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World Journal of Gastrointestinal... Dec 2019Propofol is commonly used for sedation during endoscopic procedures. Data suggests its superiority to traditional sedatives used in endoscopy including benzodiazepines...
BACKGROUND
Propofol is commonly used for sedation during endoscopic procedures. Data suggests its superiority to traditional sedatives used in endoscopy including benzodiazepines and opioids with more rapid onset of action and improved post-procedure recovery times for patients. However, Propofol requires administration by trained healthcare providers, has a narrow therapeutic index, lacks an antidote and increases risks of cardio-pulmonary complications.
AIM
To compare, through a systematic review of the literature and meta-analysis, sedation with propofol to traditional sedatives with or without propofol during endoscopic procedures.
METHODS
A literature search was performed using MEDLINE, Scopus, EMBASE, the Cochrane Library, Scopus, LILACS, BVS, Cochrane Central Register of Controlled Trials, and The Cumulative Index to Nursing and Allied Health Literature databases. The last search in the literature was performed on March, 2019 with no restriction regarding the idiom or the year of publication. Only randomized clinical trials with full texts published were included. We divided sedation therapies to the following groups: (1) Propofol versus benzodiazepines and/or opiate sedatives; (2) Propofol versus Propofol with benzodiazepine and/or opioids; and (3) Propofol with adjunctive benzodiazepine and opioid versus benzodiazepine and opioid. The following outcomes were addressed: Adverse events, patient satisfaction with type of sedation, endoscopists satisfaction with sedation administered, dose of propofol administered and time to recovery post procedure. Meta-analysis was performed using RevMan5 software version 5.39.
RESULTS
A total of 23 clinical trials were included ( = 3854) from the initial search of 6410 articles. For Group I (Propofol benzodiazepine and/or opioids): The incidence of bradycardia was not statistically different between both sedation arms (RD: -0.01, 95%CI: -0.03-+0.01, : 22%). In 10 studies, the incidence of hypotension was not statistically difference between sedation arms (RD: 0.01, 95%CI: -0.02-+0.04, : 0%). Oxygen desaturation was higher in the propofol group but not statistically different between groups (RD: -0.03, 95%CI: -0.06-+0.00, : 25%). Patients were more satisfied with their sedation in the benzodiazepine + opioid group compared to those with monotherapy propofol sedation (MD: +0.89, 95%CI: +0.62-+1.17, : 39%). The recovery time after the procedure showed high heterogeneity even after outlier withdrawal, there was no statistical difference between both arms (MD: -15.15, 95%CI: -31.85-+1.56, : 99%). For Group II (Propofol propofol with benzodiazepine and/or opioids): Bradycardia had a tendency to occur in the Propofol group with benzodiazepine and/or opioid-associated (RD: -0.08, 95%CI: -0.13--0.02, : 59%). There was no statistical difference in the incidence of bradycardia (RD: -0.00, 95%CI: -0.08-+0.08, : 85%), desaturation (RD: -0.00, 95%CI: -0.03-+0.02, : 44%) or recovery time (MD: -2.04, 95%CI: -6.96-+2.88, : 97%) between sedation arms. The total dose of propofol was higher in the propofol group with benzodiazepine and/or opiates but with high heterogeneity. (MD: 70.36, 95%CI: +53.11-+87.60, : 61%). For Group III (Propofol with benzodiazepine and opioid benzodiazepine and opioid): Bradycardia and hypotension was not statistically significant between groups (RD: -0.00, 95%CI: -0.002-+0.02, : 3%; RD: 0.04, 95%CI: -0.05-+0.13, : 77%). Desaturation was evaluated in two articles and was higher in the propofol + benzodiazepine + opioid group, but with high heterogeneity (RD: 0.15, 95%CI: 0.08-+0.22, : 95%).
CONCLUSION
This meta-analysis suggests that the use of propofol alone or in combination with traditional adjunctive sedatives is safe and does not result in an increase in negative outcomes in patients undergoing endoscopic procedures.
