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British Journal of Anaesthesia Mar 1997We have analysed randomized controlled studies which reported the incidence of postoperative nausea and vomiting (PONV) after propofol anaesthesia compared with other... (Meta-Analysis)
Meta-Analysis
We have analysed randomized controlled studies which reported the incidence of postoperative nausea and vomiting (PONV) after propofol anaesthesia compared with other anaesthetics (control). Cumulative data of early (0-6 h) and late (0-48 h) PONV were recorded as occurrence or non-occurrence of nausea or vomiting. Combined odds ratio and number-needed-to-treat were calculated for propofol as an induction or maintenance regimen, early or late outcomes, and different emetic events. This was performed for all control event rates and within a range of 20-60% control event rates. We analysed 84 studies involving 6069 patients. The effect of propofol on PONV was dependent mainly on the method of administration, time of measurement and range of control event rates. When all studies were included the number-needed-to-treat to prevent PONV with propofol was more than 9 when used for induction of anaesthesia and at best 6 when used for maintenance. Within the 20-60% control event rate range, best results were achieved with propofol maintenance to prevent early PONV: the number-needed-to-treat to prevent early nausea was 4.7 (95% confidence interval 3.8-6.3), vomiting 4.9 (4-6.1) and any emetic event 4.9 (3.7-7.1). Within the 20-60% control event rate, of five patients treated with propofol for maintenance of anaesthesia, one will not vomit or be nauseated in the immediate postoperative period who would otherwise have vomited or been nauseated. This may be clinically relevant. In all other situations the difference between propofol and control may have reached statistical significance but was of doubtful clinical relevance. Treatment efficacy should be established within a defined range of control event rates for meaningful estimates of efficacy and for comparisons.
Topics: Anesthetics, Intravenous; Antiemetics; Humans; Nausea; Postoperative Complications; Postoperative Period; Propofol; Randomized Controlled Trials as Topic; Vomiting
PubMed: 9135299
DOI: 10.1093/bja/78.3.247 -
Journal of Anesthesia, Analgesia and... Apr 2024Propofol is the most commonly used hypnotic agent used during sedation and general anesthesia (GA) practice, offering faster recovery compared to benzodiazepines.... (Review)
Review
BACKGROUND
Propofol is the most commonly used hypnotic agent used during sedation and general anesthesia (GA) practice, offering faster recovery compared to benzodiazepines. However, cardiovascular impact of propofol and pain at injection are commonly encountered side effects. Ciprofol is a novel disubstituted phenol derivative, and there is growing evidence regarding its clinical use.
METHODS
We conducted a systematic literature search (updated on 23 July 2023) to evaluate safety and efficacy of ciprofol in comparison to propofol in patients undergoing procedures under sedation or GA. We focused on randomized controlled trials (RCTs) only, extrapolating data on onset and offset, and on the side effects and the pain at injection.
RESULTS
The search revealed 14 RCTs, all conducted in China. Eight RCTs studied patients undergoing sedation, and six focused on GA. Bolus of ciprofol for sedation or induction of GA varied from 0.2 to 0.5 mg/kg. In four studies using ciprofol for maintenance of GA, it was 0.8-2.4 mg/kg/h. Ciprofol pharmacokinetics seemed characterized by slower onset and offset as compared to propofol. Pain during injection was less frequent in the ciprofol group in all the 13 studies reporting it. Eight studies reported "adverse events" as a pooled outcome, and in five cases, the incidence was higher in the propofol group, not different in the remaining ones. Occurrence of hypotension was the most commonly investigated side effects, and it seemed less frequent with ciprofol.
CONCLUSION
Ciprofol for sedation or GA may be safer than propofol, though its pharmacokinetics may be less advantageous.
PubMed: 38589912
DOI: 10.1186/s44158-024-00159-1 -
International Journal of Surgery... Mar 2018We performed a systematic review of various anaesthetic medications for endoscopic retrograde cholangiopancreatography (ERCP) and aimed to make a comprehensive... (Meta-Analysis)
Meta-Analysis Review
AIMS
We performed a systematic review of various anaesthetic medications for endoscopic retrograde cholangiopancreatography (ERCP) and aimed to make a comprehensive comparison based on a network meta-analysis.
METHODS
We searched globally recognized electronic databases, including PubMed, Cochrane Central and EMBASE, to retrieve relevant randomized controlled trials (RCTs) of anaesthetic medications for ERCP. Network meta-analysis was conducted by evaluating the procedure time, adverse effects and drug requirements. The cumulative probability P value was utilized to rank the medications under examination.
