ORCID
- J. Robert Sneyd: 0000-0003-3546-9856
Abstract
Background: Intraoperative and postoperative hypotension occur commonly and are associated with organ injury and poor outcomes. Changes in arterial blood pressure (BP) during procedural sedation are not well described. Methods: Individual patient data from five trials of propofol sedation for colonoscopy and a clinical database were pooled and explored with logistic and linear regression. A literature search and focused meta-analysis compared the incidence of hypotension with propofol and alternative forms of procedural sedation. Hypotensive episodes were characterised by the original authors' definitions (typically systolic BP <90 mm Hg). Results: In pooled individual patient data (n=939), 36% of procedures were associated with episodes of hypotension. Longer periods of propofol sedation and larger propofol doses were associated with longer-lasting and more-profound hypotension. Amongst 380 patients for whom individual BP measurements were available, 107 (28%) experienced systolic BP <90 mm Hg for >5 min, and in 89 (23%) the episodes exceeded 10 min. Meta-analysis of 18 RCTs identified an increased risk ratio for the development of hypotension in procedures where propofol was used compared with the use of etomidate (two studies; n=260; risk ratio [RR] 2.0 [95% confidence interval: 1.37–2.92]; P=0.0003), remimazolam (one study; n=384; RR 2.15 [1.61–2.87]; P=0.0001), midazolam (14 studies; n=2218; RR 1.46 [1.18–1.79]; P=0.0004), or all benzodiazepines (15 studies; n=2602; 1.67 [1.41–1.98]; P<0.00001). Hypotension was less likely with propofol than with dexmedetomidine (one study; n=60; RR 0.24 [0.09–0.62]; P=0.003). Conclusions: Hypotension is common during propofol sedation for colonoscopy and of a magnitude and duration associated with harm in surgical patients.
Publication Date
2022-01-01
Publication Title
British Journal of Anaesthesia
Volume
128
Issue
4
ISSN
0007-0912
Keywords
colonoscopy, endoscopy, hypotension, midazolam, propofol, sedation
First Page
610
Last Page
622
Recommended Citation
Sneyd, J., Absalom, A., Barends, C., & Jones, J. (2022) 'Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis', British Journal of Anaesthesia, 128(4), pp. 610-622. Retrieved from https://pearl.plymouth.ac.uk/more-foh-research/145
