Propofol versus midazolam with or without short-acting opioids for sedation in colonoscopy: a systematic review and meta-analysis of safety, satisfaction, and efficiency outcomes
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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.
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In that prior meta-analysis, anaesthesia recovery time was shorter in the propofol group than in the midazolam group.
“However, the anaesthesia recovery time was shorter in the propofol group.”
From Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis. (2024) · cites this paper as [47]
In a prior meta-analysis comparing propofol with midazolam for sedation in colonoscopies, there were no significant differences in cardiorespiratory outcomes (hypotension, hypoxia, and bradycardia) between the two sedative agents.
“In a prior meta-analysis comparing propofol with another benzodiazepine, midazolam, for sedation in colonoscopies, there were no significant differences in cardiorespiratory outcomes (encompassing hypotension, hypoxia, and bradycardia) between both sedative agents.”
From Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis. (2024) · cites this paper as [47]
In that prior meta-analysis, patients who received propofol for sedation reported greater satisfaction than those who received midazolam.
“Additionally, patients who received propofol for sedation reported greater satisfaction than those who received midazolam.47”
From Remimazolam versus propofol for sedation in gastrointestinal endoscopic procedures: a systematic review and meta-analysis. (2024) · cites this paper as [47]
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References 39 · Cited by 56
- Authors
- Dossa, F., Medeiros, B., Keng, C., Acuna, S. A., & Baxter, N. N.
- Affiliations
- St. Michael's Hospital (CA)
- Western University (CA)
- University of Toronto (CA)
- Corresponding author
- Baxter, Nancy N.
- Venue
- Gastrointestinal Endoscopy
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 91
- Issue
- 5
- Pages
- 1015-1026.e7
- ISSN
- 0016-5107 (ISSN-L)
- OpenAlex
- W2999373239
- Cited by
- 56
- References
- 39
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 11 · 2023: 6 · 2022: 12 · 2021: 7 · 2020: 3
- FWCI
- 2.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastrointestinal Endoscopy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Veterinary › Small Animals › Veterinary Pharmacology and Anesthesia
- Keywords
- propofol, midazolam, colonoscopy sedation, short-acting opioids, procedural sedation, patient satisfaction, recovery time, hypotension, hypoxia, bradycardia, procedure time, endoscopist satisfaction
- MeSH terms
- Analgesics, Opioid, Colonoscopy, Humans, Hypnotics and Sedatives, Midazolam, Personal Satisfaction, Propofol, Procedural Sedation, Treatment Outcome, Patient Satisfaction
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