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Evidence summaries

Propofol for Sedation during Colonoscopy.

Propofol for sedation during colonoscopy for generally healthy individuals may lead to faster recovery and discharge times and increased patient satisfaction without an increase in side-effects. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 20 studies with a total of 9 166 subjects. Most studies included only healthy out-patients. One large study (n = 7 286 patients) reported only rates of colonic perforation.

Recovery time (WMD -14.2 minutes, 95% CI -17.6 to -10.8, 11 studies, 758 patients) and discharge time (WMD -20.9 minutes, 95% CI -30.9 to -10.8, 7 studies, 542 patients) were shorter with use of propofol alone or in combination with another agent compared with traditional sedatives including benzodiazepines alone or a combination of a benzodiazepine and a narcotic. There was higher patient satisfaction with use of propofol (OR for dissatisfaction 0.35, 95% CI 0.23 to 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 to 1.39). Although there was higher patient satisfaction (OR for dissatisfaction 0.42, 95% CI 0.20 to 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 to 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.

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and lack of blinding).

    References

    • Singh H, Poluha W, Cheung M, Choptain N, Baron KI, Taback SP. Propofol for sedation during colonoscopy. Cochrane Database Syst Rev 2008 Oct 8;(4):CD006268. [PubMed]

Primary/Secondary Keywords