Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients

Abstract

Background This study was conducted to determine which type and dose of sedative drugs should be given to cirrhotic patients with compensation or decompensation during esophagogastroduodenoscopy (EGD) to prevent hepatic encephalopathy (HE) after sedation. Methods We reviewed the medical records of cirrhotic patients consecutively admitted to the hospital and conducted a number connection test (NCT) before and 2 h after EGD with moderate sedation. Sedation was performed using either propofol alone, midazolam alone, or combined propofol + midazolam. Results Sixty-seven patients were admitted for a screening EGD. The NCT before and after sedation were not significantly different in the propofol alone (pre-NCT = 47.3 ± 19.71 seconds vs. post-NCT = 49.4 ± 21.79 seconds, P = 0.6389). In the midazolam alone (pre-NCT = 50.3 ± 20.56 vs. post-NCT = 63.7 ± 33.17, P = 0.0021) and in the combined propofol + midazolam (pre-NCT = 47.4 ± 20.99 vs. post-NCT = 60.0 ± 30.79, P = 0.0002), NCT were significantly delayed. The propofol alone group received 52.3 ± 16.31 mg (0.82 ± 0.29 mg/kg). In 45 (67.2%) decompensated patients, only the propofol alone was not significantly different between pre-NCT (49.2 ± 22.92) and post-NCT (52.3 ± 24.90) ( P = 0.4548). Serum sodium level was significantly correlated with delta-NCT (r = 0.3594, P = 0.0028). Conclusion Propofol alone could be the best sedation strategy for cirrhotic patients with compensation or decompensation without aggravation of covert or overt HE. Hyponatremia could be a risk factor for developing or worsening HE after EGD with sedation.

Effect of Midazolam on Sedation and Hemorheology in Elderly Patients with Acute Cerebral Infarction

“…Quantitative analysis of cerebral blood supply and cerebral metabolism will help to assess the ischemic and hypoxic state of brain tissue and evaluate the therapeutic effect of drugs. The oxygen uptake rate in the brain can quantitatively reflect the degree of brain metabolism and D (a-jv) can be calculated by CaO 2 as the percentage of oxygen inhaled by brain neurons [16] . When cerebral blood flow decreases, the normal metabolic process can only be maintained by increasing the intake of blood oxygen in brain tissue and nerve cells.…”

Necessity of pharyngeal anesthesia during transoral gastrointestinal endoscopy: a randomized clinical trial

“…Several studies on the use of pharyngeal anesthesia under sedation with propofol have reported that pharyngeal anesthesia does not reduce the amount of propofol, improve endoscopists' satisfaction, or improve pharyngeal discomfort or patient satisfaction. [11][12][13][14] However, at present, benzodiazepines are more commonly administered than propofol to obtain optimal sedation during UGE, 9 as they do not require management by an anesthesiologist.…”