RESULTS
Seventeen RCTs that examined 1877 patients were included in this research. Under good convergence and efficiency, data analysis was performed using a consistency model. For the comparison of procedure times, we found that a combination of dexmedetomidine and ketamine (P = 0.19) or propofol plus pethidine (P = 0.18) seemed to be the two best medications for reducing procedure time. Additionally, midazolam combined with dexmedetomidine plus pethidine seemed to be the safest application for ERCP (P = 0.36). Propofol plus alfentanil also exhibited a good safety value (P = 0.28). For evaluation of drug requirements, the whole network connection could not be established; thus, comparisons in two subgroups were conducted. The results showed that midazolam combined with dexmedetomidine plus pethidine (P = 0.41) and propofol plus refentanil (P = 0.94) were superior to others in decreasing drug requirements.
CONCLUSIONS
Based on the objective results and our conclusions, we deemed that a combination of midazolam and dexmedetomidine was recommended, and propofol plus opioids also revealed great clinical value. However, we are still expecting more clinical research in the future.
Topics: Alfentanil; Analgesics, Opioid; Anesthetics; Cholangiopancreatography, Endoscopic Retrograde; Dexmedetomidine; Drug Therapy, Combination; Humans; Ketamine; Meperidine; Midazolam; Network Meta-Analysis; Operative Time; Propofol; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 29367034
DOI: 10.1016/j.ijsu.2018.01.018 -
Disease Markers 2022Hysteroscopy is a minimally invasive gynecologic technique that is widely practiced in outpatient procedures. The choice of anesthesia is a key factor for the surgical... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Hysteroscopy is a minimally invasive gynecologic technique that is widely practiced in outpatient procedures. The choice of anesthesia is a key factor for the surgical outcome and postoperative recovery. This study was conducted to assess the effects of different anesthetic modalities based on dexmedetomidine in outpatient hysteroscopic surgery anesthesia.
METHODS
We did a systematic review and network meta-analysis of outpatient hysteroscopic surgery anesthesia. We searched Pubmed, Embase, and Cochrane-Library from database inception to December 31, 2021. Duplicate literature was excluded and screened separately for initial screening at three tiers: article title, abstract, and full text before deciding whether to include in this study against the above criteria. Results after analysis of categorical variables were expressed as ORR Ratio (95% CI) and continuous variables were expressed as Mean Difference (95% CI). Data collation and analyses were performed using the gemtc package in the R language.
RESULTS
Four trials were finally included with data for 301 participants, three anesthetic drugs, and five anesthetic modalities. A fixed-effects model was used for the different anesthesia modalities without significant heterogeneity (all I2<20%) in the analysis of adverse events (AEs), the incidence of respiratory depression, operative time, and time in the post-anesthesia care unit (PACU). Remimazolam tosylate was associated with a lower incidence of AEs versus dexmedetomidine, and significant differences between dexmedetomidine and propofol were absent. Propofol and various doses of remimazolam tosylate resulted in a lower incidence of respiratory depression versus dexmedetomidine, with an absence of differences between propofol and dexmedetomidine. The operative time for different anesthetic modalities was, in descending order, dexmedetomidine < remimazolam tosylate (0.60 mg/kg/h <0.48 mg/kg/h) < propofol < remimazolam tosylate (1.00 mg/kg/h), despite the absence of intergroup differences. Propofol was associated with a longer time in PACU versus dexmedetomidine and remimazolam tosylate (1.00 mg/kg/h); those of dexmedetomidine and remimazolam tosylate (1.00 mg/kg/h) were similar. The time in PACU for different anesthetic modalities, in descending order, was dexmedetomidine < remimazolam tosylate (1.00 mg/kg/h) < propofol. Propofol was associated with a longer time in PACU versus dexmedetomidine and remimazolam tosylate.
CONCLUSION
In outpatient hysteroscopic surgery anesthesia, dexmedetomidine was associated with a higher incidence of AEs and respiratory depression and a shorter operative time and time in PACU versus remimazolam tosylate and propofol. Remimazolam tosylate showed safety benefits with a similar duration of PACU stay versus dexmedetomidine. Therefore, the choice of anesthetic drugs in outpatient surgery requires consideration of the patient's conditions and preferences.
Topics: Ambulatory Surgical Procedures; Anesthetics; Dexmedetomidine; Female; Humans; Hysteroscopy; Network Meta-Analysis; Outpatients; Pregnancy; Propofol; Respiratory Insufficiency
PubMed: 36188426
DOI: 10.1155/2022/2408685 -
Annals of Palliative Medicine Oct 2021Optic nerve sheath diameter (ONSD) is recognized as a surrogate indicator of intracranial pressure (ICP) during surgery. Due to the requirements of surgery, the... (Meta-Analysis)
Meta-Analysis
Effects of propofol and inhalational anesthetics on the optic nerve sheath diameter in patients undergoing surgery in the steep Trendelenburg position: a systematic review and meta-analysis.
