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Randomized controlled trial for endoscopy with propofol versus midazolam on psychometric tests and critical flicker frequency in people with cirrhosis
Author(s) -
Agrawal Amit,
Sharma Barjesh Chander,
Sharma Praveen,
Uppal Rajiv,
Sarin Shiv Kumar
Publication year - 2012
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2012.07231.x
Subject(s) - medicine , sedation , midazolam , cirrhosis , propofol , randomized controlled trial , endoscopy , colonoscopy , gastroenterology , anesthesia , colorectal cancer , cancer
Background and Aim People with cirrhosis are at increased risk of development of complications related to sedation. The aim of the present study was to compare the effects of sedation for upper gastrointestinal endoscopy ( UGIE ) with propofol and midazolam on psychometric tests and critical flicker frequency ( CFF ) in people with cirrhosis. Methods A total of 127 people with cirrhosis were randomized into three groups: propofol group ( n = 40), midazolam group ( n = 42) and no sedation ( n = 45). All patients underwent CFF test and combination of psychometry (number connection test‐A and B [ NCT‐A,B ]; digit symbol test [ DST ], line tracing test [ LTT ] and serial dotting test [ SDT ]) at baseline and at 2 h post‐endoscopy. CFF was done at 30 min and repeated every 30 min for 2 h. Results In the propofol group there was no deterioration in psychometry ( NCT‐A [55.6 ± 18.7 vs 56.4 ± 19.0 s], NCT‐B [98.2 ± 35.1 vs 97.8 ± 34.6 s], DST [26.7 ± 5.7 vs 26.3 ± 5.3], LTT [112.9 ± 35.7 vs 113.7 ± 36.6 s], SDT [94.6 ± 34.1 vs 95.2 ± 34.5 s]). Significant deterioration from baseline (39.8 ± 2.9 Hz ) was seen in CFF at 30 min (38.8 ± 2.3 Hz ) and 1 h (39.2 ± 2.4 Hz ), P = 0.01 but no difference thereafter. In the midazolam group, significant deterioration was observed on psychometry ( NCT‐A [56.0 ± 18.5 vs 60.4 ± 19.8 s], NCT‐B [99.9 ± 29.1 vs 105.9.6 ± 30.3 s], DST [26.1 ± 4.7 vs 25.2 ± 4.3], LTT [129.1 ± 34.5 vs 132.9 ± 35.4 s], SDT [95.6 ± 34.2]). No deterioration was observed in psychometry and CFF in people with cirrhosis without sedation. Conclusions Propofol sedation for UGIE was associated with earlier recovery compared with midazolam, which causes deterioration of psychometric tests and CFF for a longer time in comparison with propofol.