Safety and efficacy of propofol for sedative endoscopy in patients with compensated liver cirrhosis

Yoon, Hyo Joong; Kim, Sang Gyune; Na, Hyun Sik; Maeng, Ju Hee; Han, Sang Hoon; Jang, Jae Young; Ko, Bong Min; Hong, Su Jin; Ryu, Chang Beom; Kim, Young Soek; Moon, Jong Ho; Lee, Joon Seong; Lee, Moon Sung; Shim, Chan Sup; Kim, Boo Sung

Abstract

BACKGROUND/AIMS: Propofol is widely used for sedation during endoscopy. Because propofol may cause hepatic encephalopathy, hemodynamic compromise, and respiratory depression, cautious use is required in patients with liver cirrhosis. We evaluated the safety and efficacy of propofol in compensated cirrhosis during endoscopic examination.
METHODS
Thirty-nine cirrhotic patients (19 and 20 cases of Child Pugh classes A and B, respectively) and 56 control subjects were included. The initial dose of propofol (40 mg) was increased by 20-mg increments until moderate sedation was achieved. The number connection test, flapping tremor test, blood pressure, heart rate, oxygen saturation, liver enzymes, and prothrombin time were evaluated before and after endoscopy.
RESULTS
No significant change was observed in any parameter compared to baseline in either group. The mean dose of propofol was significantly lower in cirrhotic versus control subjects (49.7+/-15.8 versus 65.0+/-17.9 mg, respectively; p<0.001). Scores based on a visual analog scale evaluating patient satisfaction did not differ between groups (72+/-27 versus 64+/-26, respectively; p=0.196), nor did mean recovery time (16.4+/-9.8 versus 14.2+/-6.7 min, respectively; p=0.186).
CONCLUSION
Propofol is safe and effective for moderate sedation in compensated liver cirrhosis.