PubMed: 31839876
DOI: 10.4253/wjge.v11.i12.573 -
BMC Emergency Medicine Oct 2020The aim of this review is to elucidate the efficacy and side effects of ketofol in comparison to other anaesthetic agents during procedural sedation and analgesia. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of this review is to elucidate the efficacy and side effects of ketofol in comparison to other anaesthetic agents during procedural sedation and analgesia.
METHOD
The Cochrane Central Register of Controlled Trials (1996 to Feb 2019) and MEDLINE (1966 to Feb 2019) were searched, including the related randomised control trials and reviewed articles to find unpublished trials or trials not obtained via electronic searches. Inclusion criteria for the studies included comparing recovery time, recording clinician satisfaction, and assessing the adverse effects of ketofol.
RESULTS
Eleven trials consisting of a total of 1274 patients met our criteria and were included in this meta-analysis. Five trials compared ketofol with a single agent, while six trials compared ketofol with combined agents. While comparing between ketofol and a single agent (either ketamine or propofol), ketofol showed significant effect on recovery time (MD: -9.88, 95% CI: - 14.30 to - 5.46; P = 0.0003; I = 92%). However, no significant difference was observed while comparing ketofol with combined agents (RR: 0.75, 95% CI: - 6.24 to 7.74; P < 0.001; I = 98%). During single-agent comparison, ketofol showed no significant differences in terms of clinician satisfaction (RR: 2.86, 95% CI: 0.64 to 12.69; P = 0.001; I = 90%), airway obstruction (RR: 0.72, 95% CI: 0.35 to 11.48; P = 0.81; I = 0%), apnoea (RR: 0.9, 95% CI: 0.33 to 2.44; P = 0.88; I = 0%), desaturation (RR: 1.11, 95% CI: 0.64 to 1.94; P = 0.28; I = 21%), nausea (RR: 0.52, 95% CI: 0.91 to 1.41; P = 0.2; I = 38%), and vomiting (RR: 0.63, 95% CI: 0.25 to 1.61; P = 0.18; I = 42%). During comparison with combined agents, ketofol was more effective in reducing hypotension (RR: 4.2, 95% CI: 0.2 to 0.85; P = 0.76; I = 0%), but no differences were observed in terms of bradycardia (RR: 0.70, 95% CI: 0.14 to 03.63; P = 0.09; I = 53%), desaturation (RR: 1.9, 95% CI: 0.15 to 23.6; P = 0.11; I = 61%), and respiratory depression (RR: 1.98, 95% CI: 0.18 to 21.94; P = 0.12; I = 59%).
CONCLUSION
There is low certainty of evidence that ketofol improves recovery time and moderate certainty of evidence that it reduces the frequency of hypotension. There was no significant difference in terms of other adverse effects when compared to other either single or combined agents.
TRIAL REGISTRATION
PROSPERO CRD42019127278 .
Topics: Analgesics; Child; Conscious Sedation; Drug Combinations; Emergency Service, Hospital; Humans; Hypnotics and Sedatives; Ketamine; Pain Management; Propofol
PubMed: 33032544
DOI: 10.1186/s12873-020-00373-4 -
Frontiers in Medicine 2021The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of remimazolam in clinical endoscopic procedure sedation. The authors...
