Comparison of Efficacy and Safety of Remifentanil and Fentanyl in Adult Endoscopic Interventions: A Protocol for Systematic Review and Meta-analysis of randomized controlled trials

eview question / Objective Objective: To evaluate the efficacy and safety of r e m i f e n t a n i l v e r s u s f e n t a n y l f o r analgosedation during endoscopic procedures in adults.Clinical Question: Does the use of remifentanil provide more effective and safer analgosedation compared to fentanyl during endoscopic procedures in adults?PICOS:• Population: Adult patients who underwent endoscopic procedures (e.g., bronchoscopy, ERCP, colonoscopy, gastroscopy, hysteroscopy) under spontaneous ventilation.• Intervention: Bolus and/or prolonged infusion of remifentanil as an analgosedation component.• C o m p a r i s o n : U s e o f f e n t a n y l a s a n analgosedation component.• Outcomes: Pain level (VAS); induction & recovery times (Aldrete score, MPADS, PACU time); sedation level (Ramsay scale); incidence of respiratory depression/need for MV; total propofol dose; hemodynamic parameters (MAP, HR, hypotension, bradycardia); PONV; endoscopist's assessment; patient satisfaction; cognitive status in PACU.• Study Design: Randomized Controlled Trials (RCTs).Rationale Endoscopic procedures are often associated with discomfort, pain, cough, and motor agitation, which can reduce their quality, increase duration, and raise the risk of complications.Remifentanil is an ultra-short-acting opioid, which, due to its metabolism by nonspecific plasma esterases, exhibits predictable and rapid (3-5 min) elimination independent of infusion duration.Theoretically, this provides advantages: better control of analgesic depth, INPLASY 1International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY Comparison of Efficacy and Safety of Remifentanil and Fentanyl in Adult Endoscopic Interventions: A Protocol for Systematic Review and Meta-analysis of randomized controlled trialsBarkovskaya, NA; Shifman, EM; Protsenko, DN; Boyarkov, AV.