A comprehensive Cochrane review of 33 randomized controlled trials involving 12,485 adults evaluated the effectiveness and safety of propofol sedation compared with traditional opioid and benzodiazepine regimens during colonoscopy. The review found that propofol may shorten post-procedure recovery time and modestly improve patient satisfaction, while producing little to no difference in completion rates or the need for respiratory interventions. Evidence regarding discharge time and pain reduction remained uncertain, largely due to heterogeneity and low certainty across included studies.
Across three trials comparing anesthesiologist-directed versus non-anesthesiologist-directed propofol administration, findings indicated little to no difference in completion rates and patient satisfaction, with a slight reduction in recovery time in non-anesthesiologist settings. Rates of respiratory complications, perforation, and hospitalization were similarly low in both groups, though many key safety outcomes were not reported. Overall, evidence supports propofol as an effective option for improving patient experience during colonoscopy, while highlighting the need for more robust studies with standardized outcome reporting.
Keywords: propofol sedation, colonoscopy, patient recovery, endoscopy anesthesia