Propofol versus midazolam for upper gastrointestinal endoscopy in cirrhotic patients: a meta-analysis of randomized controlled trials

• Published in: PloS one 2015-02, Vol.10 (2), p.e0117585
• Main Authors: Tsai, Hsiao-Chien, Lin, Yu-Cih, Ko, Ching-Lung, Lou, Horng-Yuan, Chen, Ta-Liang, Tam, Ka-Wai, Chen, Chien-Yu
• Format: Article
• Language: English
• Subjects: Analysis; Anesthesia; Anesthesia Recovery Period; Anesthesiology; Blood flow; Bradycardia; Bradycardia - chemically induced; Bradycardia - complications; Cirrhosis; Clinical trials; Collaboration; Confidence intervals; Control methods; Deep Sedation - methods; Drug metabolism; Endoscopes; Endoscopy; Endoscopy, Gastrointestinal - methods; Fibrosis - complications; Hepatic Encephalopathy - chemically induced; Hepatic Encephalopathy - complications; Hospitals; Humans; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - therapeutic use; Hypotension; Hypotension - chemically induced; Hypotension - complications; Hypoxemia; Liver; Liver cirrhosis; Medicine; Meta-analysis; Metabolism; Midazolam; Midazolam - adverse effects; Midazolam - therapeutic use; Patients; Pharmacokinetics; Pharmacology; Phenols (Class of compounds); Physiological aspects; Population (statistical); Propofol; Propofol - adverse effects; Propofol - therapeutic use; Protein biosynthesis; Protein synthesis; Protein turnover; Randomization; Randomized Controlled Trials as Topic; Recovery; Recovery time; Sedatives; Side effects; Software; Statistical analysis; Studies; Surgery; Systematic review
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0117585

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. 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. 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. 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.