Endoscopic sedation of patients with chronic liver disease.
Endoscopic procedures are often necessary in patients with chronic liver disease. The preprocedure evaluation of such patients should include an assessment of hepatic synthetic function and identification of neuropsychiatric findings suggestive of hepatic encephalopathy. It may be possible, in some cases, to perform diagnostic esophagogastroduodenoscopy without administration of sedation; this is desirable to eliminate the risks of sedation, especially encephalopathy. Nonetheless, most patients undergoing upper and lower endoscopy require sedation. Currently, the use of propofol is preferred to benzodiazepines and opioids for endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and low risk of provoking hepatic encephalopathy. In appropriately selected patients, gastroenterologist-directed propofol administration seems safe.
Bamji
Neville
N
Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
Cohen
Lawrence B
LB
D000701:Analgesics, Opioid / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D001569:Benzodiazepines / Q000494:pharmacology; D002908:Chronic Disease; D016292:Procedural Sedation / Q000009:adverse effects* / Q000379:methods; D000075202:Contraindications; D004333:Drug Administration Routes; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008107:Liver Diseases / Q000175:diagnosis* / Q000188:drug therapy; D015742:Propofol / Q000494:pharmacology*; D012307:Risk Factors
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D015742:Propofol