Subclinical encephalopathy after conscious sedation with midazolam in cirrhotic patients?

Abstract

TO THE EDITOR: We read with interest the article by Vasudevan et al. (1), which suggests that midazolam may promote subclinical encephalopathy (SCE) in cirrhotic patients undergoing therapeutic upper gastrointestinal endoscopy. The authors show first that the mean number connection test (NCT) time was significantly prolonged in cirrhotic patients 2 h after midazolam, contrary to patients without liver disease, and second that cirrhotic patients were slower than controls in performing the NCT before and after sedation. In their study, prevalence of abnormal NCT time was significantly increased after sedation, suggesting midazolam may exacerbate SCE.