Is propofol safe when administered to cirrhotic patients during sedative endoscopy?

Abstract

Background/AimsIn patients with liver cirrhosis, drugs acting on the central nervous system can lead to hepatic encephalopathy and the effects may be prolonged. Recently, misuse of propofol has been reported and the associated risk of death have become an issue. Propofol is commonly used during sedative endoscopy; therefore, its safety in high-risk groups must be further investigated. We performed a pilot study of the safety and efficacy of propofol during endoscopy in Korean patients with cirrhosis.MethodsUpper gastrointestinal endoscopy was performed under sedation with propofol along with careful monitoring in 20 patients with liver cirrhosis and 20 control subjects. The presence or development of hepatic encephalopathy was assessed using the number connection test and neurologic examination.ResultsNeither respiratory depression nor clinically significant hypotension were observed. Immediate postanesthetic recovery at 5 and 10 minutes after the procedure was delayed in the cirrhotic patients compared with the control group; however, at 30 minutes, the postanesthetic recovery was similar in both groups. Baseline psychomotor performance was more impaired in cirrhotic patients, but propofol was not associated with deteriorated psychomotor function even in cirrhotic patients with a minimal hepatic encephalopathy.ConclusionsSedation with propofol was well tolerated in cirrhotic patients. No newly developed hepatic encephalopathy was observed.

Clinical outcomes of sedation during emergency endoscopic band ligation for variceal bleeding: Multicenter cohort study

“…This finding is consistent with the results of previous studies that found that the risk of HEP was minimal with propofol-based sedation. 27,28 We believe that propofol-based sedation can be safely used for emergency endoscopy in patients with acute variceal bleeding.…”

Propofol versus Midazolam for Upper Gastrointestinal Endoscopy in Cirrhotic Patients: A Meta-Analysis of Randomized Controlled Trials

“…However, the impact of liver cirrhosis on the effects of sedatives in cirrhotic patients remains unclear. A pilot study evaluated the safety and efficacy of propofol use during endoscopy in Korean patients with cirrhosis, and determined that sedation with propofol was well tolerated in cirrhotic patients; specifically, no deterioration in psychomotor function, even in cirrhotic patients with hepatic encephalopathy, was observed [ 28 ]. Our study is the first meta-analysis to evaluate anesthesia for UGIE in cirrhotic patients.…”

GI Endoscopy Sedation in Patients with Cirrhosis: Routine or Unpredictable?

“…Since sensitivity to the sedative and cardiorespiratory depressant effects of propofol are increased in these patients, it is recommended to decrease the dose. Nevertheless, in a study of 20 patients with liver cirrhosis and 20 control subjects undergoing upper GI endoscopy, Suh et al [7] did not observe respiratory depression or clinically significant hypotension. Although psychomotor performance was more impaired in cirrhotic patients, there was no post-procedural deterioration of psychomotor function even in cirrhotic patients with minimal hepatic encephalopathy.…”