The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of remimazolam in clinical endoscopic procedure sedation. The authors searched the databases of PubMed, Embase, and Cochrane Library for studies published until January 2, 2021, that reported remimazolam sedation for endoscopic procedures. The sedative efficiency and the incidence of adverse events were assessed as outcomes. Cochrane Review Manager Software 5.3 was used to perform the statistical analyses. Seven relevant studies involving a total of 1,996 patients were identified. We conducted a meta-analysis of the different controls used in the studies, that is, the placebo, midazolam, and propofol. The results demonstrated that remimazolam had a strong sedative effect, and its sedative efficiency was significantly higher than that of placebo [OR = 0.01, 95% CI: (0.00, 0.10), = 30%, <0.00001]. The sedative efficiency of remimazolam was significantly higher than that of midazolam [OR = 0.12, 95% CI: (0.08, 0.21), = 0%, < 0.00001] but lesser than that of propofol [OR = 12.22, 95% CI: (1.58, 94.47), = 0%, = 0.02]. Regarding the adverse events, remimazolam is associated with a lower incidence of hypotension than placebo and midazolam. Similarly, remimazolam was associated with a lower incidence of hypotension and hypoxemia than propofol. Remimazolam is a safe and effective sedative for patients undergoing endoscopic procedures. The sedative efficiency of remimazolam was significantly higher than that of midazolam but slightly lower than that of propofol. However, the respiration and circulation inhibitory effects of remimazolam were weaker than those of midazolam and propofol.
PubMed: 34381792
DOI: 10.3389/fmed.2021.655042 -
Annals of Palliative Medicine Jun 2021At present, liver cancer deaths of China account for about half of the global liver cancer deaths. The most common physiological change in anesthesia surgery for liver... (Meta-Analysis)
Meta-Analysis
BACKGROUND
At present, liver cancer deaths of China account for about half of the global liver cancer deaths. The most common physiological change in anesthesia surgery for liver cancer is liver ischemia-reperfusion injury (LIRI).
METHODS
The Chinese and English medical databases were searched using a combination of the following search terms: "propofol", "liver cancer", "anesthesia surgery", and "ischemia reperfusion injury" in Chinese or English language, respectively. The articles taking patients received propofol intravenous anesthesia surgery for LIRI in the experimental group and patients received intravenous anesthesia with non-propofol drugs for LIRI in the control group were searched. Rev Man 5.3 software was used for meta-analysis.
RESULTS
A total of 18 articles were included, and most were considered to have low-risk bias (that is, medium- and high-quality publications). The meta-analysis results indicated that the superoxide dismutase (SOD) levels from the blockage of the hepatic hilum (B-HH) to the 15-minute opening of the hepatic hilum (O-HH) showed a mean deviation (MD) of -0.33 nU/mL and 95% confidential interval (CI) of -1.81 to 1.15 nmol/L (P<0.05). The levels of malondialdehyde (MDA) from B-HH to O-HH showed a MD of 1.80 nmol/L and 95% CI of 1.53 to 2.07 nmol/l (P<0.05). The MD of alanine transaminase (ALT) levels from B-HH to O-HH was 8.24 IU/L with 95% CI 6.43 to 10.06 IU/L (P<0.05). The MD of aspartate transaminase (AST) levels from B-HH to O-HH was -11.73 IU/L with 95% CI -14.04 to -9.43 IU/L (P<0.05). The RevMan5.3 software was used to draw the funnel chart for each indicator from B-HH to OHH. The results revealed that the circles in some articles were concentrated on the midline and were basically symmetrical with the midline, indicating that the research accuracy was high and there was no bias in publication.
DISCUSSION
This meta-analysis confirmed that propofol exerted a protective effect on LIRI during anesthesia surgery with hepatic hilar blockade.
Topics: Anesthesia; Carcinoma, Hepatocellular; China; Humans; Liver; Liver Neoplasms; Propofol; Reperfusion Injury
PubMed: 34154355
DOI: 10.21037/apm-21-1242 -
Academic Emergency Medicine : Official... Jan 2008To synthesize the evidence comparing the adverse event (AE) profile and clinical effectiveness of midazolam and propofol for procedural sedation (PS) in adults in the... (Comparative Study)
Comparative Study Review
OBJECTIVES
To synthesize the evidence comparing the adverse event (AE) profile and clinical effectiveness of midazolam and propofol for procedural sedation (PS) in adults in the emergency care setting.
