Efficacy and safety of alfentanil plus propofol versus propofol only in painless gastrointestinal endoscopy: A meta-analysis

To systematically evaluate the efficacy and safety of alfentanil plus propofol versus propofol only for painless gastrointestinal endoscopy. METHODS: The Cochrane Library, PubMed, Embase, China Biology Medicine, CNKI, WanFang, and VIP databases were searched to identify randomized controlled trials on alfentanil combined with propofol versus propofol only for painless gastrointestinal endoscopy from the inception of the database to August 2022. The Rev Man 5.4 software was used for statistical analyses. RESULTS: Thirteen randomized controlled trials involving 1762 patients were identified as eligible for this study. The meta-analysis showed that compared with propofol, alfentanil combined with propofol had a more stable mean arterial pressure [mean difference (MD) = 5.38, 95% confidence interval (CI): 1.97–8.80; P = .002], heart rate (MD = 3.78, 95% CI: 1.30–6.26; P = .003) and pulse oxygen saturation (MD = 1.90, 95% CI: 0.93–2.78; P = .0001); a lower propofol dose (standard mean difference = −2.82, 95% CI: −3.70 to −1.94; P < .00001), lower awakening time (MD = −3.23, 95% CI: −4.01 to −2.45; P < .00001) and lower directional force recovery time (MD = −3.62, 95% CI: −4.22 to −3.03; P < .00001); a lower incidence of nausea and vomiting (relative risk [RR] = 0.32, 95% CI: 0.14–0.71; P = .005), body movement (RR = 0.27, 95% CI: 0.13–0.54; P = .0002), hypotension (RR = 0.23, 95% CI: 0.12–0.46; P < .0001), respiratory depression (RR = 0.37, 95% CI: 0.15–0.89; P = .03) and cough reflex (RR = 0.33, 95% CI: 0.12–0.89; P = .03). CONCLUSION: This meta-study found that current evidence indicates that alfentanil plus propofol is better than propofol alone for painless gastrointestinal endoscopy and is associated with a lower incidence of adverse reactions. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to validate these above conclusions.