title: Safety of propofol in cirrhotic patients undergoing colonoscopy and endoscopic retrograde cholangiography:  results of a prospective controlled study.
abstract: OBJECTIVE
  Safety of propofol sedation in patients with liver cirrhosis undergoing colonoscopy or endoscopic retrograde cholangiopancreatography (ERCP) remains to be studied. The aim of this study was to investigate whether the use of propofol is safe for endoscopic procedures more complex than gastroscopy in patients with liver cirrhosis in a prospective controlled study.
  
  
  METHODS
  Two hundred and fourteen consecutive patients, with or without cirrhosis, who underwent colonoscopy or ERCP with propofol sedation were recruited between January and June 2009. Administration of sedation was performed by anesthesiologists and outcome measures were recorded. Main outcomes were complication rates and recovery times.
  
  
  RESULTS
  Sixty-one (28.5%) cirrhotic patients and 153 (71.5%) noncirrhotic patients were included. The incidence of sedation-related complications did not significantly differ between the two populations (11.5 vs. 17.0%, respectively, P=0.31). The mean (±SD) dose of propofol administered (213±86 vs. 239±100 mg, P=0.07), the mean time to achieve adequate sedation (3.3±1.1 vs. 3.0±1.2 min, P=0.21), the mean total duration of the endoscopic procedure (24.5±10.6 vs. 27.4±11.8 min, P=0.08), the mean time to reach Observer's Assessment of Alertness and Sedation Scale 5 (17.2±4.4 vs. 18.4±5.6 min, P=0.15), the mean time from completion of the procedure to release (9.0±2.5 vs. 9.1±3.2 min, P=0.86), and the mean time to full recovery (42.2±7.3 vs. 42.3±7.8 min, P=0.88) were very similar between the two groups. The limitation of this study was lack of randomization, and a control group of cirrhotic patients using standard sedation with benzodiazepines and opioids.
  
  
  CONCLUSIONS
  Propofol deep sedation administered by an anesthesiologist with appropriate monitorings seems to be a safe procedure during colonoscopy or ERCP in cirrhotic patients.
authors.affiliation: Department of Internal Medicine, Savigliano Hospital, Savigliano (CN), Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Fagà
authors.forename: Mariella
authors.initials: M
authors.lastname: De Cento
authors.forename: Chiara
authors.initials: C
authors.lastname: Giordanino
authors.forename: Claudio
authors.initials: C
authors.lastname: Barletti
authors.forename: Mauro
authors.initials: M
authors.lastname: Bruno
authors.forename: Patrizia
authors.initials: P
authors.lastname: Carucci
authors.forename: Claudio
authors.initials: C
authors.lastname: De Angelis
authors.forename: Wilma Debernardi
authors.initials: WD
authors.lastname: Venon
authors.forename: Alessandro
authors.initials: A
authors.lastname: Musso
authors.forename: Dario
authors.initials: D
authors.lastname: Reggio
authors.forename: Sharmila
authors.initials: S
authors.lastname: Fagoonee
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Pellicano
authors.forename: Simone
authors.initials: S
authors.lastname: Ceretto
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
authors.forename: Giorgio
authors.initials: G
authors.lastname: Saracco
mesh_terms: D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D016292:Procedural Sedation / Q000009:adverse effects* / Q000379:methods; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007432:Intraoperative Period; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol