Propofol versus midazolam with or without short-acting opioids for sedation in colonoscopy: a systematic review and meta-analysis of safety, satisfaction, and efficiency outcomes

Abstract

Background and Aims: Propofol is increasingly being used for sedation in colonoscopy; however, its benefits over midazolam (AE short-acting opioids) are not well quantified. The objective of this study was to compare safety, satisfaction, and efficiency outcomes of propofol versus midazolam (AE short-acting opioids) in patients undergoing colonoscopy. Methods: We systematically searched Medline, Embase, and the Cochrane library (to July 30, 2018) for randomized controlled trials of colonoscopies performed with propofol versus midazolam (AE short-acting opioids). We pooled odds ratios for cardiorespiratory outcomes using mixed-effects conditional logistic models. We pooled standardized mean differences (SMDs) for patient and endoscopist satisfaction and efficiency outcomes using random-effects models. Results: Nine studies of 1427 patients met the inclusion criteria. There were no significant differences in cardiorespiratory outcomes (hypotension, hypoxia, bradycardia) between sedative groups. Patient satisfaction was high in both groups, with most patients reporting willingness to undergo a future colonoscopy with the same sedative regimen. In the meta-analysis, patients sedated with propofol had greater satisfaction than those sedated with midazolam (AE short-acting opioids) (SMD, .54; 95% confidence interval [CI], .30-.79); however, there was considerable heterogeneity. Procedure time was similar between groups (SMD, .15; 95% CI, .04-.27), but recovery time was shorter in the propofol group (SMD, .41; 95% CI, .08-.74). The median difference in recovery time was 3 minutes, 6 seconds shorter in patients sedated with propofol. Conclusions: Both propofol and midazolam (AE short-acting opioids) result in high patient satisfaction and appear to be safe for use in colonoscopy. The marginal benefits to propofol are small improvements in satisfaction and recovery time. (Gastrointest Endosc 2020;91:1015-26.) Sedation used in colonoscopy can improve the experience for both patients and endoscopists. Globally, there is considerable variation in sedative practices. 1 In Europe, sedative use varies substantially by country and by region. 2 In some areas almost all patients receive sedation for colonoscopy, whereas in other areas Abbreviations: ASA,

The propofol-sparing effect of intravenous lidocaine in elderly patients undergoing colonoscopy: a randomized, double-blinded, controlled study

“…Opioids sedatives have been widely used in enteroscopy [16]. Fahima et al [17] found that combined administration of opioids with propofol in colonoscopy was statistically safe to the patients with higher satisfaction feedback. However, the increased sensitivity to propofol in some individuals, especially in elderly patients could lead to the development of profound hypotension and prolonged apnea when propofol is used as a sedative during colonoscopy.…”

Comparison of post-anesthesia recovery time in sedated patients for colonoscopy using midazolam or fentanyl associated with propofol

“…The dose used, when calculated based on the patient's weight, is in accordance with the literature. 6,7,12,17,19,20,23 The consumption of propofol was not statistically significant. However, a greater consumption of propofol was observed in patients of Group A, both in relation to the total dose and in the dose per kilo of the patient.…”

“…Previous studies used different levels of sedation or combinations of drugs or objectives. 6,7,13,[17][18][19][20][21][22] In the present study, the analyzed population showed similar social characteristics in both groups, except for the presence of comorbidities, which was more frequent in patients of Group B. Regarding the sedative dose used, fixed concentrations of midazolam and fentanyl were administered, aiming at standardizing the level of sedation and also facilitating the preparation of the syringes.…”

“…7,12,[17][18][19][20][21][22] The colonoscopy exams were performed due to several indications, including polypectomy, which may justify the higher mean exam length (Exam Length) in relation to other studies. 6,17,20,23 As for the recovery time, it was observed that patients sedated with fentanyl and propofol (Group B) had a shorter recovery time in PARR1 when compared to those who received midazolam and propofol (Group A). These data corroborate those by Turk et al, 20 in which they demonstrated that the association of fentanyl and propofol resulted in shorter post-anesthetic recovery time when compared to the association between alfentanil and propofol.…”

Sedation Practices for Routine Gastrointestinal Endoscopy: A Systematic Review of Recommendations

“…7 Whether deep sedation with propofol provides additional bene ts when compared with moderate sedation with midazolam is debated. 8,9 Sedation practices vary considerably across jurisdictions. 7,[10][11][12] In an international study at 21 centres across 11 countries, Froehlich et al 7 found large differences in the types of sedatives used, the individuals responsible for administering sedation, the number of staff members present for sedated colonoscopy, and the equipment used to monitor sedated patients.…”