Randomized controlled trial for endoscopy with propofol versus midazolam on psychometric tests and critical flicker frequency in people with cirrhosis

Agrawal, Amit; Sharma, Barjesh Chander; Sharma, Praveen; Uppal, Rajiv; Sarin, Shiv Kumar

doi:10.1111/j.1440-1746.2012.07231.x

Cited by 22 publications

(52 citation statements)

References 31 publications

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“…Based on the screening criteria for titles and abstracts, 955 studies were excluded. After reviewing the full text of the remaining 48 reports, five eligible RCTs were subjected to further analysis [ 1 , 23 – 26 ].…”

Section: Resultsmentioning

confidence: 99%

“…A propofol group was compared with a midazolam group in all of the trials. One RCT investigated the outcomes in cirrhotic patients who underwent UGIE without undergoing sedation [ 23 ]. In addition, one RCT compared the outcomes in a nonsedated group without cirrhosis [ 24 ], and one study compared the outcomes in nonsedated and noncirrhotic patients who were matched to the cirrhotic group [ 1 ].…”

Section: Resultsmentioning

confidence: 99%

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

Tsai

Lin

et al. 2015

PLoS ONE

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BackgroundSedation during gastrointestinal endoscopy is often achieved using propofol or midazolam in general population. However, impaired protein synthesis, altered drug metabolism, and compromised hepatic blood flow in patients with liver cirrhosis might affect the pharmacokinetics of sedatives, placing cirrhotic patients undergoing endoscopy at a greater risk of adverse events. The objective of this study was to assess comparative efficacies and safety of propofol and midazolam in cirrhotic patients undergoing endoscopy.MethodsRandomized, controlled trials comparing propofol with midazolam in cirrhotic patients undergoing gastrointestinal endoscopy were selected. We performed the meta-analysis, using a random-effect model, the Review Manager, Version 5.2, statistical software package (Cochrane Collaboration, Oxford, UK) according to the PRISMA guidelines.ResultsFive studies between 2003 and 2012, including 433 patients, were included. Propofol provided a shorter time to sedation (weight mean difference: -2.76 min, 95% confidence interval: -3.00 to -2.51) and a shorter recovery time (weight mean difference -6.17 min, 95% confidence interval: -6.81 to -5.54) than midazolam did. No intergroup difference in the incidence of hypotension, bradycardia, or hypoxemia was observed. Midazolam was associated with the deterioration of psychometric scores for a longer period than propofol.ConclusionThis meta-analysis suggests that Propofol sedation for endoscopy provides more rapid sedation and recovery than midazolam does. The risk of sedation-related side effects for propofol does not differ significantly from that of midazolam. The efficacy of propofol in cirrhotic patients undergoing endoscopy is superior to those of midazolam.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Tsai

Lin

et al. 2015

PLoS ONE

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“…This study has several limitations. First, in contrast to previous studies 19 - 23) , we used flumazenil as a reversal agent for the Midazolam group after the completion of EIS because we have used flumazenil routinely in all sedations with midazolam for EIS. Flumazenil has a halflife of 50 minutes, which is shorter than the halflife of midazolam 28) .…”

Section: Discussionmentioning

confidence: 99%

Propofol is a more effective and safer sedative agent than midazolam in endoscopic injection sclerotherapy for esophageal varices in patients with liver cirrhosis: a randomized controlled trial

Watanabe

Hikichi

Takagi

et al. 2018

FJMS

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The efficacy of sedation during endoscopic injection sclerotherapy (EIS) for esophageal varices (EVs) in patients with liver cirrhosis remains unclear. The aim of this study is to compare the efficacy and safety between propofoland midazolambased sedation for EIS. Methods : Twentythree patients with EVs were prospectively and randomly assigned to midazolambased (Midazolam group) or propofolbased (Propofol group) sedation. All patients underwent a number connection test (NCT) to evaluate minimal hepatic encephalopathy (MHE) on the day before and at 2 and 24 hours following EIS. The primary endpoint was exacerbation of MHE after EIS, which was defined as deterioration of the NCT. The secondary endpoints were postoperative awareness, technical success rate, frequency of body movement, patient and operator satisfaction, cardiorespiratory dynamics during EIS, and adverse events. Results : Exacerbations of MHE at 2 hours after EIS compared with those before EIS were not significantly different between the two groups. In both groups, the deterioration of NCT scores before and 2 hours after EIS was observed (Propofol group : 60.0 vs. 70.0 s, P = 0.026 ; Midazolam group : 42.5 vs. 67.0 s, P = 0.002). There were no significant differences in awareness, technical success rate, or patient satisfaction. However, the frequency of body movement in the Propofol group was significantly lower than that in the Midazolam group (1 vs. 4, P = 0.045), and operator satisfaction in the Propofol group was significantly higher than that in the Midazolam group (P = 0.016). No adverse events were observed. Conclusions : Propofolbased sedation exacerbated MHE after EIS similarly to midazolambased sedation in patients with liver cirrhosis. However, propofolbased sedation provided stable sedation with a lower frequency of body movements and high operator satisfaction.

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“…5 The first thing to consider before drug selection in patients with cirrhosis is the pharmacokinetic profile, with an emphasis on fast metabolism in the liver and excretion by the kidney. 6 In this respect, propofol is a useful drug for EVL. 7 Unlike benzodiazepine, propofol does not worsen mild HEP.…”

Section: Introductionmentioning

confidence: 99%

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

Park

Jung

et al. 2020

Digestive Endoscopy

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Background and Aims Few studies have directly compared the efficacy of sedated‐ and un‐sedated endoscopic variceal ligation (EVL) for acute variceal bleeding. We aimed to determine whether sedation during EVL in patients with variceal bleeding is safe and effective. Methods We analyzed data from patients who underwent EVL for acute variceal bleeding according to sedation in six hospitals of Hallym University Medical Center. The primary endpoint was treatment failure, defined as a failure to control bleeding, death during EVL, or rebleeding within 5 days. Secondary endpoints included the procedure time, adverse events, and 30‐day mortality. Results Of 1,300 patients who were included, only 430 (33.1%) received sedation during EVL. Propofol alone was used for sedation in 85% of sedated‐EVLs. The mean procedure time in the sedation group was shorter than that of the non‐sedation group (12.4 ± 9.5 min versus 13.8 ± 9.4 min, P = 0.010). The proportion of treatment failure did not differ between the groups (7.4% versus 9.1%, P = 0.374). In the multivariable analysis, an AIMS65 score ≥2 and blood transfusion within 72 hours were associated with treatment failure of EVL; however, the use of sedation was not (odds ratio [95% confidence interval (CI)] = 0.96 [0.60–1.51]). Adverse events during EVL and hepatic encephalopathy did not differ between the two groups. Sedation also did not affect the 30‐day mortality (hazard ratio [95% CI] = 0.99 [0.66–1.47]). Conclusion Sedation reduced the procedure time of EVL. Sedation is safe to use during EVL for variceal bleeding in patients with cirrhosis.

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Randomized controlled trial for endoscopy with propofol versus midazolam on psychometric tests and critical flicker frequency in people with cirrhosis

Abstract: Propofol sedation for UGIE was associated with earlier recovery compared with midazolam, which causes deterioration of psychometric tests and CFF for a longer time in comparison with propofol.

Cited by 22 publications

References 31 publications

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

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

Propofol is a more effective and safer sedative agent than midazolam in endoscopic injection sclerotherapy for esophageal varices in patients with liver cirrhosis: a randomized controlled trial

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

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