Abstract
(1) Background: Although etomidate-based sedation is an effective and safe protocol in endoscopic procedures, there is a lack of evidence regarding the safety of etomidate in patients with liver cirrhosis (LC). This study aimed to compare the neurologic safety and efficacy of etomidate and propofol for endoscopic sedation in patients with LC. (2) Methods: From December 2017 to December 2019, consecutive cirrhotic patients who underwent sedative endoscopy using either etomidate or propofol were randomly recruited. The primary endpoint was the number connection test (NCT), and the secondary endpoints included factors for the safety of sedatives during endoscopy. (3) Results: 63 patients were enrolled in each of the etomidate and propofol groups. The NCT times were significantly lower in the etomidate group than in the propofol group. Furthermore, severe or very severe degree of encephalopathy was higher in the propofol group but was not significantly different. Pharmacological properties and the overall incidence of respiratory and cardiovascular events did not differ significantly between the groups. (4) Conclusion: Etomidate-based sedation exacerbates neither subclinical nor overt hepatic encephalopathy. It guarantees efficacies similar to those of propofol regarding rapid sedation, fast recovery, and early discharge, with no increased risk of adverse respiratory or cardiovascular events in patients with LC.
Highlights
Patients with compensated or decompensated liver cirrhosis (LC) are usually referred to diagnostic or therapeutic endoscopy to be screened for varices and portal hypertensive gastropathy, or endoscopic bleeding control [1,2]
This study aimed to evaluate neurologic outcomes in patients with LC undergoing etomidate-based and prTohpisofsotul-dbaysaeidmseeddtaotioevnadluuartiengneeunrdoloosgciocpoyu. tcOoumrerseisnulptastiinendtiscawteiththLaCt tuhnedseerdgaotiinvge eetffoemctisdaotfeetboamseiddaatnedwpitrhopreogfoalr-dbatsoepdhsaerdmataicoonlodguircianlgpernopdeorstcioeps yw. eOreursirmesiulaltrstointdhiocasteeotfhpatrothpeofsoeld. aAtivltehoeuffgehcts inodfuecttoimonidtiamteew, riethcorveegrayrdtimtoep, ahnadrmpaactoielongt iscaatlispfraocptieorntidesidwneortedsiimffeirlabrettowteheonsethoef gprrooupposfo, el.toAmlthidoautgeh proved to be a favorable agent to achieve safe and effective sedation in patients with LC with regard to cognitive function
It took longer for patients in the propofol group to complete the number connection test (NCT) after an endoscopic procedure than those in the etomidate group
Summary
Patients with compensated or decompensated liver cirrhosis (LC) are usually referred to diagnostic or therapeutic endoscopy to be screened for varices and portal hypertensive gastropathy, or endoscopic bleeding control [1,2]. Patients with hepatic dysfunction who undergo endoscopic sedation could be at increased risk of adverse events related to sedation. Among these adverse events is the exacerbation of minimal hepatic encephalopathy (MHE), which is a major concern in these patients. Because many drugs are metabolized in the liver, sedative drugs can lead to a risk of excessive and prolonged drug effect due to higher plasma concentration and delayed clearance [4]. Most studies [11,12,13] reported that the use of propofol during endoscopy for patients with LC is safe, since it does not lead to acute deterioration in MHE. Propofol-based sedation in patients with LC may have limited utility in clinical practice, despite its previously reported advantages
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