Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis.

BACKGROUND: Intraoperative and postoperative hypotension occur commonly and are associated with organ injury and poor outcomes. Changes in arterial blood pressure (BP) during procedural sedation are not well described. METHODS: Individual patient data from five trials of propofol sedation for colonoscopy and a clinical database were pooled and explored with logistic and linear regression. A literature search and focused meta-analysis compared the incidence of hypotension with propofol and alternative forms of procedural sedation. Hypotensive episodes were characterised by the original authors' definitions (typically systolic BP <90 mm Hg). RESULTS: In pooled individual patient data (n=939), 36% of procedures were associated with episodes of hypotension. Longer periods of propofol sedation and larger propofol doses were associated with longer-lasting and more-profound hypotension. Amongst 380 patients for whom individual BP measurements were available, 107 (28%) experienced systolic BP <90 mm Hg for >5 min, and in 89 (23%) the episodes exceeded 10 min. Meta-analysis of 18 RCTs identified an increased risk ratio for the development of hypotension in procedures where propofol was used compared with the use of etomidate (two studies; n=260; risk ratio [RR] 2.0 [95% confidence interval: 1.37-2.92]; P=0.0003), remimazolam (one study; n=384; RR 2.15 [1.61-2.87]; P=0.0001), midazolam (14 studies; n=2218; RR 1.46 [1.18-1.79]; P=0.0004), or all benzodiazepines (15 studies; n=2602; 1.67 [1.41-1.98]; P<0.00001). Hypotension was less likely with propofol than with dexmedetomidine (one study; n=60; RR 0.24 [0.09-0.62]; P=0.003). CONCLUSIONS: Hypotension is common during propofol sedation for colonoscopy and of a magnitude and duration associated with harm in surgical patients.

A case study exploring associations between popular media attention of scientific research and scientific citations.

The association between mention of scientific research in popular media (e.g., the mainstream media or social media platforms) and scientific impact (e.g., citations) has yet to be fully explored. The purpose of this study was to clarify this relationship, while accounting for some other factors that likely influence scientific impact (e.g., the reputations of the scientists conducting the research and academic journal in which the research was published). To accomplish this purpose, approximately 800 peer-reviewed articles describing original research were evaluated for scientific impact, popular media attention, and reputations of the scientists/authors and publication venue. A structural equation model was produced describing the relationship between non-scientific impact (popular media) and scientific impact (citations), while accounting for author/scientist and journal reputation. The resulting model revealed a strong association between the amount of popular media attention given to a scientific research project and corresponding publication and the number of times that publication is cited in peer-reviewed scientific literature. These results indicate that (1) peer-reviewed scientific publications receiving more attention in non-scientific media are more likely to be cited than scientific publications receiving less popular media attention, and (2) the non-scientific media is associated with the scientific agenda. These results may inform scientists who increasingly use popular media to inform the general public and scientists concerning their scientific work. These results might also inform administrators of higher education and research funding mechanisms, who base decisions partly on scientific impact.