Safety of propofol in cirrhotic patients undergoing colonoscopy and endoscopic retrograde cholangiography

Abstract

Propofol deep sedation administered by an anesthesiologist with appropriate monitorings seems to be a safe procedure during colonoscopy or ERCP in cirrhotic patients.

Gastrointestinal endoscopy in the cirrhotic patient

“…While information is fairly limited on the increased risks of sedation with benzodiazepines and opioids, the use of propofol has increased in this population, as it has in the population of patients who do not have chronic liver disease [2][3][4]. While there is a wide range of practices depending on the country, it is our opinion that sedation should be utilized in elective diagnostic endoscopy as it improves the quality of the procedure [5].…”

“…From the available data, propofol appears to represent a safe and effective medication for sedation in patients with cirrhosis [2,4,6,8,9,10,11]. In our opinion, propofol is the drug of choice in these patients, but, as with most medications, the endoscopist needs to understand that metabolism in the setting of chronic liver disease may be significantly impaired and requires expert intervention.…”

“…There are a growing number of publications suggesting the safety of propofol (with or without short-acting opioids) for the management of patients with liver disease who require upper endoscopy [1,2,4,6,8,11,28,48,49]. Propofol seems to have many advantages including rapid induction, short half-life, equivalent levels of amnesia to other benzodiazepines, and no dosage adjustment requirements in liver disease.…”

“…Endoscopy is usually successfully performed with the use of moderate (conscious) sedation [10]. There are no specific sedation guidelines for patients with advanced liver disease, and the cirrhotic population is more susceptible to complications related to sedation than their counterparts, which is likely related to higher plasma levels of the drug or delayed clearance [2,6,11,48,49]. There is even less available data investigating sedation in patients with higher CPT scores and American Society for Anesthesiologists classifications, which can lead to a higher rate of complications and encephalopathy [3,7,48,50].…”

Endoscopic management of post-liver transplant biliary complications

“…For these reasons, at our center, like most of the other hospitals in the United States, ERC's are usually performed under anesthetist administered general anesthesia or monitored anesthesia care using propofol. Safety of opioids/benzodiazepines as well as propofol based regimens have been adequately demonstrated for GI endoscopic procedures, in several studies [99,100] . However, there is no such data available in post-LT patients, and is an area for further research.…”