Efficacy and safety of alfentanil plus propofol versus propofol only in painless gastrointestinal endoscopy: a meta-analysis

Abstract

Abstract Objective: To systematically evaluate the efficacy and safety of alfentanil plus propofol versus propofol-only for painless gastrointestinal endoscopy. Methods: The Cochrane Library, PubMed, Embase, China Biology Medicine (CBM), CNKI, WanFang and VIP databases were searched to identify randomized controlled trials (RCTs) on alfentanil combined with propofol versus propofol only for painless gastrointestinal endoscopy from the inception of the database to August 2022. The Rev Man 5.4 software was used for statistical analyses. Results: Thirteen RCTs involving 1762 patients were identified as eligible for this study. The meta-analysis showed that compared with propofol, alfentanil combined with propofol had a more stable mean arterial pressure (MD=5.38, 95%CI: 1.97～8.80; P=0.002), heart rate (MD=3.78, 95%CI: 1.30～6.26; P=0.003) and pulse oxygen saturation (MD=1.90, 95%CI: 0.93~2.78; P=0.0001); a lower propofol dose (SMD=-2.82, 95%CI: -3.70~-1.94; P<0.00001), awakening time (MD=-3.23, 95%CI: -4.01~-2.45; P<0.00001) and directional force recovery time (MD=-3.62, 95%CI: -4.22～-3.03; P<0.00001); a lower incidence of nausea and vomiting (RR=0.32, 95%CI: 0.14~0.71; P=0.005), body movement (RR=0.27, 95%CI: 0.13～0.54; P=0.0002), hypotension (RR=0.23, 95%CI: 0.12～0.46; P<0.0001), respiratory depression (RR=0.37, 95%CI: 0.15～0.89; P=0.03) and cough reflex (RR=0.33, 95%CI: 0.12~0.89; P=0.03). Conclusion: This meta-study found that current evidence indicates that alfentanil plus propofol is better than propofol alone for painless gastrointestinal endoscopy and is associated with a lower incidence of adverse reactions. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to validate these above conclusions.