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Propofol for sedation during colonoscopySingh H, Poluha W, Cheung M, Choptain N, Baron KI, Taback SP
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SummaryPropofol for sedation during colonoscopy can lead to faster recovery after the procedure and higher patient satisfaction.Irrespective of the initial screening test, colonoscopy is the final step in colorectal cancer screening. With the advent of the colorectal cancer screening programs in many countries, an increasing number of colonoscopies are being performed each year. Sedation for colonoscopy can improve patients' tolerance of the procedure and enhance colonoscopy completion rates. There is no consensus on the preferred drugs for sedation during colonoscopy. This review found that use of propofol for sedation during colonoscopy can lead to faster recovery after the procedure and higher patient satisfaction, without any increase in side-effects as compared to the use of drugs traditionally used (narcotics and/or benzodiazepines) for sedation during colonoscopy.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
October 08. 2008 AbstractBackgroundPropofol is increasingly used for sedation during colonoscopy, with many recent reports of randomized controlled trials (RCTs) and large non-randomized case series. ObjectivesThe primary objective was to identify, analyze and summarize RCTs comparing the relative effectiveness, patient acceptance and safety of propofol for colonoscopy, to traditional sedatives (narcotics and/or benzodiazepines). Search strategyWe searched Medline, Cancerlit, EMBASE, CINAHL, LILACS, Biological Abstracts, Web of Science and the Cochrane Controlled Trials Registry database between January 1980 and June 2007; and conference proceeding abstracts for DDW, EUGW and ACG between 1990 and June 2007. There were no language restrictions. Selection criteriaRandomized controlled trials comparing use of propofol and traditional agents or administration of propofol by anesthesiologists to that by non-anesthesiologists for sedation during colonoscopy. Data collection and analysisTwo reviewers independently extracted the data. The data were pooled using the Cochrane Collaborations' methodology and statistical software RevMan 4.2.10. Main resultsTwenty studies met the inclusion criteria for the primary objective. Most studies included only healthy out-patients. Recovery and discharge times were shorter with use of propofol. There was higher patient satisfaction with use of propofol (OR for dissatisfaction 0.35, 95% CI 0.23, 0.53). There was no difference in procedure time, cecal intubation rate or complications. There was no difference in pain control with non- patient controlled sedation (PCS) use of propofol as compared to the traditional agents (OR 0.90; 95% CI 0.58, 1.39). Although there was higher patient satisfaction (OR for dissatisfaction 0.42, 95% CI 0.20, 0.89), the pain control was inferior with use of PCS use of propofol as compared to the use of traditional agents (OR 3.09; 95% CI 2.15, 4.46). There was only one study comparing administration of propofol by anesthesiologists to that by non-anesthesiologists for sedation during colonoscopy, with no difference in procedure time or patient satisfaction. Authors' conclusionsPropofol for sedation during colonoscopy for generally healthy individuals can lead to faster recovery and discharge times, increased patient satisfaction without an increase in side-effects. More studies with standardized end-points are needed to compare propofol administration by anesthesiologists to that by non-anesthesiologists. |