title: Propofol versus midazolam for upper gastrointestinal endoscopy in cirrhotic patients: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Sedation during gastrointestinal endoscopy is often achieved using propofol or midazolam in general population. However, impaired protein synthesis, altered drug metabolism, and compromised hepatic blood flow in patients with liver cirrhosis might affect the pharmacokinetics of sedatives, placing cirrhotic patients undergoing endoscopy at a greater risk of adverse events. The objective of this study was to assess comparative efficacies and safety of propofol and midazolam in cirrhotic patients undergoing endoscopy.
  
  
  METHODS
  Randomized, controlled trials comparing propofol with midazolam in cirrhotic patients undergoing gastrointestinal endoscopy were selected. We performed the meta-analysis, using a random-effect model, the Review Manager, Version 5.2, statistical software package (Cochrane Collaboration, Oxford, UK) according to the PRISMA guidelines.
  
  
  RESULTS
  Five studies between 2003 and 2012, including 433 patients, were included. Propofol provided a shorter time to sedation (weight mean difference: -2.76 min, 95% confidence interval: -3.00 to -2.51) and a shorter recovery time (weight mean difference -6.17 min, 95% confidence interval: -6.81 to -5.54) than midazolam did. No intergroup difference in the incidence of hypotension, bradycardia, or hypoxemia was observed. Midazolam was associated with the deterioration of psychometric scores for a longer period than propofol.
  
  
  CONCLUSIONS
  This meta-analysis suggests that Propofol sedation for endoscopy provides more rapid sedation and recovery than midazolam does. The risk of sedation-related side effects for propofol does not differ significantly from that of midazolam. The efficacy of propofol in cirrhotic patients undergoing endoscopy is superior to those of midazolam.
authors: Department of Anesthesiology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
authors: Hsiao-Chien
authors: HC
authors: Tsai
authors: Department of Anesthesiology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
authors: Yu-Cih
authors: YC
authors: Lin
authors: Department of Anesthesiology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
authors: Ching-Lung
authors: CL
authors: Ko
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Horng-Yuan
authors: HY
authors: Lou
authors: Department of Anesthesiology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Ta-Liang
authors: TL
authors: Chen
authors: Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for Evidence-based Medicine, Taipei Medical University, Taipei, Taiwan; Center for Evidence-based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
authors: Ka-Wai
authors: KW
authors: Tam
authors: Department of Anesthesiology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Chien-Yu
authors: CY
authors: Chen
mesh_terms: D000762:Anesthesia Recovery Period; D001919:Bradycardia / Q000139:chemically induced / Q000150:complications; D054810:Deep Sedation / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005355:Fibrosis / Q000150:complications; D006501:Hepatic Encephalopathy / Q000139:chemically induced / Q000150:complications; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D007022:Hypotension / Q000139:chemically induced / Q000150:complications; D008874:Midazolam / Q000009:adverse effects / Q000627:therapeutic use*; D015742:Propofol / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012984:Software
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol
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