error.