Impairment of Psychomotor Responses After Conscious Sedation in Cirrhotic Patients Undergoing Therapeutic Upper Gi Endoscopy

Abstract

A total of 61 consecutive cirrhotic patients who underwent therapeutic upper GI endoscopy completed the study. The mean presedation NCT time was 43.5 s (95% CI = 39.0-48.1 s) and the mean postsedation NCT time 60.0 s (95% CI = 50.7-69.3 s). The difference between the mean pre- and postsedation NCT times was 16.4 s (95% CI = 9.8-23.1 s; p < 0.001). A total of 38 consecutive patients without clinical or biochemical evidence of liver disease who presented for upper GI endoscopy completed the NCT as described for the group of cirrhotic patients. The mean (+/- SD) baseline NCT time was 34.7+/-7.9 s (95% CI = 32.1-37.2 s), whereas the mean postsedation NCT time was 33.7+/-8.5 s (95% CI = 30.9-36.5 s). This difference was not statistically significant (p = 0.177). Using the upper limit of the 95% CI of the mean (37.4 s) of the presedation time in the patients without liver disease as the cut-off between normal and encephalopathy, the number of cirrhotic patients with abnormal presedation NCT times was 33 patients (54.1%), and this number rose to 46 patients (75.4%) after sedation with midazolam. This increase in proportion of cirrhotic patients with prolonged NCT time was statistically significant (p < 0.001).

Sedation during upper GI endoscopy in cirrhotic outpatients: a randomized, controlled trial comparing propofol and fentanyl with midazolam and fentanyl

“…5,9,11,[16][17][18][19] Nevertheless, caution is advised when sedation with benzodiazepines and opioids is administered in patients with liver disease. Hepatic flow is one of the main factors involved in metabolism and elimination of midazolam.…”

Psychomotor recovery and blood propofol level in colonoscopy when using propofol sedation

“…Recovery from sedation varies significantly, depending on the drug used, and, although alertness can be recovered quickly and the patient may be fit for discharge after sedation with a benzodiazepine plus an opioid, neuromotor function is often impaired, and most international recommendations regarding the recovery of patients from sedated endoscopy ban the patient from active participation in traffic for 24 hours. [1][2][3][4][5] Our study demonstrated that residual effects of midazolam after EGD affected various aspects of psychomotor function for at least 2 hours after the injection. 8 The average recovery time after colonoscopy also was much longer for patients receiving a combination of a benzodiazepine and a narcotic (54.9 minutes) than for patients receiving propofol alone (15.6 minutes).…”

Évaluation du risque de la sédation par propofol en endoscopie digestive par le gastroentérologue: revue de la littérature

“…Les patients d'âge avancé et les patients présentant une pathologie coronarienne ou pulmonaire avaient un risque augmenté de complications cardiorespiratoires liées à une sédation pour une endoscopie digestive [51,52].…”

“…Les patients cirrhotiques sédatés par benzodiazépine présentaient fréquemment des encéphalopathies postendoscopies [52].…”

“…L'utilisation du propofol pour la sédation en endoscopie ne semble pas augmenter le risque de complication cardiorespiratoire par rapport à une sédation par benzodiazé-pine ± morphinique, lorsque l'HGE est responsable de cette sédation [38]. De plus, le propofol permet d'améliorer la satisfaction des patients [15,52,53], d'induire une AG en quelques secondes après son injection [50], de réduire le temps de surveillance postopératoire du fait de son métabo-lisme rapide (temps de demi-vie de 2 à 4 minutes) [54], d'améliorer le réveil, grâce à l'absence de nausées ou vomissements et d'amnésie antérograde.…”