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.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : ASA, CFF, HE, MHE, MOAAS, NCT, PHES
Mappa
| 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 - agosto 2009 Ritorno al numero
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