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Propofol as safe as traditional anesthesia for GI endoscopy
Sedation with propofol was associated with a comparable risk for cardiopulmonary adverse events as traditional sedative agents for gastrointestinal endoscopic procedures, according to the results of a systematic review and meta-analysis.
Further, researchers found propofol was associated with reduced complications in simple endoscopic procedures and did not appear to increase complications when used in advanced procedures or when administered by a gastroenterologist.
Vaibhav Wadhwa
John J. Vargo
“Propofol use for endoscopy is as safe and effective as traditional sedative agents,” Vaibhav Wadhwa, MD, from the department of internal medicine at the Cleveland Clinic, told Healio Gastroenterology in an email. “We also found that endoscopist-directed sedation was equally effective with non–anesthetist-directed sedation.”
Wadhwa and colleagues from the Cleveland Clinic, including John J. Vargo, MD, MPH, performed an updated meta-analysis comparing cardiopulmonary adverse events (hypoxia, hypotension and arrhythmia) associated with propofol vs. traditional sedatives. They searched relevant literature published up to September 2014 and included 27 randomized trials comprising 2,518 patients, 1,324 of whom received propofol and 1,194 of whom received midazolam, meperidine, pethidine, remifentanil and/or fentanyl.
“Despite the wide variation in geography and personnel, there was no significant heterogeneity among these trials,” and most were of good methodologic quality, the researchers wrote.
The pooled OR for developing any complication with propofol compared with traditional sedatives was 0.77 (95% CI, 0.56-1.07). For hypoxia the pooled OR was 0.82 (95% CI, 0.63-1.07), for hypotension it was 0.92 (95% CI, 0.64-1.32) and for arrhythmia it was 1.07 (95% CI, 0.68-1.68).
Among patients who underwent non-advanced endoscopic procedures (esophagogastroduodenoscopy, colonoscopy and sigmoidoscopy), those who received propofol had a 39% lower risk for complications compared with those who received traditional sedatives (OR = 0.61; 95% CI, 0.38-0.99).
Patients who underwent advanced endoscopic procedures (endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, endoscopic submucosal dissection and balloon enteroscopy) had similar complication rates with propofol vs. traditional sedatives (OR = 0.86; 95% CI, 0.56-1.34).
Adverse events were also similar when propofol was administered by a gastroenterologist vs. an anesthesiologist, ICU physician or critical care physician (OR = 0.82; 95% CI, 0.55-1.21).
The researchers concluded that propofol sedation does not increase the cardiopulmonary adverse event rate compared with traditional sedative agents in simple or advanced gastrointestinal endoscopic procedures and that gastroenterologist-directed sedation with propofol is noninferior to non-gastroenterologist sedation.
“We hope this would improve upon the current sedation practices across the country and alleviate any concerns there are about propofol use in endoscopy,” Wadhwa said. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.