title: Is propofol safe when administered to cirrhotic patients during sedative endoscopy?
abstract: OBJECTIVE
  In patients with liver cirrhosis, drugs acting on the central nervous system can lead to hepatic encephalopathy and the effects may be prolonged. Recently, misuse of propofol has been reported and the associated risk of death have become an issue. Propofol is commonly used during sedative endoscopy; therefore, its safety in high-risk groups must be further investigated. We performed a pilot study of the safety and efficacy of propofol during endoscopy in Korean patients with cirrhosis.
  
  
  METHODS
  Upper gastrointestinal endoscopy was performed under sedation with propofol along with careful monitoring in 20 patients with liver cirrhosis and 20 control subjects. The presence or development of hepatic encephalopathy was assessed using the number connection test and neurologic examination.
  
  
  RESULTS
  Neither respiratory depression nor clinically significant hypotension were observed. Immediate postanesthetic recovery at 5 and 10 minutes after the procedure was delayed in the cirrhotic patients compared with the control group; however, at 30 minutes, the postanesthetic recovery was similar in both groups. Baseline psychomotor performance was more impaired in cirrhotic patients, but propofol was not associated with deteriorated psychomotor function even in cirrhotic patients with a minimal hepatic encephalopathy.
  
  
  CONCLUSIONS
  Sedation with propofol was well tolerated in cirrhotic patients. No newly developed hepatic encephalopathy was observed.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Sang Jun
authors.initials: SJ
authors.lastname: Suh
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Yim
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Eileen L
authors.initials: EL
authors.lastname: Yoon
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Beom Jae
authors.initials: BJ
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Hyun
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Jung
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Ja Seol
authors.initials: JS
authors.lastname: Koo
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Kyung Jin
authors.initials: KJ
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Rok Son
authors.initials: RS
authors.lastname: Choung
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Yeon
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Byun
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Jai Hyun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Ryu
mesh_terms: D000328:Adult; 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*; D056910:Republic of Korea
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: Hepatic encephalopathy; Liver cirrhosis; Propofol; Sedative endoscopy