METHODS
The authors conducted a systematic review of randomized controlled trials (RCTs) and observational studies reporting the use of either midazolam and/or propofol for adult PS in the emergency department (ED). A systematic search strategy was developed and applied to six bibliographic reference databases. Three emergency medicine journals, the Canadian Adverse Drug Reaction Newsletter, and conference proceedings were hand-searched. Retrieved articles were reviewed and data were abstracted using standardized data collection. Trial quality was assessed using the Jadad score. The outcomes assessed were the proportion of patients with AEs and the pooled mean difference in the proportion of patients with successful PS.
RESULTS
Of 229 articles identified, 28 met the inclusion criteria for the analysis of AEs. Only one major AE to PS was found, resulting in no statistically significant difference in the proportion of major AEs between agents. Four studies were RCTs that met the inclusion criteria for the analysis of clinical effectiveness. Two trials met criteria for good quality. The RCTs enrolled between 32 and 86 patients, and the most common indications for PS were orthopedic reductions and cardioversions. There was a nonsignificant difference in the proportion of patients with successful PS in favor of propofol (effect difference 2.9%, 95% confidence interval (CI) = -6.5 to 15.2).
CONCLUSIONS
The authors found no significant difference in the safety profile and the proportion of successful PS between midazolam and propofol for adults in the ED.
Topics: Adult; Conscious Sedation; Emergency Medical Services; Humans; Hypnotics and Sedatives; Midazolam; Outcome and Process Assessment, Health Care; Propofol; Treatment Outcome
PubMed: 18211306
DOI: 10.1111/j.1553-2712.2007.00022.x -
Gastroenterology Research and Practice 2018The majority of children who undergo gastrointestinal (GI) endoscopy require anesthesia or procedural sedation for comfort, cooperation, and procedure efficiency. The... (Review)
Review
BACKGROUND
The majority of children who undergo gastrointestinal (GI) endoscopy require anesthesia or procedural sedation for comfort, cooperation, and procedure efficiency. The safety profile of propofol is not well established in children but has been studied in the literature.
OBJECTIVE
The aim of this study is to evaluate and compare the safety of propofol-only sedation for GI endoscopy procedures to other anesthetic regimes in the pediatric population.
METHODS
A search was conducted in the MEDLINE, Embase, and Cochrane Library databases. Randomized clinical trials and prospective cohorts were included in the study.
RESULTS
No significant difference was noted in total complications between the two cohorts with a pooled OR of 1.31 (95% CI: 0.57-3.04, chi = 0.053, = 54.31%). The pooled rate of complications in the studies was 23.4% for those receiving propofol only and 18.2% for those receiving other anesthetic regimens. Sensitivity analysis was performed removing a study with a very different control comparison compared to the rest of the studies included. Once excluded, there was minimal heterogeneity in the remaining studies and a significant difference in overall complications was detected, with more complications seen in the propofol-only group compared to the other anesthetic groups (OR 1.87, 95% CI 1.09-3.20).
CONCLUSION
Significantly higher incidence of cardiorespiratory complications was noted in the propofol-only versus other anesthetic regimens in pediatric patients undergoing GI endoscopy in this meta-analysis. However, the overall quality of the evidence is very low.
HOW TO APPLY THIS KNOWLEDGE FOR ROUTINE CLINICAL PRACTICE
Clinicians providing sedation to a pediatric population for GI endoscopy should consider there may be increased risks when using a propofol-only regimen, but further study is needed.
PubMed: 30210535
DOI: 10.1155/2018/6501215 -
Translational Pediatrics Feb 2022During treatment of acute respiratory failure (ARF) in children, sedation can reduce pain, improve tolerance, and reduce the incidence of adverse events, so selecting an...
BACKGROUND
During treatment of acute respiratory failure (ARF) in children, sedation can reduce pain, improve tolerance, and reduce the incidence of adverse events, so selecting an appropriate sedation strategy is very important for improving prognosis and quality of life. Both dexmedetomidine and propofol have good sedative effects, so we investigated the application of these drugs in critically ill children with ARF by literature search and meta-analysis.