BACKGROUND
Optic nerve sheath diameter (ONSD) is recognized as a surrogate indicator of intracranial pressure (ICP) during surgery. Due to the requirements of surgery, the adjustment to the steep Trendelenburg position and the establishment of CO2 pneumoperitoneum can lead to an increase in ICP, resulting in an increase in the ONSD. Anesthetic agents have different impacts on cerebral blood volume and ICP. The aim of this study was to evaluate the effects of propofol and inhalational anesthetics on the ONSD based on data from randomized controlled trials (RCTs).
METHODS
The electronic databases of PubMed, EMBASE, Ovid MEDLINE, the Cochrane Library, and other databases were searched systematically using specified keywords from their inception to June 2021. The Chi-square test and I2 test were used to evaluate the heterogeneity across the studies. The weighted mean difference (WMD) with 95% confidence interval (CI) were adopted to analyze continuous data.
RESULTS
A total of 379 patients from 7 studies were involved in this meta-analysis. There were borderline significant differences in the ONSD atT2 between propofol and the control group: T2 (WMD =-0.15, 95% CI: -0.31, -0.00, P=0.005). There were significant differences at T3 (WMD =-0.23,95% CI: -0.42, -0.05, P =0.013) and T4 (WMD =-0.18, 95% CI: -0.29, -0.07, P =0 .001). After statistical verification, there was no significant difference in the ONSD at T1 between the 2 groups: T1 (WMD =-0.08, 95% CI: -0.26, 0.10, P =0 .368). There were also no significant differences in mean arterial pressure (MAP) (P=0.654, 0.445, 0.698, and 0.562, respectively) and end tidal CO2 (ETCO2) (P=0.081, 0.506, 0.126, and 0.983, respectively) at T1, T2, T3 and T4 between propofol and inhalational anesthetics.
DISCUSSION
The findings in the present study indicated that the ONSD during propofol anesthesia was significantly lower than that during inhalational anesthesia after adopting the Trendelenburg position and CO2 pneumoperitoneum. These analysis results suggest that propofol anesthesia may help to minimize changes in ICP compared to inhalational anesthetics.
Topics: Anesthetics, Inhalation; Head-Down Tilt; Humans; Laparoscopy; Male; Optic Nerve; Propofol; Prostatectomy; Randomized Controlled Trials as Topic; Robotic Surgical Procedures
PubMed: 34763494
DOI: 10.21037/apm-21-2363 -
Medicine Feb 2023Propofol is increasingly being used for sedation in gastrointestinal endoscopy; however, owing to its side effects, an alternative drug is needed. We aimed to compare... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Propofol is increasingly being used for sedation in gastrointestinal endoscopy; however, owing to its side effects, an alternative drug is needed. We aimed to compare the safety, satisfaction, and efficacy outcomes of etomidate versus propofol in patients undergoing gastrointestinal endoscopy, including advanced endoscopic procedures.
METHODS
We systematically searched Embase, PubMed, Cochrane Central Register of Controlled Trials, CINAHL (via EBSCO), China National Knowledge Infrastructure, and Web of Science (1946-April 2020) databases for randomized controlled trials of gastrointestinal endoscopy (upper gastrointestinal endoscopy, colonoscopy, and advanced endoscopy) using etomidate or propofol as sedatives. We pooled odds ratios (ORs) for the safety profile and patient and anesthesiologist satisfaction using mixed-effects conditional logistic models and standardized mean differences for efficiency outcomes using random-effects models.
RESULTS
Twenty-four studies involving 3875 patients were included. Compared with propofol, etomidate resulted in significantly reduced apnea (OR: 0.22; 95% confidence interval [CI]: 0.13-0.37; P < .001), hypoxemia (OR: 0.43; 95% CI: 0.35-0.54; P < .001), hypotension (OR: 0.20; 95% CI: 0.11-0.36; P < .001), and bradycardia (OR: 0.52; 95% CI: 0.30-0.91; P = .02) but led to increased myoclonus (OR: 8.54; 95% CI: 5.20-14.01; P < .001) and lowered anesthesiologist satisfaction (OR: 0.60; 95% CI: 0.39-0.91; P = .02).
CONCLUSION
Etomidate may be a good alternative to propofol for gastrointestinal endoscopy, especially advanced endoscopy. Etomidate appears to be safe as an inducer for hemodynamically unstable patients or older adult patients undergoing gastrointestinal endoscopy.
