Propofol versus midazolam for upper gastrointestinal endoscopy in cirrhotic patients

A meta-analysis of randomized controlled trials

Hsiao Chien Tsai, Yu Cih Lin, Ching Lung Ko, Horng Yuan Lou, Ta-Liang Chen, Ka-Wai Tam, Chien-Yu Chen

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Sedation during gastrointestinal endoscopy is often achieved using propofol or midazolam in general population. However, impaired protein synthesis, altered drug metabolism, and compromised hepatic blood flow in patients with liver cirrhosis might affect the pharmacokinetics of sedatives, placing cirrhotic patients undergoing endoscopy at a greater risk of adverse events. The objective of this study was to assess comparative efficacies and safety of propofol and midazolam in cirrhotic patients undergoing endoscopy. Methods: Randomized, controlled trials comparing propofol with midazolam in cirrhotic patients undergoing gastrointestinal endoscopy were selected.We performed the meta-analysis, using a random-effect model, the Review Manager, Version 5.2, statistical software package (Cochrane Collaboration, Oxford, UK) according to the PRISMA guidelines. Results: Five studies between 2003 and 2012, including 433 patients, were included. Propofol provided a shorter time to sedation (weight mean difference: -2.76 min, 95% confidence interval: -3.00 to -2.51) and a shorter recovery time (weight mean difference -6.17 min, 95% confidence interval: -6.81 to -5.54) than midazolam did. No intergroup difference in the incidence of hypotension, bradycardia, or hypoxemia was observed. Midazolam was associated with the deterioration of psychometric scores for a longer period than propofol. Conclusion: This meta-analysis suggests that Propofol sedation for endoscopy provides more rapid sedation and recovery than midazolam does. The risk of sedation-related side effects for propofol does not differ significantly from that of midazolam. The efficacy of propofol in cirrhotic patients undergoing endoscopy is superior to those of midazolam.

Original languageEnglish
Article numbere0117585
JournalPLoS One
Volume10
Issue number2
DOIs
Publication statusPublished - Feb 3 2015

Fingerprint

gastrointestinal endoscopy
Gastrointestinal Endoscopy
Endoscopy
Midazolam
Propofol
meta-analysis
sedation
Meta-Analysis
Randomized Controlled Trials
endoscopy
pharmacokinetics
confidence interval
liver cirrhosis
sedatives
hypotension
Confidence Intervals
Weights and Measures
Recovery
blood flow
Pharmacokinetics

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Propofol versus midazolam for upper gastrointestinal endoscopy in cirrhotic patients : A meta-analysis of randomized controlled trials. / Tsai, Hsiao Chien; Lin, Yu Cih; Ko, Ching Lung; Lou, Horng Yuan; Chen, Ta-Liang; Tam, Ka-Wai; Chen, Chien-Yu.

In: PLoS One, Vol. 10, No. 2, e0117585, 03.02.2015.

Research output: Contribution to journalArticle

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abstract = "Background: Sedation during gastrointestinal endoscopy is often achieved using propofol or midazolam in general population. However, impaired protein synthesis, altered drug metabolism, and compromised hepatic blood flow in patients with liver cirrhosis might affect the pharmacokinetics of sedatives, placing cirrhotic patients undergoing endoscopy at a greater risk of adverse events. The objective of this study was to assess comparative efficacies and safety of propofol and midazolam in cirrhotic patients undergoing endoscopy. Methods: Randomized, controlled trials comparing propofol with midazolam in cirrhotic patients undergoing gastrointestinal endoscopy were selected.We performed the meta-analysis, using a random-effect model, the Review Manager, Version 5.2, statistical software package (Cochrane Collaboration, Oxford, UK) according to the PRISMA guidelines. Results: Five studies between 2003 and 2012, including 433 patients, were included. Propofol provided a shorter time to sedation (weight mean difference: -2.76 min, 95{\%} confidence interval: -3.00 to -2.51) and a shorter recovery time (weight mean difference -6.17 min, 95{\%} confidence interval: -6.81 to -5.54) than midazolam did. No intergroup difference in the incidence of hypotension, bradycardia, or hypoxemia was observed. Midazolam was associated with the deterioration of psychometric scores for a longer period than propofol. Conclusion: This meta-analysis suggests that Propofol sedation for endoscopy provides more rapid sedation and recovery than midazolam does. The risk of sedation-related side effects for propofol does not differ significantly from that of midazolam. The efficacy of propofol in cirrhotic patients undergoing endoscopy is superior to those of midazolam.",
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