title: Deep sedation with propofol does not precipitate hepatic encephalopathy during elective upper endoscopy.
abstract: 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.
authors.affiliation: Unidad de Gastroenterología, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Amorós
authors.forename: José R
authors.initials: JR
authors.lastname: Aparicio
authors.forename: Marta
authors.initials: M
authors.lastname: Garmendia
authors.forename: Juan A
authors.initials: JA
authors.lastname: Casellas
authors.forename: Juan
authors.initials: J
authors.lastname: Martínez
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jover
mesh_terms: 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
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol