title: Similar Risk of Cardiopulmonary Adverse Events Between Propofol and Traditional Anesthesia for Gastrointestinal Endoscopy: A Systematic Review and Meta-analysis.
abstract: 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. The aim of this study was to compare the sedation-related adverse events associated with use of propofol vs nonpropofol agents for endoscopic procedures. We also wanted to determine the influence of duration or complexity of the procedures and endoscopist-directed (gastroenterologist) vs non-gastroenterologist-directed sedation on the outcomes.
  
  
  
  A search was conducted using Medline, EMBASE, and the Cochrane controlled trials registry. 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. Random-effects models were used for 2-proportion comparisons.
  
  
  
  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. Most of the included studies were randomized trials of moderate quality and nonsignificant heterogeneity (Cochran Q, 26.07; P = .13). Compared with traditional sedative agents, the pooled odds ratio with the use of propofol for developing hypoxia for all the procedures combined was 0.82 (95% confidence interval [CI], 0.63-1.07), and for developing hypotension was 0.92 (95% CI, 0.64-1.32). In the nonadvanced endoscopic procedure group, those who received propofol were 39% less likely to develop complications than those receiving traditional sedative agents (odds ratio, 0.61; 95% CI, 0.38-0.99). There was no difference in the complication rate for the advanced endoscopic procedure group (odds ratio, 0.86; 95% CI, 0.56-1.34). A subgroup analysis did not show any difference in adverse events when propofol was administered by gastroenterologists or nongastroenterologists.
  
  
  
  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.
authors.affiliation: Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Vaibhav
authors.initials: V
authors.lastname: Wadhwa
authors.affiliation: Department of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Danny
authors.initials: D
authors.lastname: Issa
authors.affiliation: Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sushil
authors.initials: S
authors.lastname: Garg
authors.affiliation: Department of Biostatistics, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: vargoj@ccf.org.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
mesh_terms: D000758:Anesthesia / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000453:epidemiology; D016099:Endoscopy, Gastrointestinal; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000453:epidemiology; D000860:Hypoxia / Q000139:chemically induced* / Q000453:epidemiology; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D018570:Risk Assessment
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol
keywords: Advanced Endoscopic Procedures; Colonoscopy; Endoscopy; Meta-Analysis; Outcomes; Propofol; Traditional Sedative Agents