Sedation with propofol plus fentanyl for cirrhotic patients during upper gastrointestinal endoscopy

Objective To prospectively study the safety and feasibility of sedation with propofol plus fentanyl for cirrhotic patients undergoing upper gastrointestinal endoscopy （UGIE）. Methods A total of 50 cirrhotic patients and 50 control subjects without liver diseases referred to UGIE were assigned to the cirrhotic sedation group and the non-cirrhotic sedation group, respectively. Patients of both groups received sedation with propofol plus fentanyl. Meanwhile, 30 cirrhotic patients underwent conventional UGIE. Vital signs of all subjects were recorded before sedation and procedure, five minutes, ten minutes and one hour after the pro- cedure. Number connection test A （NCT-A） and line tracing test （LTT） were completed for all patients be- fore sedation or procedures and 4 hours after endoscopy procedures. Occurrence of sedation-related complica- tions was measured. Results In the cirrhotic sedation group and the non-cirrhotic sedation group, blood pressure, heart rate, respiratory rate and saturation of pulse oximetry decreased of different degrees after sedation （ P 〉 0. 05 or P 〈 0. 05 ）, but returned to normal one hour after endoscopy procedures （ P 〉 0. 05 ）. The total complication rates differed significantly between the cirrhotic sedation group and the non-cirrhotic sedation group [ 36% （18/50） v.s. 14% （7/50）, P 〈 0. 05 ]. However, the rate of such complications as hypotension,bradycardia and hypoxemia in both groups was of no statistical difference （ P 〉 0.05 ）. No cir- rhotic patient developed overt hepatic encephalopathy after procedures. In addition, the NCT-A and LTY times before and after sedation in the cirrhotic sedation group and the cirrhotic non-sedation group were lon- ger than those before and after procedure in the non-cirrhotic sedation group （before sedation or procedure： （55.1 ±22.1）s, （58.6±23.1）sv.s. （36.9±7.0）s, （98.6±33.1）s, （89.5±15.6）s v.s. （81.4±13.6）s, P〈0.05; four hours after procedure ： （54.4±21.6）s, （58.3±22.4）s v.s. （36.3±6.3）s, （ 88.4±30. 6） s, （80. 2±15. 9） s v.s. （ 71.8±12. 0） s, P 〈0. 05, while there was no difference between cirrhotic sedation group and cirrhotic non-sedation group （ P 〉 0.05 ）. Within-group comparison showed NCT-A did not change （ P 〉 0.05 ） , whereas, LTT was obviously shorter than pre-sedation or pre-proeedure （P 〈 0. 05 ） due to ＂learning effect＂. The differences in the NCT-A and LTT times before and after sedation or procedure were not significant among the three groups （P 〉 0. 05 ）. Conclusion Sedation with propofol plus fentanyl is relatively safe in eirrhotic patients during UGIE, which will not precipitate hepatic encepha- lopathy or cause irreversible complications. Key words: Liver cirrhosis ;  Propofol;  Endoscopes;  Hepatic encephalopathy;  Complication