Deep sedation with propofol does not precipitate hepatic encephalopathy during elective upper endoscopy.
BACKGROUND
The risk of hepatic encephalopathy (HE) precipitated by propofol has not been established.


OBJECTIVE
To know whether the use of propofol for endoscopy in patients with cirrhosis induces minimal or overt HE.


METHODS
A cohort study.


METHODS
A tertiary-referral university hospital endoscopy unit.


METHODS
Patients with cirrhosis who received an endoscopy with propofol sedation. We excluded patients with clinical HE. A group of patients without liver disease was included to compare the incidence of adverse effects.


METHODS
Minimal HE (MHE) was diagnosed by using the psychometric hepatic encephalopathy score (PHES) battery of psychometric tests. Cognitive status before and 1 hour after the endoscopy was evaluated by measuring the critical flicker frequency (CFF).


METHODS
Overt and minimal HE.


RESULTS
Twenty patients with cirrhosis and 20 patients without cirrhosis were included. There were no differences between groups in the incidence of adverse effects. Thirteen patients (65%) had MHE before the endoscopy. No patient developed overt HE after sedation. We did not observe differences in CFF before and after sedation in patients without MHE: median (25th-75th percentile), 40.8 Hz (37.1-46.0 Hz) versus 41.1 Hz (36.0-44.3 Hz), P = .8). None of the patients who were without MHE showed a decrease in the CFF under the cutoff of 39 Hz after sedation. There were not significant changes in CFF before and after propofol sedation in patients previously diagnosed of MHE: median (25th-75th percentile), 40.6 Hz (36.8-49.1 Hz) versus 42.7 Hz (36.8-52.4 Hz), P = .08.


CONCLUSIONS
A small number of patients were included in the study.


CONCLUSIONS
The use of propofol in the sedation of patients with cirrhosis during endoscopic procedures does not precipitate minimal or overt HE.
Amorós
Amparo
A
Unidad de Gastroenterología, Hospital General Universitario de Alicante, Alicante, Spain.
Aparicio
José R
JR
Garmendia
Marta
M
Casellas
Juan A
JA
Martínez
Juan
J
Jover
Rodrigo
R
D015331:Cohort Studies; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods; D017558:Elective Surgical Procedures; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006501:Hepatic Encephalopathy / Q000139:chemically induced; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D008103:Liver Cirrhosis; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000009:adverse effects; D012307:Risk Factors
D006993:Hypnotics and Sedatives; D015742:Propofol