Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands; Grow School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2023 Aug;287:137-146. doi: 10.1016/j.ejogrb.2023.05.035. Epub 2023 Jun 1.
To identify which gynecologic procedures are eligible to be performed under PSA with propofol and to describe safety and effectiveness of these procedures in this setting.
A systematic review of the literature was conducted in Pubmed (MEDLINE), Embase and The Cochrane Library from inception until September 21st 2022. Cohort studies and randomized controlled trials were included when they reported on clinical outcomes of gynecologic procedures under procedural sedation and analgesia in which propofol was used as an anesthetic. Studies were excluded when sedation without propofol was used, when they only mentioned the use of procedural sedation and analgesia but did not describe any clinical outcome parameters or when < 10 patients were included. The primary outcome parameter was completeness of procedure. Secondary outcome parameters were type of gynecologic procedure, intraoperative complication rate, patient satisfaction, postoperative pain, duration of hospital admission, patient's discomfort and ease of procedure as judged by the surgeon. The Cochrane risk of bias tool and the ROBINS-I tool were used for bias assessment. A narrative synthesis of the findings from the included studies was provided. Numbers and percentages were presented, as well as means with standard deviations and medians with interquartile range where applicable.
Eight studies were included. A total of 914 patients underwent gynecologic surgical procedures with procedural sedation and analgesia with propofol. Gynecological procedures varied from hysteroscopic procedures, vaginal prolapse surgery and laparoscopic procedures. The percentage of complete procedures was 89.8%-100%. Complications occurred in 0-6.5% of patients. Other outcomes were measured in various ways, but overall patient satisfaction was high and postoperative pain was low.
The use of PSA with propofol is promising for a wide range of gynecologic procedures, including hysteroscopic procedures, vaginal prolapse surgery and laparoscopic procedures. The use of PSA with propofol seems to be effective and safe and leads to high degree of patient satisfaction. More research is needed in order to determine for which types of procedures PSA can be used.
确定哪些妇科程序有资格在 PSA 下使用异丙酚进行，并描述在这种情况下这些程序的安全性和有效性。
对 Pubmed（MEDLINE）、Embase 和 The Cochrane Library 中的文献进行系统综述，检索时间从建库至 2022 年 9 月 21 日。当报告在程序镇静和镇痛下进行妇科程序的临床结果，其中异丙酚用作麻醉剂时，纳入队列研究和随机对照试验。当镇静不使用异丙酚时、仅提到使用程序镇静和镇痛但未描述任何临床结果参数或纳入患者<10 例时，排除这些研究。主要结果参数是程序的完整性。次要结果参数是妇科程序的类型、术中并发症发生率、患者满意度、术后疼痛、住院时间、患者不适和手术难度（由外科医生判断）。使用 Cochrane 偏倚风险工具和 ROBINS-I 工具评估偏倚。提供了纳入研究结果的叙述性综合。提供了数字和百分比，以及适用时的均值和标准差以及中位数和四分位距。
纳入了 8 项研究。共有 914 例患者接受了妇科手术程序的程序镇静和镇痛，使用异丙酚。妇科程序从宫腔镜程序、阴道脱垂手术和腹腔镜程序等。完全手术的比例为 89.8%-100%。并发症发生率为 0-6.5%。其他结果以各种方式进行测量，但总体患者满意度高，术后疼痛低。
PSA 联合异丙酚在多种妇科程序中具有广阔的应用前景，包括宫腔镜程序、阴道脱垂手术和腹腔镜程序。PSA 联合异丙酚似乎有效且安全，患者满意度高。需要更多的研究来确定 PSA 可以用于哪些类型的程序。
