Original articleClinical endoscopyA systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures
Section snippets
Search strategy
We performed a systematic search of the medical literature for randomized controlled trials (RCTs) of moderate sedation in unselected adults undergoing upper endoscopy or colonoscopy. We searched the EMBASE (1980–January 2007) and MEDLINE (1950–January 2007) computerized bibliographic databases. We did not search for abstracts or unpublished data. The detailed search strategy is available from the authors on request. In brief, the search terms included endoscopy or individual procedure names
Results
Our initial search strategy yielded 1218 unique articles. After initial title and abstract review, 87 complete articles were retrieved for detailed review and 1 meta-analysis.14 Fifty studies were excluded for the following reasons: administration of fixed doses of medication (27), administration of oral agents (3), duplicate publication (2), administration of deep sedation or general anesthesia (3), patient-controlled analgesia (3), not an RCT (8), study of sedation for ERCP (2), a selected
Discussion
Because moderate sedation is so widely used for endoscopic procedures, we sought to assess the relative safety, efficacy, and efficiency of currently available therapies, focusing on the most widely used medications. We note that the marked variability in study design, methodologic quality, regimens tested, and outcomes assessed in the studies included in our systematic review limit the ability to define an “optimal” moderate sedation regimen. We emphasize that pooling results from multiple
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Digestion
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2022, Clinical Gastroenterology and HepatologyCitation Excerpt :For routine colonoscopy, there has been a shift from moderate sedation administered by the endoscopist to monitored anesthesia care (MAC), typically with propofol sedation.12,13 The use of MAC can result in more rapid onset and deeper sedation, although it is more costly and only marginally impacts patient satisfaction.14,15 Although MAC is generally safe, administrative database studies have demonstrated an association between anesthesia assistance for colonoscopy and an increased risk of adverse events when compared with moderate sedation.16-18