BACKGROUND AND AIMS Propofol is increasingly being used for sedation in colonoscopy; however, its benefits over midazolam (± short-acting opioids) are not well quantified. The objective of this study was to compare safety, satisfaction, and efficiency outcomes of propofol versus midazolam (± short-acting opioids) in patients undergoing colonoscopy. METHODS We systematically searched Medline, Embase, and the Cochrane library (to July 30, 2018) for randomized controlled trials of colonoscopies performed with propofol versus midazolam (± short-acting opioids). We pooled odds ratios for cardiorespiratory outcomes using mixed-effects conditional logistic models. We pooled standardized mean differences (SMDs) for patient and endoscopist satisfaction and efficiency outcomes using random-effects models. RESULTS Nine studies of 1427 patients met the inclusion criteria. There were no significant differences in cardiorespiratory outcomes (hypotension, hypoxia, bradycardia) between sedative groups. Patient satisfaction was high in both groups, with most patients reporting willingness to undergo a future colonoscopy with the same sedative regimen. In the meta-analysis, patients sedated with propofol had greater satisfaction than those sedated with midazolam (± short-acting opioids) (SMD, .54; 95% confidence interval [CI], .30-.79); however, there was considerable heterogeneity. Procedure time was similar between groups (SMD, .15; 95% CI, .04-.27), but recovery time was shorter in the propofol group (SMD, .41; 95% CI, .08-.74). The median difference in recovery time was 3 minutes, 6 seconds shorter in patients sedated with propofol. CONCLUSIONS Both propofol and midazolam (± short-acting opioids) result in high patient satisfaction and appear to be safe for use in colonoscopy. The marginal benefits to propofol are small improvements in satisfaction and recovery time.

中文翻译：

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丙泊酚与咪达唑仑加或不加短效阿片类药物在结肠镜检查中的镇静作用：对安全性，满意度和效率结果的系统评价和荟萃分析。

背景与目的异丙酚已越来越多地用于结肠镜检查中的镇静作用。但是，其与咪达唑仑（±短效阿片类药物）相比的益处尚未得到很好的量化。这项研究的目的是比较接受结肠镜检查的患者中丙泊酚与咪达唑仑（±短效阿片类药物）的安全性，满意度和效率结果。方法我们系统地搜索了Medline，Embase和Cochrane库（至2018年7月30日），以丙泊酚与咪达唑仑（±短效阿片类药物）进行结肠镜检查的随机对照试验。我们使用混合效应条件对数模型汇总了心肺预后的比值比。我们使用随机效应模型汇总了患者和内镜医师满意度和效率结果的标准化均值差（SMD）。结果1427例患者的9项研究符合纳入标准。镇静组之间的心肺预后（低血压，低氧，心动过缓）无显着差异。两组患者的满意度都很高，大多数患者报告愿意接受相同镇静方案的未来结肠镜检查。在荟萃分析中，使用丙泊酚镇静的患者比用咪达唑仑镇静（±短效阿片类药物）镇静的患者满意度更高（SMD，0.54； 95％置信区间[CI] ，. 30-.79）。但是，存在很大的异质性。两组之间的手术时间相似（SMD，.15； 95％CI，.04-.27），但是丙泊酚组的恢复时间更短（SMD，.41； 95％CI，.08-.74）。丙泊酚镇静患者的恢复时间中位数差异为3分钟，短了6秒。结论丙泊酚和咪达唑仑（±短效阿片类药物）均能提高患者满意度，并且在结肠镜检查中似乎是安全的。异丙酚的边际收益是满意度和恢复时间的微小改善。