title: Propofol sedation during endoscopy in patients with cirrhosis, and utility of psychometric tests and critical flicker frequency in assessment of recovery from sedation.
abstract: OBJECTIVE
  Patients with cirrhosis who undergo endoscopy under sedation could be at increased risk of complications. We assessed the utility of the critical flicker frequency (CFF) in the recovery of cognitive function.
  
  
  METHODS
  This was a prospective study in patients with cirrhosis who underwent endoscopy under sedation with propofol in a tertiary care center. The main outcome was deterioration in cognitive function as measured by the number connection test A and B (NCT-A, -B), digit symbol test (DST), serial dotting test (SDT), and line tracing test (LTT) before and 2 h after endoscopy. CFF was recorded before and then every 30 min after endoscopy for the next 2 h.
  
  
  RESULTS
  In the 108 patients there was no deterioration in results of the psychometric tests after the endoscopy (NCT-A 65.2 ± 44.4 vs. 62.4 ± 43.6 s, P = 0.01; NCT-B 110.4 ± 34.7 vs. 109.6 ± 44.6 s, P = 0.45; DST 26.2 ±1 0.0 vs. 26.7 ± 9.9, P = 0.25; SDT 88.6 ± 47.5 vs. 84.3 ± 44.1 s, P = 0.02; LTT 116.6 ± 55.2 vs. 115.4 ± 51.3 s, P = 0.47.) Patients with minimal hepatic encephalopathy (MHE; n = 64) did not show any deterioration in cognitive function at 2 h (NCT-A 87.7 ± 45.4 vs. 84.3 ± 44.9 s, P = 0.06; NCT-B 134.8 ± 65.4 vs. 132.7 ± 58.8 s, P = 0.46; DST 21.4 ± 8.9 vs. 22.2 ± 8.8, P = 0.09; SDT 107.1 ± 53.0 vs. 102.7 ± 48.5 s, P = 0.03; and LTT 131.5 ± 62.2 vs. 129.6 ± 57.2 s, P = 0.46). There was a significant difference between CFF at baseline and at 30 min and 1 h but no difference thereafter in non-MHE patients, MHE patients, and in controls. A total of 30 patients (28 %) had CFF < 38 Hz. In these patients, CFF at 2 h did not significantly differ from baseline CFF (35.9 ± 1.5 vs. 36.1 ± 2.0 Hz; P = 0.19). A total of 10 patients (9 %) had transient hypoxemia and 18 (17 %) had hypotension during the procedure. The endoscopy was completed in all patients.
  
  
  CONCLUSIONS
  Propofol is safe in patients with cirrhosis and the CFF is a useful tool for the assessment of recovery from sedation in these patients.
authors.affiliation: Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.
authors.forename: P
authors.initials: P
authors.lastname: Sharma
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.forename: B C
authors.initials: BC
authors.lastname: Sharma
authors.forename: M
authors.initials: M
authors.lastname: Kumar
authors.forename: H
authors.initials: H
authors.lastname: Garg
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.forename: S K
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D003071:Cognition / Q000187:drug effects* / Q000502:physiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005425:Flicker Fusion; D006501:Hepatic Encephalopathy / Q000175:diagnosis; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000494:pharmacology*; D008103:Liver Cirrhosis; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000009:adverse effects / Q000494:pharmacology*; D011446:Prospective Studies; D011594:Psychometrics
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol