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Review
. 2017 Nov;5(7):1037-1045.
doi: 10.1177/2050640616688140. Epub 2017 Jan 12.

Dexmedetomidine vs propofol for gastrointestinal endoscopy: A meta-analysis

Toshihiro Nishizawa  1   2 , Hidekazu Suzuki  3 , Naoki Hosoe  4 , Haruhiko Ogata  4 , Takanori Kanai  2 , Naohisa Yahagi  1
Affiliations
Review

Dexmedetomidine vs propofol for gastrointestinal endoscopy: A meta-analysis

Toshihiro Nishizawa et al. United European Gastroenterol J. 2017 Nov.

Abstract

Background and aim: Several randomized controlled trials have compared sedation with dexmedetomidine and propofol in gastrointestinal endoscopy, with contradictory results. We conducted a meta-analysis of data from randomized controlled trials that compared dexmedetomidine with propofol.

Methods: We searched PubMed, the Cochrane library, and the Igaku-chuo-zasshi database for randomized trials eligible for inclusion in our meta-analysis. We identified six eligible randomized trials from the database search, and compared the effect of propofol versus dexmedetomidine with respect to: (a) patient's satisfaction level, (b) body movement or gagging, (c) cardiopulmonary complications, and (d) change in heart rate. Data from eligible studies were combined to calculate pooled risk difference (RD) or weighted mean difference (WMD).

Results: Compared to propofol, dexmedetomidine significantly decreased the patient's satisfaction level (WMD: -0.678, 95% confidence interval (CI): -1.149 to -0.207, p = 0.0048), and there was no significant heterogeneity among the trial results. The pooled RD for developing body movement or gagging when using dexmedetomidine was 0.107 (95% CI: -0.09 to 0.305, p = 0.288), with no significant differences. Compared with propofol, the pooled RD for hypotension, hypoxia, and bradycardia with dexmedetomidine sedation were -0.029 (95% CI: -0.11 to 0.05), -0.080 (95% CI: -0.178 to 0.018), and 0.022 (95% CI: -0.027 to 0.07), respectively, with no significant differences. Compared to propofol, dexmedetomidine significantly decreased the heart rate (WMD: -10.41, 95% CI: -13.77 to -7.051, p ≤ 0.0001), without significant heterogeneity.

Conclusions: In gastrointestinal endoscopy, patient satisfaction level was higher in propofol administration, when compared to dexmedetomidine. The risk of complications was similar.

Keywords: Dexmedetomidine; endoscopy; meta-analysis; propofol; randomized controlled trial.

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Figures

Figure 1.
Figure 1.
Flow of randomized clinical trials (RCTs) included in the meta-analysis.
Figure 2.
Figure 2.
Forest plot displaying the weighted mean difference and 95% confidence interval of each study for patient’s satisfaction level. DEX: dexmedetomidine; PF: propofol; EGD: upper gastrointestinal endoscopy; ESD: endoscopic submucosal dissection.
Figure 3.
Figure 3.
Forest plot displaying the risk difference and 95% CI of each study for body movement or gagging. DEX: dexmedetomidine; PF: propofol; EGD: upper gastrointestinal endoscopy; ESD: endoscopic submucosal dissection; CI: confidence interval.
Figure 4.
Figure 4.
Forest plot displaying the risk difference and 95% confidence interval of each study for hypotension. DEX: dexmedetomidine; PF: propofol; EGD: upper gastrointestinal endoscopy; ESD: endoscopic submucosal dissection; CS: colonoscopy.
Figure 5.
Figure 5.
Forest plot displaying the risk difference and 95% CI of each study for hypoxia. DEX: dexmedetomidine; PF: propofol; EGD: upper gastrointestinal endoscopy; ESD: endoscopic submucosal dissection; CS: colonoscopy; CI: confidence interval.
Figure 6.
Figure 6.
Forest plot displaying the risk difference and 95% CI of each study for bradycardia. DEX: dexmedetomidine; PF: propofol; EGD: upper gastrointestinal endoscopy; ESD: endoscopic submucosal dissection; CS: colonoscopy; CI: confidence interval.
Figure 7.
Figure 7.
Forest plot displaying the weighted mean difference and 95% CI of each study for heart rate. DEX: dexmedetomidine; PF: propofol; EGD: upper gastrointestinal endoscopy; ESD: endoscopic submucosal dissection; CS: colonoscopy; CI: confidence interval.
Figure 8.
Figure 8.
Funnel plot of the included studies for heart rate.
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