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Session: ePoster: Colon and Colorectal Cancer 1 (Sun8)

EP264 - Non-anaesthesiologist directed propofol sedation for colonoscopy: a systematic review and meta-analysis

Sunday, May 11, 2025
9:22 AM – 9:27 AM PT
Location: Monitor 4, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Garrett Johnson, MD, MSc (he/him/his)

    General Surgery Resident
    University of Manitoba
    WINNIPEG, MB, Canada

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • GO

    George Okoli, MD, PhD

    Researcher
    George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
    Winnipeg, Manitoba, Canada

    Disclosure information not submitted.

  • NA

    Nicole Askin, MLIS

    Librarian
    WRHA Virtual Library, University of Manitoba, Winnipeg, Canada
    Winnipeg, Manitoba, Canada

    Disclosure information not submitted.

  • AA

    Ahmed Abou-Setta, MD, PhD

    Assistant professor
    Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
    Winnipeg, Manitoba, Canada

    Disclosure information not submitted.

    • Senior Author(s)

  • HS

    Harminder Singh, MD, MPH, FRCP

    Associate professor
    Section of Gastroenterology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
    Winnipeg, Manitoba, Canada

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Garrett Johnson, MD, MSc: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Colonoscopy can be uncomfortable. Traditionally, endoscopist-directed opioids and/or benzodiazepines are administered to maximize patient comfort. Propofol sedation is an alternative with enhanced recovery times and patient satisfaction but increased costs when involving anesthesiologists. In most jurisdictions, propofol does require an anaesthesiologist to administer, which limits access. We synthesized randomized controlled trials (RCTs) comparing relative efficacy, patient acceptance and safety of non-anaesthesiologist directed propofol sedation for colonoscopy compared to sedation provided by anaesthesiologists.

Methods/Interventions: MEDLINE, EMBASE, Cochrane Central, CINAHL, LILACS, and Web of Science were searched until February 2024 for RCTs comparing non-anaesthesiologists to anaesthesiologist-directed propofol sedation during colonoscopy. Two authors independently identified RCTs, extracted data, assessed risk of bias (ROB 2.0 tool), and evidence certainty (GRADE instrument).

Results/Outcomes: Three studies were identified comparing anesthesiologist to non-anesthesiologist directed propofol sedation during colonoscopy. There were no differences in cecal intubation rate (RR: 1.00; 95%CI 0.97 to 1.01, 3 RCTs, 433 patients, high certainty), pain score (mean difference; MD: -0.02; 95%CI -0.26 to 0.22, 1 RCT, 277 patients, moderate certainty), patient satisfaction score (MD: 0.02; 95%CI -0.13 to 0.09, 1 RCTs, 277 patients, high certainty), proportion of satisfied patients (Risk ratio; RR: 1.02; 95%CI 0.93 to 1.12, 2 RCTs, 327 patients, moderate certainty), or complications; although apnea events, hospital admissions, colonic perforations, and death were not reported in any study. There was a small decrease in recovery time (MD: -9.0 mins; 95%CI -16.3 to 1.7, 1 RCTs, 277 patients, low certainty) for those administered sedation by non-anesthesiologists.

Conclusion/Discussion: Non-anesthesiologist compared to anesthesiologist directed propofol sedation for
colonoscopy results in little to no difference in cecal intubation rate, pain score, patient satisfaction, recovery times, or safety. While study quality was generally good for available outcomes, there were very few studies with less than 500 total included patients, and therefore somewhat limited data on some important safety outcomes, indicating a need for further research.