METHODS
We searched Embase, The Cochrane Library, PubMed, Ovid, Clinicaltrials.org, and Google Scholar for randomized controlled trials (RCTs) preferentially but not exclusively, and used RevMan 5.4 to analyze the screened literature.
RESULTS
Seven studies were included in the quantitative meta-analysis, with a total of 1,188 patients. There was no significant difference in the effect of dexmedetomidine and propofol on the duration of tracheal intubation in children with ARF [mean difference (MD) =-0.05; 95% confidence interval (CI): (-0.42, 0.32); Z=0.26; P=0.79], but dexmedetomidine sedation could reduce the intensive care unit (ICU) stay in children with ARF [MD =-0.62; 95% CI: (-1.08, -0.16); Z=2.65; P=0.008], and shorten the total hospital stay [MD =-1.94; 95% CI: (-2.63, -1.25); Z=5.48; P<0.00001]. There was no significant effect on mortality between the two groups [odds ratio (OR) =0.48; 95% CI: (0.19, 1.25); Z=1.50; P=0.13]. The incidence rate of bradycardia with dexmedetomidine sedation was higher than with propofol [OR =12.30; 95% CI: (2.28, 66.47); Z=2.92; P=0.004], and the incidence of hypotension was also higher [OR =6.99, 95% CI: (1.22, 39.86); Z=2.19; P=0.03].
DISCUSSION
Compared with propofol, dexmedetomidine can significantly reduce the ICU stay and hospital stay. However, bradycardia and hypotension may occur during the use of dexmedetomidine, which requires close attention and timely intervention.
PubMed: 35282029
DOI: 10.21037/tp-22-20 -
Anaesthesia Oct 2014With the popularity of ambulatory surgery ever increasing, we carried out a systematic review and meta-analysis to determine whether the type of anaesthesia used had any... (Comparative Study)
Comparative Study Meta-Analysis Review
With the popularity of ambulatory surgery ever increasing, we carried out a systematic review and meta-analysis to determine whether the type of anaesthesia used had any bearing on patient outcomes. Total intravenous propofol anaesthesia was compared with two of the newer inhalational agents, sevoflurane and desflurane. In total, 18 trials were identified; only trials where nitrous oxide was administered to, or omitted from, both groups were included. A total of 1621 patients were randomly assigned to either propofol (685 patients) or inhalational anaesthesia (936 patients). If surgical causes of unplanned admissions were excluded, there was no difference in unplanned admission to hospital between propofol and inhalational anaesthesia (1.0% vs 2.9%, respectively; p = 0.13). The incidence of postoperative nausea and vomiting was lower with propofol than with inhalational agents (13.8% vs 29.2%, respectively; p < 0.001). However, no difference was noted in post-discharge nausea and vomiting (23.9% vs 20.8%, respectively; p = 0.26). Length of hospital stay was shorter with propofol, but the difference was only 14 min on average. The use of propofol was also more expensive, with a mean (95% CI) difference of £6.72 (£5.13-£8.31 (€8.16 (€6.23-€10.09); $11.29 ($8.62-$13.96))) per patient-anaesthetic episode (p < 0.001). Therefore, based on the published evidence to date, maintenance of anaesthesia using propofol appeared to have no bearing on the incidence of unplanned admission to hospital and was more expensive, but was associated with a decreased incidence of early postoperative nausea and vomiting compared with sevoflurane or desflurane in patients undergoing ambulatory surgery.
Topics: Ambulatory Surgical Procedures; Anesthesia, Intravenous; Costs and Cost Analysis; Desflurane; Humans; Isoflurane; Methyl Ethers; Postoperative Nausea and Vomiting; Propofol; Sevoflurane
PubMed: 24847783
DOI: 10.1111/anae.12713 -
Journal of Gastrointestinal Oncology Dec 2022This study sought to explore the effects of sevoflurane and propofol on postoperative nausea and vomiting (PONV) in patients with colorectal cancer (CRC). Sevoflurane...
