Pharmacological agents for procedural sedation and analgesia in patients undergoing gastrointestinal endoscopy: a systematic review and network meta-analysis

作者：Jiaxin Li, Yue Liu, Siyu Chen, Xiaowen Dai, J.-Y Wang · 发表于：EClinicalMedicine · 年份：2025 · DOI：10.1016/j.eclinm.2025.103307 · 被引用次数：16 · 研究领域：Anesthesia and Sedative Agents、Nausea and vomiting management、Enhanced Recovery After Surgery

Background: Procedural sedation and analgesia is crucial for gastrointestinal endoscopy to improve patient comfort and facilitate procedural success. However, pharmacological agents differ in their efficacy and safety profiles, and the optimal agent to balance these outcomes remains uncertain, creating challenges in clinical decision-making. Therefore, we conducted a network meta-analysis to comprehensively evaluate and compare the efficacy and safety of various pharmacological agents. Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 10, 2025. Randomised controlled trials (RCTs) comparing at least two intravenous pharmacological agents in adult patients undergoing gastrointestinal endoscopy were included. Evidence quality was assessed using the Cochrane Risk of Bias 2.0 tool. Efficacy outcomes included sedation success rate and induction time; safety outcomes included time to full alertness, recovery time, and adverse events (hypoxia, hypotension, bradycardia, and postoperative nausea and vomiting [PONV]). A random-effects network meta-analysis was performed. Risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes were calculated, with 95% confidence intervals (CIs). Treatment rankings were presented using surface under the cumulative ranking (SUCRA) curves. The study protocol was registered with PROSPERO (CRD42024572207). Findings: The network meta-analysis incl...