Topics: Humans; Aged; Propofol; Etomidate; Endoscopy, Gastrointestinal; Hypnotics and Sedatives; Colonoscopy
PubMed: 36820568
DOI: 10.1097/MD.0000000000032876 -
BMC Cancer Dec 2019The potential risk for cognitive impairment following surgery and anesthesia is a common concern, especially in the elderly and more fragile patients. The risk for... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
The potential risk for cognitive impairment following surgery and anesthesia is a common concern, especially in the elderly and more fragile patients. The risk for various neurocognitive effects is thus an area of importance. The independent impact of surgery and anesthesia is still not known. Likewise, the independent effect of different drugs used during anesthesia is a matter of debate, as is the number and amounts of drugs used and the "depth of anesthesia." So, understanding the drug-related phenomenon and mechanisms for postoperative cognitive impairment is essential. This meta-analysis aims to compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function in elderly patients with lung cancer.
METHODS
This study is a systematic review and meta-analysis for controlled clinical studies. Public-available online databases were searched to identify eligible randomized placebo-controlled trials or prospective cohort studies concerning the effects of propofol and sevoflurane on postoperative cognitive function. The primary endpoints are postoperative mini-mental state examination (MMSE) scores at various time points; the secondary endpoint is the serum S100beta concentration 24 h after surgery. Standard mean differences (SMDs) along with 95% confidence intervals (CIs) were extracted and analyzed using random or fixed-effects models. Analyses regarding heterogeneity, risk of bias assessment, and sensitivity were performed.
RESULTS
We searched 1626 eligible publications and 14 studies of 1404 patients were included in the final analysis. The majority of included studies had been undertaken in Asian populations. Results suggested that propofol has a greater adverse effect on cognitive function in the elderly patients with lung cancer than sevoflurane. There were significant differences in issues of MMSE 6 h (11 studies; SMD -1.391, 95% CI -2.024, - 0.757; p < 0.001), MMSE 24 h (14 studies; SMD -1.106, 95% CI -1.588, - 0.624; p < 0.001), MMSE 3d (11 studies; SMD -1.065, 95% CI -1.564, - 0.566; p < 0.001), MMSE 7d (10 studies; SMD -0.422, 95% CI -0.549, - 0.295; p < 0.001), and serum S100beta concentration at 1 day after surgery (13 studies; SMD 0.746, 95% CI 0.475, 1.017; p < 0.001).
CONCLUSION
Propofol has a more significant adverse effect on postoperative cognitive function in elderly patients with lung cancer than sevoflurane.
Topics: Age Factors; Aged, 80 and over; Anesthesia; Anesthetics, Inhalation; Anesthetics, Intravenous; Cognitive Dysfunction; Humans; Lung Neoplasms; Postoperative Complications; Propofol; Randomized Controlled Trials as Topic; Sevoflurane
PubMed: 31870348
DOI: 10.1186/s12885-019-6426-2 -
Medicine Oct 2021Postoperative cognitive dysfunction (POCD) is a very common event in elderly noncardiac surgical patients. The effects of inhalational anaesthetics and propofol on the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Postoperative cognitive dysfunction (POCD) is a very common event in elderly noncardiac surgical patients. The effects of inhalational anaesthetics and propofol on the incidence of POCD and postoperative cognitive status at different time points after surgery are currently unclear.
METHODS
We searched the Embase, Medline, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs), in which inhalation anaesthesia and propofol anaesthesia were compared. The incidence of POCD or postoperative cognitive status was assessed in elderly patients undergoing noncardiac surgery.
RESULTS
Fifteen RCTs with 1854 patients were included in this meta-analysis. The incidence of POCD on postoperative Days 2-6 after propofol anaesthesia was markedly lower than that after inhalation anaesthesia (risk ratio (RR): 0.37, 95% confidence interval (CI): 0.15-0.88, P = .025), and Mini-Mental State Examination (MMSE) scores after propofol anaesthesia were substantially higher than those after inhalation anaesthesia (standard mean difference (SMD): 0.59, 95% CI: 0.07-1.11, P = .026). The levels of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were much lower after propofol anaesthesia than after inhalation anaesthesia (SMD: -2.027, 95% CI: -3.748- -0.307, P = .021; SMD: -0.68, 95% CI: -0.93- -0.43, P < .001).
CONCLUSIONS
The moderate evidence from this meta-analysis shows that, in elderly noncardiac surgical patients, propofol anaesthesia is superior to inhalation anaesthesia for attenuating of early POCD incidence, and low-level evidence shows that cognitive status is higher and systemic inflammation is less severe after propofol anaesthesia in the early days after surgery.
