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Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis
BACKGROUND: Intraoperative and postoperative hypotension occur commonly and are associated with organ injury and poor outcomes. Changes in arterial blood pressure (BP) during procedural sedation are not well described. METHODS: Individual patient data from five trials of propofol sedation for colono...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9008870/ https://www.ncbi.nlm.nih.gov/pubmed/34916051 http://dx.doi.org/10.1016/j.bja.2021.10.044 |
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author | Sneyd, J. Robert Absalom, Anthony R. Barends, Clemens R.M. Jones, Jordan B. |
author_facet | Sneyd, J. Robert Absalom, Anthony R. Barends, Clemens R.M. Jones, Jordan B. |
author_sort | Sneyd, J. Robert |
collection | PubMed |
description | BACKGROUND: Intraoperative and postoperative hypotension occur commonly and are associated with organ injury and poor outcomes. Changes in arterial blood pressure (BP) during procedural sedation are not well described. METHODS: Individual patient data from five trials of propofol sedation for colonoscopy and a clinical database were pooled and explored with logistic and linear regression. A literature search and focused meta-analysis compared the incidence of hypotension with propofol and alternative forms of procedural sedation. Hypotensive episodes were characterised by the original authors' definitions (typically systolic BP <90 mm Hg). RESULTS: In pooled individual patient data (n=939), 36% of procedures were associated with episodes of hypotension. Longer periods of propofol sedation and larger propofol doses were associated with longer-lasting and more-profound hypotension. Amongst 380 patients for whom individual BP measurements were available, 107 (28%) experienced systolic BP <90 mm Hg for >5 min, and in 89 (23%) the episodes exceeded 10 min. Meta-analysis of 18 RCTs identified an increased risk ratio for the development of hypotension in procedures where propofol was used compared with the use of etomidate (two studies; n=260; risk ratio [RR] 2.0 [95% confidence interval: 1.37–2.92]; P=0.0003), remimazolam (one study; n=384; RR 2.15 [1.61–2.87]; P=0.0001), midazolam (14 studies; n=2218; RR 1.46 [1.18–1.79]; P=0.0004), or all benzodiazepines (15 studies; n=2602; 1.67 [1.41–1.98]; P<0.00001). Hypotension was less likely with propofol than with dexmedetomidine (one study; n=60; RR 0.24 [0.09–0.62]; P=0.003). CONCLUSIONS: Hypotension is common during propofol sedation for colonoscopy and of a magnitude and duration associated with harm in surgical patients. |
format | Online Article Text |
id | pubmed-9008870 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-90088702022-04-15 Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis Sneyd, J. Robert Absalom, Anthony R. Barends, Clemens R.M. Jones, Jordan B. Br J Anaesth Cardiovascular BACKGROUND: Intraoperative and postoperative hypotension occur commonly and are associated with organ injury and poor outcomes. Changes in arterial blood pressure (BP) during procedural sedation are not well described. METHODS: Individual patient data from five trials of propofol sedation for colonoscopy and a clinical database were pooled and explored with logistic and linear regression. A literature search and focused meta-analysis compared the incidence of hypotension with propofol and alternative forms of procedural sedation. Hypotensive episodes were characterised by the original authors' definitions (typically systolic BP <90 mm Hg). RESULTS: In pooled individual patient data (n=939), 36% of procedures were associated with episodes of hypotension. Longer periods of propofol sedation and larger propofol doses were associated with longer-lasting and more-profound hypotension. Amongst 380 patients for whom individual BP measurements were available, 107 (28%) experienced systolic BP <90 mm Hg for >5 min, and in 89 (23%) the episodes exceeded 10 min. Meta-analysis of 18 RCTs identified an increased risk ratio for the development of hypotension in procedures where propofol was used compared with the use of etomidate (two studies; n=260; risk ratio [RR] 2.0 [95% confidence interval: 1.37–2.92]; P=0.0003), remimazolam (one study; n=384; RR 2.15 [1.61–2.87]; P=0.0001), midazolam (14 studies; n=2218; RR 1.46 [1.18–1.79]; P=0.0004), or all benzodiazepines (15 studies; n=2602; 1.67 [1.41–1.98]; P<0.00001). Hypotension was less likely with propofol than with dexmedetomidine (one study; n=60; RR 0.24 [0.09–0.62]; P=0.003). CONCLUSIONS: Hypotension is common during propofol sedation for colonoscopy and of a magnitude and duration associated with harm in surgical patients. Elsevier 2022-04 2021-12-13 /pmc/articles/PMC9008870/ /pubmed/34916051 http://dx.doi.org/10.1016/j.bja.2021.10.044 Text en © 2021 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Cardiovascular Sneyd, J. Robert Absalom, Anthony R. Barends, Clemens R.M. Jones, Jordan B. Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis |
title | Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis |
title_full | Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis |
title_fullStr | Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis |
title_full_unstemmed | Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis |
title_short | Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis |
title_sort | hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis |
topic | Cardiovascular |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9008870/ https://www.ncbi.nlm.nih.gov/pubmed/34916051 http://dx.doi.org/10.1016/j.bja.2021.10.044 |
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