Comparison of Propofol Monotherapy and Propofol Combination Therapy for Sedation During Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis

Abstract

Background

Previous randomized controlled trials have reported conflicting findings comparing propofol combination therapy(PCT) with propofol monotherapy(PMT) for sedation of patients undergoing gastrointestinal endoscopy. Therefore, a systematic review was performed to compare the efficacy and safety of PCT and PMT in such patients.

Methods

We searched MEDLINE, EMBASE and CENTRAL databases to identify all randomized controlled trials that compared the efficacy and safety of PCT and PMT for sedation of patients undergoing gastrointestinal endoscopy. The primary endpoints were the incidence of respiratory complications, hypotension, and arrhythmia, the dose of propofol used, and the recovery time. The procedure duration and the satisfaction of patients and doctors were also evaluated.

Results

A total of 2250 patients from 22 studies were included in the final analysis. The combined analysis did not reveal any difference between PCT and PMT in the incidence of respiratory complications(risk ratio[RR],0.80; 95% CI, 0.52 to 1.23;I²=58.34%), hypotension(RR,1.06; 95% CI, 0.63 to 1.78; I²=72.13%), arrhythmia(RR,1.40; 95% CI, 0.74 to 2.64;I²=43.71%), recovery time(standardized mean difference[SMD],0.16; 95% CI, -0.49 to 0.81;I²=95.9%) and procedure duration(SMD,0.04; 95% CI, -0.05 to 0.14;I²=0.0%), patient satisfaction(SMD,0.13; 95% CI, -0.26 to 0.52; I²=89.63%) or doctor satisfaction(SMD,0.01; 95% CI, -0.15 to 0.17;I²=0.00%).

However, the dose of propofol used was significantly lower in PCT than in PMT(SMD,-1.38; 95% CI, -1.99 to -0.77;I²=97.70%).

Conclusion

PCT showed comparable efficacy and safety to PMT with respect to respiratory complications, hypotension and arrhythmia, recovery time, procedure duration, patient satisfaction, and doctor satisfaction. However, the average dose of propofol used was higher in PMT.

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