Even though propofol use for gastrointestinal endoscopic procedures has increased over the past decade, there is a perception that it causes a higher rate of cardiopulmonary adverse events.
Dr John Vargo and colleagues from Ohio, USA compared the sedation-related adverse events associated with use of propofol vs nonpropofol agents for endoscopic procedures.
The team also wanted to determine the influence of duration or complexity of the procedures and endoscopist-directed vs non–gastroenterologist-directed sedation on the outcomes.
The researchers conducted a search using Medline, EMBASE, and the Cochrane controlled trials registry.
|The pooled odds ratio with the use of propofol for developing hypoxia was 0.8|
|Clinical Gastroenterology & Hepatology|
The following cardiopulmonary adverse events were assessed: hypoxia, hypotension, and arrhythmias.
The procedures were divided into 2 groups based on the procedure length: a nonadvanced endoscopic procedure group consisting of esophagogastroduodenoscopy, colonoscopy, and sigmoidoscopy, and an advanced endoscopic procedures group including endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, balloon enteroscopy, and endoscopic submucosal dissection.
Pooled odds ratios for complications were calculated for all the procedures combined and then separately for the 2 groups.
Of the 2117 citations identified, 27 original studies qualified for this meta-analysis and included 2518 patients.
Of these, 1324 received propofol, and 1194 received midazolam, meperidine, pethidine, remifentanil, and/or fentanyl.
The researchers found that most of the included studies were randomized trials of moderate quality and nonsignificant heterogeneity.
Compared with traditional sedative agents, the team found that the pooled odds ratio with the use of propofol for developing hypoxia for all the procedures combined was 0.8, and for developing hypotension was 0.9.
In the nonadvanced endoscopic procedure group, those who received propofol were 39% less likely to develop complications than those receiving traditional sedative agents.
The team found no difference in the complication rate for the advanced endoscopic procedure group.
A subgroup analysis did not show any difference in adverse events when propofol was administered by gastroenterologists or nongastroenterologists.
Dr Vargo's team concludes, "Propofol sedation has a similar risk of cardiopulmonary adverse events compared with traditional agents for gastrointestinal endoscopic procedures."
"Propofol use in simple endoscopic procedures was associated with a decreased number of complications."
"When used for gastrointestinal endoscopic procedures of a complex nature and longer duration, propofol was not associated with increased rates of hypoxemia, hypotension, or arrhythmias."
"Administration of propofol by gastroenterologists does not appear to increase the complication rates."