Key messages
-
Sedation using propofol instead of traditional sedatives may improve recovery time and patient satisfaction scores for people undergoing colonoscopy. Propofol sedation has little to no effect on colonoscopy completion rates or complications compared to traditional sedatives (opioids or benzodiazepines, or both). Effects on time to discharge and pain score are uncertain.
-
Non-anesthesiologist-directed propofol sedation for colonoscopy may result in a small reduction in recovery times compared to anesthesiologist-directed propofol. However, there is little to no difference between groups in colonoscopy completion rate, pain score, patient satisfaction, and respiratory events requiring intervention.
-
Additional studies are needed with more people and high-quality reporting to reach stronger conclusions about the effects of propofol for sedation during colonoscopy compared to traditional sedatives, and looking at outcomes for non-anesthesiologist-guided sedation such as deaths and hospital admissions.
What is a colonoscopy?
A colonoscopy is a common procedure used to diagnose many diseases of the digestive tract. A long, flexible tube (colonoscope) with a small video camera at the tip is inserted through the anus into the rectum and large intestine (colon) to look for intestinal diseases including inflammation, infections, polyps, or cancers. In addition to using the colonoscope to take photos and videos to assist in diagnosis, tissue samples (biopsies) can also be taken during the colonoscopy. In some cases, more extensive removal of tissue, including removal of polyps or even early-stage cancers, can be done during a colonoscopy. Medications are often used to sedate patients so they can comfortably tolerate the colonoscopy procedure.
What did we want to find out?
Many studies have compared different sedative medications used for this procedure, and who can safely administer these medications. We wanted to know the effects of propofol sedation for colonoscopy in adult patients compared to traditional sedatives (opioids or benzodiazepines, or both). We also looked at the effects of propofol sedation for adult patients undergoing colonoscopy administered by anesthesiologists compared to that administered by non-anesthesiologists.
What did we do?
We searched for studies comparing propofol versus traditional sedatives for colonoscopy, and those comparing propofol sedation administered by anesthesiologists versus that administered by non-anesthesiologists. We compared and summarized the results of the studies and rated our confidence in the evidence based on factors such as study methods and sizes.
What did we find?
We identified 30 studies (12,036 people) comparing propofol to traditional sedatives, and three studies (449 people) comparing propofol administered by anesthesiologists to that administered by non-anesthesiologists for colonoscopy. The studies took place between 1993 and 2024.
Main results
Sedation with propofol for colonoscopies may lead to improved recovery time and patient satisfaction scores. Effects on time to discharge and pain scores are uncertain. Colonoscopy completion rates, colonic perforation (accidently poking a hole in the colon), and respiratory events (lack of oxygen) leading to a medical intervention from a care provider were no different with propofol compared to traditional sedatives. Non-anesthesiologist-directed propofol sedation for colonoscopy results in little to no difference in colonoscopy completion rate, pain score, patient satisfaction, or respiratory events leading to a medical intervention compared to anesthesiologist-directed propofol sedation, but may slightly reduce recovery time.
What are the limitations of the evidence?
For the comparison of propofol versus traditional sedatives during colonoscopy, we have mostly low confidence in the evidence because there were problems with the reporting of outcomes in the studies that could have influenced the results. For the comparison of anesthesiologist- versus non-anesthesiologist-directed sedation, our confidence in the evidence ranged from high to low; where our confidence was limited, there were very few studies, and they did not report all of the outcomes that we were interested in.
How up-to-date is this evidence?
The evidence is current to February 2024.
Baca abstrak penuh
Propofol is increasingly used for sedation during colonoscopy, with many recent reports of randomised controlled trials (RCTs) and large non-randomized case series.
Matlamat
The primary aim of this review was to assess the effects of propofol sedation for colonoscopy in adult patients compared to opioids or benzodiazepines, or both. Our secondary aim was to assess the effects of propofol sedation for adult patients undergoing colonoscopy administered by anesthesiologists compared to that administered by non-anesthesiologists.
Kaedah Pencarian
In the previous iteration of this review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cancerlit, CINAHL, LILACS, Biological Abstracts, and Web of Science databases for entries up to December 2010. In the current update, we searched CENTRAL (Ovid), Ovid MEDLINE, Ovid Embase, CINAHL (EBSCO), LILACS (VHL), Web of Science Core Collection (Clarivate), WHO ICTRP, and ClinicalTrials.gov from December 2010 until February 2024. We applied no language restrictions.
Kriteria Pemilihan
Randomized controlled trials comparing use of propofol and traditional agents or administration of propofol by anaesthesiologists to that by non-anesthesiologists for sedation during colonoscopy.
Pengumpulan Data dan Analisis
Two reviewers independently extracted the data. The data were pooled using the Cochrane Collaborations' methodology and statistical software RevMan 5.1.
Keputusan Utama
Twenty two studies met the inclusion criteria for the primary objective in this updated review, in which we have included results from three additional publications. Many of the studies had a potential of moderate to high risk of bias and combing data for some of the outcomes was problematic. Most studies included only healthy out-patients. Recovery (11 studies; 776 patients) and discharge times (7 studies; 542 patients) were shorter with use of propofol. There was higher patient satisfaction with use of propofol (10 studies, 819 patients; OR for dissatisfaction 0.35, 95% CI 0.23, 0.53). There was no difference in procedure time (9 studies; 736 patients) or complication rates. There was no difference in pain control with non- patient controlled sedation (PCS) use of propofol as compared to the traditional agents (5 studies, 396 patients; OR 0.90; 95% CI 0.58, 1.39).
There was only one study (94 patients) comparing administration of propofol by anaesthesiologists to that by non-anesthesiologists for sedation during colonoscopy, with no difference in procedure time or patient satisfaction.
Kesimpulan Pengarang
Propofol sedation for colonoscopy may improve recovery time and patient satisfaction scores, without affecting cecal intubation, perforations, or respiratory events requiring intervention, compared to traditional sedative regimens. Effects on time to discharge and pain score are uncertain. Evidence for this comparison was generally of low certainty, indicating the need for better-quality studies and more standardized outcome reporting. Non-anesthesiologist- compared to anesthesiologist-directed propofol sedation for colonoscopy results in little to no difference in cecal intubation rate and patient satisfaction, but may slightly reduce recovery times. There is likely little to no difference between groups in pain scores, and there may be little to no difference in respiratory events requiring intervention. The certainty of the evidence was high for many outcomes in this second comparison; however, there were very few studies, and many important safety outcomes were not examined.
Funding
This review was funded by operating grants from the George and Fay Yee Centre for Healthcare Innovation, the Department of Surgery, Section of General Surgery, and the Clinician Investigator Program, all at the University of Manitoba, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada.
Registration
Protocol and previous versions available via https://doi.org/10.1002/14651858.CD006268, and https://doi.org/10.1002/14651858.CD006268.pub2
