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Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Patients with cirrhosis frequently require sedation for elective endoscopic procedures. Several sedation protocols are available, but choosing an appropriate sedative in patients with cirrhosis is challenging. AIM: To conduct a systematic review and meta-analysis to compare propofol and...

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Autores principales: Guacho, John Alexander Lata, de Moura, Diogo Turiani Hourneaux, Ribeiro, Igor Braga, da Ponte Neto, Alberto Machado, Singh, Shailendra, Tucci, Marina Gammaro Baldavira, Bernardo, Wanderley Marques, de Moura, Eduardo Guimarães Hourneaux
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443824/
https://www.ncbi.nlm.nih.gov/pubmed/32879659
http://dx.doi.org/10.4253/wjge.v12.i8.241
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author Guacho, John Alexander Lata
de Moura, Diogo Turiani Hourneaux
Ribeiro, Igor Braga
da Ponte Neto, Alberto Machado
Singh, Shailendra
Tucci, Marina Gammaro Baldavira
Bernardo, Wanderley Marques
de Moura, Eduardo Guimarães Hourneaux
author_facet Guacho, John Alexander Lata
de Moura, Diogo Turiani Hourneaux
Ribeiro, Igor Braga
da Ponte Neto, Alberto Machado
Singh, Shailendra
Tucci, Marina Gammaro Baldavira
Bernardo, Wanderley Marques
de Moura, Eduardo Guimarães Hourneaux
author_sort Guacho, John Alexander Lata
collection PubMed
description BACKGROUND: Patients with cirrhosis frequently require sedation for elective endoscopic procedures. Several sedation protocols are available, but choosing an appropriate sedative in patients with cirrhosis is challenging. AIM: To conduct a systematic review and meta-analysis to compare propofol and midazolam for sedation in patients with cirrhosis during elective endoscopic procedures in an attempt to understand the best approach. METHODS: This systematic review and meta-analysis was conducted using the PRISMA guidelines. Electronic searches were performed using MEDLINE, EMBASE, Central Cochrane, LILACS databases. Only randomized control trials (RCTs) were included. The outcomes studied were procedure time, recovery time, discharge time, and adverse events (bradycardia, hypotension, and hypoxemia). The risk of bias assessment was performed using the Revised Cochrane Risk-of-Bias tool for randomized trials (RoB-2). Quality of evidence was evaluated by GRADEpro. The meta-analysis was performed using Review Manager. RESULTS: The search yielded 3,576 records. Out of these, 8 RCTs with a total of 596 patients (302 in the propofol group and 294 in the midazolam group) were included for the final analysis. Procedure time was similar between midazolam and propofol groups (MD: 0.25, 95%CI: -0.64 to 1.13, P = 0.59). Recovery time (MD: -8.19, 95%CI: -10.59 to -5.79, P < 0.00001). and discharge time were significantly less in the propofol group (MD: -12.98, 95%CI: -18.46 to -7.50, P < 0.00001). Adverse events were similar in both groups (RD: 0.02, 95%CI: 0-0.04, P = 0.58). Moreover, no significant difference was found for bradycardia (RD: 0.03, 95%CI: -0.01 to 0.07, P = 0.16), hypotension (RD: 0.03, 95%CI: -0.01 to 0.07, P = 0.17), and hypoxemia (RD: 0.00, 95%CI: -0.04 to 0.04, P = 0.93). Five studies had low risk of bias, two demonstrated some concerns, and one presented high risk. The quality of the evidence was very low for procedure time, recovery time, and adverse events; while low for discharge time. CONCLUSION: This systematic review and meta-analysis based on RCTs show that propofol has shorter recovery and patient discharge time as compared to midazolam with a similar rate of adverse events. These results suggest that propofol should be the preferred agent for sedation in patients with cirrhosis.
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spelling pubmed-74438242020-09-01 Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials Guacho, John Alexander Lata de Moura, Diogo Turiani Hourneaux Ribeiro, Igor Braga da Ponte Neto, Alberto Machado Singh, Shailendra Tucci, Marina Gammaro Baldavira Bernardo, Wanderley Marques de Moura, Eduardo Guimarães Hourneaux World J Gastrointest Endosc Meta-Analysis BACKGROUND: Patients with cirrhosis frequently require sedation for elective endoscopic procedures. Several sedation protocols are available, but choosing an appropriate sedative in patients with cirrhosis is challenging. AIM: To conduct a systematic review and meta-analysis to compare propofol and midazolam for sedation in patients with cirrhosis during elective endoscopic procedures in an attempt to understand the best approach. METHODS: This systematic review and meta-analysis was conducted using the PRISMA guidelines. Electronic searches were performed using MEDLINE, EMBASE, Central Cochrane, LILACS databases. Only randomized control trials (RCTs) were included. The outcomes studied were procedure time, recovery time, discharge time, and adverse events (bradycardia, hypotension, and hypoxemia). The risk of bias assessment was performed using the Revised Cochrane Risk-of-Bias tool for randomized trials (RoB-2). Quality of evidence was evaluated by GRADEpro. The meta-analysis was performed using Review Manager. RESULTS: The search yielded 3,576 records. Out of these, 8 RCTs with a total of 596 patients (302 in the propofol group and 294 in the midazolam group) were included for the final analysis. Procedure time was similar between midazolam and propofol groups (MD: 0.25, 95%CI: -0.64 to 1.13, P = 0.59). Recovery time (MD: -8.19, 95%CI: -10.59 to -5.79, P < 0.00001). and discharge time were significantly less in the propofol group (MD: -12.98, 95%CI: -18.46 to -7.50, P < 0.00001). Adverse events were similar in both groups (RD: 0.02, 95%CI: 0-0.04, P = 0.58). Moreover, no significant difference was found for bradycardia (RD: 0.03, 95%CI: -0.01 to 0.07, P = 0.16), hypotension (RD: 0.03, 95%CI: -0.01 to 0.07, P = 0.17), and hypoxemia (RD: 0.00, 95%CI: -0.04 to 0.04, P = 0.93). Five studies had low risk of bias, two demonstrated some concerns, and one presented high risk. The quality of the evidence was very low for procedure time, recovery time, and adverse events; while low for discharge time. CONCLUSION: This systematic review and meta-analysis based on RCTs show that propofol has shorter recovery and patient discharge time as compared to midazolam with a similar rate of adverse events. These results suggest that propofol should be the preferred agent for sedation in patients with cirrhosis. Baishideng Publishing Group Inc 2020-08-16 2020-08-16 /pmc/articles/PMC7443824/ /pubmed/32879659 http://dx.doi.org/10.4253/wjge.v12.i8.241 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Meta-Analysis
Guacho, John Alexander Lata
de Moura, Diogo Turiani Hourneaux
Ribeiro, Igor Braga
da Ponte Neto, Alberto Machado
Singh, Shailendra
Tucci, Marina Gammaro Baldavira
Bernardo, Wanderley Marques
de Moura, Eduardo Guimarães Hourneaux
Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials
title Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials
title_full Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials
title_fullStr Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials
title_full_unstemmed Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials
title_short Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials
title_sort propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis: a systematic review and meta-analysis of randomized controlled trials
topic Meta-Analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443824/
https://www.ncbi.nlm.nih.gov/pubmed/32879659
http://dx.doi.org/10.4253/wjge.v12.i8.241
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