Cargando…
Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients
This study was conducted to determine which type and dose of sedative drugs should be given to cirrhotic patients with compensation or decompensation during esophagogastroduodenoscopy (EGD) to prevent hepatic encephalopathy (HE) after sedation. METHODS: We reviewed the medical records of cirrhotic p...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams And Wilkins
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337114/ https://www.ncbi.nlm.nih.gov/pubmed/32433420 http://dx.doi.org/10.1097/MEG.0000000000001755 |
_version_ | 1783554449139040256 |
---|---|
author | Jeong, Joonho Jung, Kyoungwon Seo, Kwang Il Yun, Byung Cheol Han, Byung Hoon Lee, Sang Uk Moon, Won |
author_facet | Jeong, Joonho Jung, Kyoungwon Seo, Kwang Il Yun, Byung Cheol Han, Byung Hoon Lee, Sang Uk Moon, Won |
author_sort | Jeong, Joonho |
collection | PubMed |
description | This study was conducted to determine which type and dose of sedative drugs should be given to cirrhotic patients with compensation or decompensation during esophagogastroduodenoscopy (EGD) to prevent hepatic encephalopathy (HE) after sedation. METHODS: We reviewed the medical records of cirrhotic patients consecutively admitted to the hospital and conducted a number connection test (NCT) before and 2 h after EGD with moderate sedation. Sedation was performed using either propofol alone, midazolam alone, or combined propofol + midazolam. RESULTS: Sixty-seven patients were admitted for a screening EGD. The NCT before and after sedation were not significantly different in the propofol alone (pre-NCT = 47.3 ± 19.71 seconds vs. post-NCT = 49.4 ± 21.79 seconds, P = 0.6389). In the midazolam alone (pre-NCT = 50.3 ± 20.56 vs. post-NCT = 63.7 ± 33.17, P = 0.0021) and in the combined propofol + midazolam (pre-NCT = 47.4 ± 20.99 vs. post-NCT = 60.0 ± 30.79, P = 0.0002), NCT were significantly delayed. The propofol alone group received 52.3 ± 16.31 mg (0.82 ± 0.29 mg/kg). In 45 (67.2%) decompensated patients, only the propofol alone was not significantly different between pre-NCT (49.2 ± 22.92) and post-NCT (52.3 ± 24.90) (P = 0.4548). Serum sodium level was significantly correlated with delta-NCT (r = 0.3594, P = 0.0028). CONCLUSION: Propofol alone could be the best sedation strategy for cirrhotic patients with compensation or decompensation without aggravation of covert or overt HE. Hyponatremia could be a risk factor for developing or worsening HE after EGD with sedation. |
format | Online Article Text |
id | pubmed-7337114 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Lippincott Williams And Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-73371142020-07-13 Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients Jeong, Joonho Jung, Kyoungwon Seo, Kwang Il Yun, Byung Cheol Han, Byung Hoon Lee, Sang Uk Moon, Won Eur J Gastroenterol Hepatol Original Articles: Hepatology This study was conducted to determine which type and dose of sedative drugs should be given to cirrhotic patients with compensation or decompensation during esophagogastroduodenoscopy (EGD) to prevent hepatic encephalopathy (HE) after sedation. METHODS: We reviewed the medical records of cirrhotic patients consecutively admitted to the hospital and conducted a number connection test (NCT) before and 2 h after EGD with moderate sedation. Sedation was performed using either propofol alone, midazolam alone, or combined propofol + midazolam. RESULTS: Sixty-seven patients were admitted for a screening EGD. The NCT before and after sedation were not significantly different in the propofol alone (pre-NCT = 47.3 ± 19.71 seconds vs. post-NCT = 49.4 ± 21.79 seconds, P = 0.6389). In the midazolam alone (pre-NCT = 50.3 ± 20.56 vs. post-NCT = 63.7 ± 33.17, P = 0.0021) and in the combined propofol + midazolam (pre-NCT = 47.4 ± 20.99 vs. post-NCT = 60.0 ± 30.79, P = 0.0002), NCT were significantly delayed. The propofol alone group received 52.3 ± 16.31 mg (0.82 ± 0.29 mg/kg). In 45 (67.2%) decompensated patients, only the propofol alone was not significantly different between pre-NCT (49.2 ± 22.92) and post-NCT (52.3 ± 24.90) (P = 0.4548). Serum sodium level was significantly correlated with delta-NCT (r = 0.3594, P = 0.0028). CONCLUSION: Propofol alone could be the best sedation strategy for cirrhotic patients with compensation or decompensation without aggravation of covert or overt HE. Hyponatremia could be a risk factor for developing or worsening HE after EGD with sedation. Lippincott Williams And Wilkins 2020-06-01 2020-08 /pmc/articles/PMC7337114/ /pubmed/32433420 http://dx.doi.org/10.1097/MEG.0000000000001755 Text en Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/) (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Original Articles: Hepatology Jeong, Joonho Jung, Kyoungwon Seo, Kwang Il Yun, Byung Cheol Han, Byung Hoon Lee, Sang Uk Moon, Won Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients |
title | Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients |
title_full | Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients |
title_fullStr | Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients |
title_full_unstemmed | Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients |
title_short | Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients |
title_sort | propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients |
topic | Original Articles: Hepatology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337114/ https://www.ncbi.nlm.nih.gov/pubmed/32433420 http://dx.doi.org/10.1097/MEG.0000000000001755 |
work_keys_str_mv | AT jeongjoonho propofolalonepreventsworseninghepaticencephalopathyratherthanmidazolamaloneorcombinedsedationafteresophagogastroduodenoscopyincompensatedordecompensatedcirrhoticpatients AT jungkyoungwon propofolalonepreventsworseninghepaticencephalopathyratherthanmidazolamaloneorcombinedsedationafteresophagogastroduodenoscopyincompensatedordecompensatedcirrhoticpatients AT seokwangil propofolalonepreventsworseninghepaticencephalopathyratherthanmidazolamaloneorcombinedsedationafteresophagogastroduodenoscopyincompensatedordecompensatedcirrhoticpatients AT yunbyungcheol propofolalonepreventsworseninghepaticencephalopathyratherthanmidazolamaloneorcombinedsedationafteresophagogastroduodenoscopyincompensatedordecompensatedcirrhoticpatients AT hanbyunghoon propofolalonepreventsworseninghepaticencephalopathyratherthanmidazolamaloneorcombinedsedationafteresophagogastroduodenoscopyincompensatedordecompensatedcirrhoticpatients AT leesanguk propofolalonepreventsworseninghepaticencephalopathyratherthanmidazolamaloneorcombinedsedationafteresophagogastroduodenoscopyincompensatedordecompensatedcirrhoticpatients AT moonwon propofolalonepreventsworseninghepaticencephalopathyratherthanmidazolamaloneorcombinedsedationafteresophagogastroduodenoscopyincompensatedordecompensatedcirrhoticpatients |