Deep sedation with propofol does not precipitate hepatic encephalopathy during elective upper endoscopy - 23/08/11
Reprint requests: Rodrigo Jover, MD, Unidad de Gastroenterología, Hospital General Universitario de Alicante, Pintor Baeza, 12, 03010, Alicante, Spain.Alicante, Spain
Abstract |
Background |
The risk of hepatic encephalopathy (HE) precipitated by propofol has not been established.
Objective |
To know whether the use of propofol for endoscopy in patients with cirrhosis induces minimal or overt HE.
Design |
A cohort study.
Setting |
A tertiary-referral university hospital endoscopy unit.
Patients |
Patients with cirrhosis who received an endoscopy with propofol sedation. We excluded patients with clinical HE. A group of patients without liver disease was included to compare the incidence of adverse effects.
Interventions |
Minimal HE (MHE) was diagnosed by using the psychometric hepatic encephalopathy score (PHES) battery of psychometric tests. Cognitive status before and 1 hour after the endoscopy was evaluated by measuring the critical flicker frequency (CFF).
Main Outcome Measurements |
Overt and minimal HE.
Results |
Twenty patients with cirrhosis and 20 patients without cirrhosis were included. There were no differences between groups in the incidence of adverse effects. Thirteen patients (65%) had MHE before the endoscopy. No patient developed overt HE after sedation. We did not observe differences in CFF before and after sedation in patients without MHE: median (25th-75th percentile), 40.8 Hz (37.1-46.0 Hz) versus 41.1 Hz (36.0-44.3 Hz), P = .8). None of the patients who were without MHE showed a decrease in the CFF under the cutoff of 39 Hz after sedation. There were not significant changes in CFF before and after propofol sedation in patients previously diagnosed of MHE: median (25th-75th percentile), 40.6 Hz (36.8-49.1 Hz) versus 42.7 Hz (36.8-52.4 Hz), P = .08.
Limitation |
A small number of patients were included in the study.
Conclusions |
The use of propofol in the sedation of patients with cirrhosis during endoscopic procedures does not precipitate minimal or overt HE.
Le texte complet de cet article est disponible en PDF.Abbreviations : ASA, CFF, HE, MHE, MOAAS, NCT, PHES
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| See CME section; p. 369. |
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| If you want to chat with an author of this article, you may contact him at jover_rod@gva.es. |
Vol 70 - N° 2
P. 262-268 - août 2009 Retour au numéro
Article précédent
- EUS-guided FNA for the diagnosis of GI stromal cell tumors: sensitivity and cytologic yield
- Paul S. Sepe, Bhavani Moparty, Martha B. Pitman, John R. Saltzman, William R. Brugge
- Toward safer sedation in patients with cirrhosis: have we done enough?
- Paul J. Thuluvath
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