LIMITATIONS
The sample size was not sufficiently large for systemic inflammation, and the tools to identify POCD were not uniform in the included studies.
Topics: Anesthesia, Inhalation; Anesthetics, Inhalation; Anesthetics, Intravenous; Humans; Mental Status and Dementia Tests; Postoperative Cognitive Complications; Propofol; Randomized Controlled Trials as Topic; Surgical Procedures, Operative
PubMed: 34713863
DOI: 10.1097/MD.0000000000027668 -
Medicine May 2019Sedation with etomidate or propofol alone during gastroscopy has many side effects. A systematic review and meta-analysis were conducted to evaluate the safety and... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Sedation with etomidate or propofol alone during gastroscopy has many side effects. A systematic review and meta-analysis were conducted to evaluate the safety and efficacy of the combined use of propofol and etomidate for sedation during gastroscopy.
METHODS
PubMed, Embase, Medline (via Ovid SP), Cochrane library databases, CINAHL (via EBSCO), China Biology Medicine disc (CBMdisc), Wanfang, VIP, and China National Knowledge Infrastructure (CNKI) databases were systematically searched. We included randomized controlled trials (RCTs) comparing the combined use of propofol and etomidate vs etomidate or propofol alone for sedation during gastroscopy. Data were pooled using the random-effects models or fixed-effect model based on heterogeneity.
RESULTS
Fifteen studies with 2973 participants were included in the analysis. Compared to propofol alone, the combined use of propofol and etomidate possibly increased recovery time (SMD = 0.14, 95% CI = 0.04-0.24; P = .005), and the risk for myoclonus (OR = 3.07, 95% CI = 1.73-5.44; P < .001), injection pain, and nausea and vomiting. Furthermore, compared to propofol alone, the combination of propofol and etomidate produced an apparent beneficial effect for mean arterial pressure (MAP) after anesthesia (SMD = 1.32, 95% CI = 0.38-2.26; P = .006), SPO2 after anesthesia (SMD = 0.99, 95% CI = 0.43-1.55; P < .001), apnea or hypoxemia (OR = 0.16, 95% CI = 0.08-0.33; P < .001), injection pain, and body movement. Further, compared to etomidate alone, the combination of propofol and etomidate reduced the risk for myoclonus (OR = 0.15, 95% CI = 0.11-0.22; P < .001), body movement, and nausea and vomiting.
CONCLUSION
The combination of propofol and etomidate might increase recovery time vs that associated with propofol, but it had fewer side effects on circulation and respiration in patients undergoing gastroscopy. The combined use of propofol and etomidate can improve and produce an apparent beneficial effect on the adverse effects of propofol or etomidate alone, and it was safer and more effective than propofol or etomidate alone.
Topics: Anesthetics, Combined; Anesthetics, Intravenous; Arterial Pressure; China; Etomidate; Female; Gastroscopy; Humans; Hypoxia; Injection Site Reaction; Male; Myoclonus; Nausea; Propofol; Randomized Controlled Trials as Topic; Risk; Vomiting
PubMed: 31096522
DOI: 10.1097/MD.0000000000015712 -
International Journal of Clinical and... 2015Patient-controlled sedation (PCS) has been suggested as an alternative method for sedative colonoscopy. However, as any new techniques, PCS introduction as a potential... (Review)
Review
BACKGROUND
Patient-controlled sedation (PCS) has been suggested as an alternative method for sedative colonoscopy. However, as any new techniques, PCS introduction as a potential alternative to traditional intravenous sedation (IVS) has brought about challenges. To evaluate the advantages and disadvantages between PCS and IVS more comprehensively, we conducted a systematic review and meta-analysis of the published literature.
METHODS
Several databases were searched from inception to 1 April, 2015, for trials comparing PCS with IVS for colonoscopy. The outcomes of interest included time for cecal intubation, rate of complete colonoscopy, dose of sedative drugs used, pain scores, recovery time, complications. Inconsistency was quantified using I (2) statistics.
RESULTS
In all, 12 trials were finally selected (1091 patients, with 545 in the PCS group, and 546 in the IVS group). The total propofol used, time for cecal intubation, rate of complete colonoscopy and pain score had no statistical difference between the two groups. However, PCS showed a reduction in the recovery time, incidence of oxygen desaturation and hypotension. The rates of other complications and patients' willingness to repeat the same sedation had no statistical difference between the two groups.
CONCLUSION
PCS is as feasible and effective as traditional IVS for colonoscopy, and there is a tendency that PCS shows its superiority in recovery time, incidence for oxygen saturation and hypotension.
PubMed: 26884890
DOI: No ID Found