A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures - 23/08/11
Reprint requests: Kenneth R. McQuaid, MD, GI Section, 111B, VA Medical Center, 4150 Clement St, San Francisco, CA 94121.San Francisco, Los Angeles, California, USA
Abstract |
Background |
Numerous agents are available for moderate sedation in endoscopy.
Objective |
Our purpose was to compare efficacy, safety, and efficiency of agents used for moderate sedation in EGD or colonoscopy.
Design |
Systematic review of computerized bibliographic databases for randomized trials of moderate sedation that compared 2 active regimens or 1 active regimen with placebo or no sedation.
Patients |
Unselected adults undergoing EGD or colonoscopy with a goal of moderate sedation.
Main Outcome Measurements |
Sedation-related complications, patient assessments (satisfaction, pain, memory, willingness to repeat examination), physician assessments (satisfaction, level of sedation, patient cooperation, examination quality), and procedure-related efficiency outcomes (sedation, procedure, or recovery time).
Results |
Thirty-six studies (N = 3918 patients) were included. Sedation improved patient satisfaction (relative risk [RR] = 2.29, range 1.16-4.53) and willingness to repeat EGD (RR = 1.25, range 1.13-1.38) versus no sedation. Midazolam provided superior patient satisfaction to diazepam (RR = 1.18, range 1.07-1.29) and less frequent memory of EGD (RR = 0.57, range 0.50-0.60) versus diazepam. Adverse events and patient/physician assessments were not significantly different for midazolam (with or without narcotics) versus propofol except for slightly less patient satisfaction (RR = 0.90, range 0.83-0.97) and more frequent memory (RR = 3.00, range 1.25-7.21) with midazolam plus narcotics. Procedure times were similar, but sedation and recovery times were shorter with propofol than midazolam-based regimens.
Limitations |
Marked variability in design, regimens tested, and outcomes assessed; relatively poor methodologic quality (Jadad score ≤3 in 23/36 trials).
Conclusions |
Moderate sedation provides a high level of physician and patient satisfaction and a low risk of serious adverse events with all currently available agents. Midazolam-based regimens have longer sedation and recovery times than does propofol.
Le texte complet de cet article est disponible en PDF.Abbreviations : RCT, RR
Plan
Vol 67 - N° 6
P. 910-923 - mai 2008 Retour au numéro
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