Objective

To identify which gynecologic procedures are eligible to be performed under PSA with propofol and to describe safety and effectiveness of these procedures in this setting.

Methods

A systematic review of the literature was conducted in Pubmed (MEDLINE), Embase and The Cochrane Library from inception until September 21st 2022.

Cohort studies and randomized controlled trials were included when they reported on clinical outcomes of gynecologic procedures under procedural sedation and analgesia in which propofol was used as an anesthetic. Studies were excluded when sedation without propofol was used, when they only mentioned the use of procedural sedation and analgesia but did not describe any clinical outcome parameters or when < 10 patients were included.

The primary outcome parameter was completeness of procedure. Secondary outcome parameters were type of gynecologic procedure, intraoperative complication rate, patient satisfaction, postoperative pain, duration of hospital admission, patient’s discomfort and ease of procedure as judged by the surgeon.

The Cochrane risk of bias tool and the ROBINS-I tool were used for bias assessment.

A narrative synthesis of the findings from the included studies was provided. Numbers and percentages were presented, as well as means with standard deviations and medians with interquartile range where applicable.

Results

Eight studies were included. A total of 914 patients underwent gynecologic surgical procedures with procedural sedation and analgesia with propofol. Gynecological procedures varied from hysteroscopic procedures, vaginal prolapse surgery and laparoscopic procedures. The percentage of complete procedures was 89.8%−100%. Complications occurred in 0–6.5% of patients. Other outcomes were measured in various ways, but overall patient satisfaction was high and postoperative pain was low.

Conclusion

The use of PSA with propofol is promising for a wide range of gynecologic procedures, including hysteroscopic procedures, vaginal prolapse surgery and laparoscopic procedures. The use of PSA with propofol seems to be effective and safe and leads to high degree of patient satisfaction. More research is needed in order to determine for which types of procedures PSA can be used.

中文翻译：

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妇科手术中丙泊酚（PSA）程序镇静和镇痛：文献的系统回顾

客观的

确定哪些妇科手术适合在使用异丙酚的 PSA 下进行，并描述在此情况下这些手术的安全性和有效性。

方法

Pubmed (MEDLINE)、Embase 和 Cochrane 图书馆对自成立至 2022 年 9 月 21 日期间的文献进行了系统回顾。

当报告使用异丙酚作为麻醉剂的程序镇静和镇痛下妇科手术的临床结果时，纳入了队列研究和随机对照试验。当使用不使用异丙酚的镇静剂、仅提及使用程序镇静和镇痛但未描述任何临床结果参数或纳入<10名患者时，研究被排除。

主要结果参数是程序的完整性。次要结果参数是妇科手术类型、术中并发症发生率、患者满意度、术后疼痛、住院时间、患者不适以及外科医生判断的手术难易程度。

使用 Cochrane 偏倚风险工具和 ROBINS-I 工具进行偏倚评估。

提供了纳入研究结果的叙述性综合。提供了数字和百分比，以及标准差平均值和四分位距中位数（如果适用）。

结果

其中包括八项研究。共有 914 名患者接受了妇科手术，并使用异丙酚进行程序镇静和镇痛。妇科手术包括宫腔镜手术、阴道脱垂手术和腹腔镜手术。完成手术的百分比为89.8%−100%。0-6.5% 的患者出现并发症。其他结果以各种方式进行测量，但患者总体满意度较高，术后疼痛较低。

结论

PSA 与异丙酚的使用有望用于广泛的妇科手术，包括宫腔镜手术、阴道脱垂手术和腹腔镜手术。PSA 与异丙酚的使用似乎是有效和安全的，并且患者满意度很高。需要更多的研究来确定 PSA 可用于哪些类型的手术。