Effects of sevoflurane and propofol on postoperative nausea and vomiting in patients with colorectal cancer placed under general anesthesia: a systematic review and meta-analysis.
BACKGROUND
This study sought to explore the effects of sevoflurane and propofol on postoperative nausea and vomiting (PONV) in patients with colorectal cancer (CRC). Sevoflurane inhalation anesthesia has the advantages of short induction time, stable hemodynamic, stable anesthesia maintenance and short recovery time, and its anesthetic effect is similar to that of propofol, so it is worthy of comparative analysis.
METHODS
The PubMed, Cochrane, Web of Science, Embase, clinical research register and CQVIP databases were searched to retrieve the data of randomized controlled trials (RCTs) published between October 2000 and October 2021 on the effects of sevoflurane and propofol on nausea and vomiting after laparoscopic surgery in patients with CRC. Applying the inclusion criteria, the literature selection, data extraction, and quality evaluation assessments were carried out for the included articles. The I test was used to evaluate the heterogeneity between the studies, and the meta-analysis was performed using RevMan 5.2.6 software provided by Cochrane.
RESULTS
A total of 12 RCTs were included in this meta-analysis. There was statistically significant differences in changes in postoperative heart rate [odds ratio (OR) =3.55, 95% confidence interval (CI): 2.40, 5.27, P<0.00001, I=0%, Z=6.30], mean artery pressure (MAP) (OR =2.58, 95% CI: 2.04, 3.26, P<0.00001, I=58%, Z=7.87), the incidence of PONV (OR =1.73, 95% CI: 1.38, 2.17, P<0.00001, I=46%, Z=4.78), and the incidence of postoperative disturbance of consciousness (OR =2.09, 95% CI: 1.62, 3.07, P<0.00001, I=63%, Z=5.67) between the experimental group and the control group.
CONCLUSIONS
Combining anesthesia with sevoflurane and propofol had good prevention and treatment effects for PONV in patients with CRC who underwent a laparoscopy and had a moderate central sedation effect.
PubMed: 36636047
DOI: 10.21037/jgo-22-783 -
Medicine Sep 2018Propofol and midazolam are widely used for the sedation of bronchoscopy. This systematic review and meta-analysis is conducted to compare the efficacy of propofol and... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Propofol and midazolam are widely used for the sedation of bronchoscopy. This systematic review and meta-analysis is conducted to compare the efficacy of propofol and midazolam for bronchoscopy.
METHODS
The databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases are systematically searched for collecting the randomized controlled trials (RCTs) regarding the efficacy of propofol and midazolam for bronchoscopy.
RESULTS
This meta-analysis has included 4 RCTs. Compared with midazolam intervention in patients undergoing bronchoscopy, propofol intervention is associated with remarkably reduced recovery time [standard mean difference (SMD) = -0.74; 95% confidence interval (95% CI) = -1.04 to -0.45; P < .00001], but demonstrates no significant impact on operation time (SMD = -0.01; 95% CI = -0.16 to 0.13; P = .87), induction time (SMD = -0.58; 95% CI = -1.19 to 0.03; P = .06), lowest oxyhemoglobin saturation (SpO2, SMD = 0.24; 95% CI = -0.09 to 0.58; P = .15), SpO2 <90% [risk ratio (RR) = 1.02; 95% CI = 0.82-1.25; P = .88), and major arrhythmias (RR = 0.56; 95% CI = 0.26-1.19; P = .13).
CONCLUSION
Propofol sedation is able to reduce recovery time and shows similar safety compared with midazolam sedation during bronchoscopy.
Topics: Anesthetics, Intravenous; Bronchoscopy; Humans; Hypnotics and Sedatives; Midazolam; Pain, Procedural; Propofol; Randomized Controlled Trials as Topic
PubMed: 30200147
DOI: 10.1097/MD.0000000000012229