Endoscopy 2011; 43(5): 400-405
DOI: 10.1055/s-0030-1256182
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Propofol sedation during endoscopy in patients with cirrhosis, and utility of psychometric tests and critical flicker frequency in assessment of recovery from sedation

P.  Sharma1 , S.  Singh2 , B.  C.  Sharma1 , M.  Kumar1 , H.  Garg1 , A.  Kumar1 , S.  K.  Sarin1
  • 1Institute of Liver and Biliary Sciences, Vasant Kunj, Delhi, India
  • 2Department of Hepatology and Anesthesia, Vasant Kunj, Delhi, India
Further Information

Publication History

submitted 21 August 2010

accepted after revision 1 December 2010

Publication Date:
04 May 2011 (online)

Background and study aims: 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.

Patients and 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.

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S. K. SarinMD 

Institute of Liver and Biliary Sciences

Vasant Kunj
New Delhi 110070
India

Fax: +91-11-23233336

Email: shivsarin@gmail.com

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