Sedation by non-anesthesiologists: are opioids and benzodiazepines outdated?

At least 3 systematic reviews have assessed the safety of propofol versus traditional agents used for sedation in gastrointestinal endoscopic procedures. These reviews uncovered a marked variability in study design and found the quality of the included randomized controlled trials to be poor. To date there is no demonstrated difference in the endoscopic safety or efficacy of propofol sedation compared to sedation with benzodiazepine with or without an opioid. However, a trend towards reduced complications and higher levels of satisfaction and cost-effectiveness with propofol during colonoscopies, and higher levels of patient satisfaction and improved efficacy may also be expected by using propofol during upper gastrointestinal endoscopies.