title: Safety and effectiveness of low-dose propofol sedation during and after esophagogastroduodenoscopy in child A and B cirrhotic patients.
abstract: BACKGROUND
  Effective and safe sedation for patients with liver cirrhosis is problematic.
  
  
  OBJECTIVE
  To examine the safety and effectiveness of low-dose propofol sedation during and after esophagogastroduodenoscopy (EGD) in cirrhotic patients.
  
  
  METHODS
  Study 1 was a prospective study in cirrhotic patients who underwent diagnostic EGD under propofol sedation. Propofol was given by bolus injection with an age-adjusted standard protocol consisting of 40 mg for patients <70 years, 30 mg for patients aged 70-89 years; additional injections of 20 mg propofol were given up to a maximum of 120 mg. The principal parameter was the occurrence of adverse events within 24 h after EGD. Secondary parameters included successful procedures, complications, and full recovery within 60 min. In Study 2, the residual effects of propofol were evaluated using a driving simulator and blood propofol concentrations in a subset of cirrhotic patients undergoing EGD and compared with healthy individuals. The principal parameter was driving ability.
  
  
  RESULTS
  Study 1: Consecutive cirrhotic patients were entered and all 163 successfully completed EGD. The mean dose of propofol was 46 mg (range 30-120 mg). No complications occurred. Full recovery had occurred in 100 % 60 min after the procedure. No adverse events occurred within 24 h after EGD. Study 2: There were no significant differences in blood propofol levels between cirrhotic patients (n = 21) and healthy individuals (n = 20) after sedation. In cirrhotic patients, there was no deterioration in driving ability as compared with healthy individuals.
  
  
  CONCLUSIONS
  Low-dose propofol sedation provided safe and effective sedation for EGD in cirrhotic patients with rapid recovery.
authors.affiliation: Department of Metabolic Regulation, Institute on Aging and Adaptation, Shinshu University Graduate School of Medicine, Shinshu, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Akira
authors.initials: A
authors.lastname: Horiuchi
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Nakayama
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Katsuyama
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Isobe
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Aoyama
authors.forename: Eiji
authors.initials: E
authors.lastname: Tanaka
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ohmori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving; D016022:Case-Control Studies; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol