Efficacy Of Propofol Research Articles

The efficacy and safety of ciprofol and propofol in patients undergoing colonoscopy: A double-blind, randomized, controlled trial

Study objectivePropofol is a commonly utilized anesthetic for painless colonoscopy, but its usage is occasionally limited due to its potential side effects, including cardiopulmonary suppression and injection pain. To address this limitation, the novel compound ciprofol has been proposed as a possible alternative for propofol. This study sought to determine whether there are any differences in the safety and efficacy of propofol and ciprofol for painless colonoscopy. DesignRandomized clinical trial. SettingSingle-centre, class A tertiary hospital, November 2021 to November 2022. PatientsAdult, American Society of Anesthesiologists Physical Status I to II and body mass index of 18 to 30 kg m−2 patients scheduled to undergo colonoscopy. InterventionsConsecutive patients were randomly allocated in a 1:1 ratio to receive sedation for colonoscopy with ciprofol (group C) or propofol (group P). MeasurementsThe primary outcome was the success rate of colonoscopy. The secondary outcomes were onset time of sedation, operation time, recovery time and discharge time, patients and endoscopists satisfaction, side effects (e.g. injection pain, myoclonus, drowsiness, dizziness, procedure recall, nausea and vomiting) and incidence rate of cardiopulmonary adverse events. Main resultsNo significant difference was found in the success rate of colonoscopy between the two groups (ciprofol 96.3% vs. propofol 97.6%; mean difference − 1.2%, 95% CI: −6.5% to 4.0%, P = 0.650). However, group C showed prolonged sedation (63.4 vs. 54.8 s, P < 0.001) and fully alert times (9 vs 8 min, P = 0.013), as well as reduced incidences of injection pain (0 vs. 40.2%, P < 0.001), respiratory depression (2.4% vs. 13.4%, P = 0.021) and hypotension (65.9% vs. 80.5%, P = 0.034). Patients satisfaction was also higher in Group C (10 vs 9, P < 0.001). ConclusionsCiprofol can be used independently for colonoscopy. When comparing the sedation efficacy of ciprofol and propofol, a 0.4 mg kg−1 dose of ciprofol proved to be equal to a 2.0 mg kg−1 dose of propofol, with fewer side effects and greater patient satisfaction during the procedure.

Evaluation of propofol and remifentanil combination for controlled hypotension during anesthesia in pediatric nasal endoscopic surgery

Purpose: To investigate the safety and efficacy of propofol in combination with remifentanil for controlled hypotension during pediatric nasal endoscopic surgery. &#x0D; Methods: The study involved 30 patients who underwent controlled hypotension measures with remifentanil during the operation (study group), and 30 patients who did not receive controlled hypotension measures (control group). Various parameters including vital signs, operation time, intraoperative bleeding, surgical field quality, anesthesia quality, postoperative recovery time, adverse reaction rate, pain scores, and serum C-reactive protein levels were compared between the two groups. &#x0D; Results: The results revealed a significant decrease in mean arterial pressure and heart rate in the study group during the operation compared to control group. Moreover, study group exhibited improved operation time, reduced intraoperative bleeding, and better surgical field quality compared to control group. Pain scores and serum C-reactive protein levels were also lower in the study group. However, there were no significant differences in recovery time, anesthesia quality, postoperative adverse reaction rate, or cognitive function between the two groups. &#x0D; Conclusion: Propofol in combination with remifentanil for controlled hypotension is a safe and effective anesthesia approach for pediatric nasal endoscopic surgery. Future studies will require larger sample size from different study centers to improve the robustness of the findings of this study.

Efficacy of propofol with sevoflurane to produce balanced anaesthesia in dogs

Efficacy of propofol with sevoflurane to produce balanced anaesthesia in dogs

Assessment of alcohol withdrawal syndrome: new perspectives

Alcohol withdrawal syndrome is one of the most important consequences of alcohol use disorder, a complex neuropsychiatric disorder, which is firstly treated in non-specific and secondly in psychiatric/addictive in- or outpatient units. On the other hand, alcohol withdrawal syndrome is one of the most important outcomes of the severity of alcohol use disorder, further, it can lead to the development of alcohol-related seizure and delirium tremens. Hence, early recognition and optimal treatment of alcohol withdrawal syndrome have a critical importance. Therefore, the main goal of the present review was - by systematically summarizing the scientific data published during the past two decades - to form a unique diagnostic and therapeutic algorithm. During the recognition and the course of alcohol withdrawal syndrome, the Clinical Institute Withdrawal Assessment for Alcohol, Revised scale, while in the risk assessment the Prediction of Alcohol Withdrawal Severity Scale are the recommended psychometric tools. Benzodiazepines are the key elements of the pharmacotherapy of alcohol withdrawal syndrome. Many studies have evaluated that diazepam, chlordiazepoxide, lorazepam and oxazepam with distinct indications have sufficient evidence in the treatment of alcohol withdrawal syndrome. However, in the past few years some authors have recommended the importance of non-benzodiazepine medications. The efficacy of propofol, phenobarbital, carbamazepin, oxcarbamazepin and alpha-2 receptor agonists in the treatment of alcohol withdrawal syndrome have been revealed. Furthermore, it has been evaluated that benzodiazepines are recommended in the treatment of alcohol-related seizure and delirium tremens. In the present review, our aim was to construct a unique, up-to-date diagnostic and therapeutic algorithm by summarizing the related papers published during the past two decades. Hence this scheme may be useful in the optimal treatment of patients diagnosed with alcohol use disorder and it could help to conduct further clinical researches. Orv Hetil. 2023; 164(38): 1487-1496.

Safety and Efficacy of Propofol- and Ketamine-Based Procedural Sedation Regimen in Pediatric Patients During Burn Repetitive Dressing Change: 10 Years Single Center Experience.

It is crucial to provide an adequate level of sedation and analgesia during burn dressing changes in the pediatric population due to the amount of pain and anxiety patients experience during the procedure. To evaluate the safety and efficacy of an intensivist-based deep sedation regimen using a combination of propofol and ketamine to provide procedural sedation to pediatric burn patients. This is a retrospective chart review of pediatric patients who underwent inpatient burn wound dressing changes from 2011 through 2021. Demographic and clinical data, including age, length of the procedure, recovery time, medication doses, and adverse events, were collected. A total of 104 patients aged between 45 and 135 months with a median total burn body surface area (TBSA) of 11.5 percent (interquartile range [IQR] 4.0, 25.0) underwent 378 procedural sedation encounters with propofol- and ketamine-based sedation. The median total dose of propofol was 7 mg/kg (IRQ 5.3, 9.2). Of these sedations, 64 (17 percent) had minor adverse events, of which 50 (13 percent) were transient hypoxemia, 12 (3 percent) were upper airway obstruction, and 2 (0.5 percent) were hypotension. There were no serious adverse events. Hypoxemia was not related to age, weight, gender, burn TBSA, or total dose of propofol. There were 35 (33.6 percent) patients who had repetitive sedation encounters with no statistically significant changes in propofol dose or adverse events with the repeated encounters. Children can be effectively sedated for repetitive inpatient burn dressing changes. Given the high-risk patient populations, this procedure should be performed under the vigilance of highly trained providers.

Efficacy of propofol for the prevention of emergence agitation after sevoflurane anaesthesia in children: A meta-analysis.

BackgroundEmergence agitation (EA) is a common postoperative behavioral disorder, predominantly in pediatric patients, after sevoflurane general anesthesia. This study was aimed at assessing propofol's efficacy and clinical conditions established for preventing EA in children under sevoflurane anesthesia.MethodsRandomized controlled trials (RCTs) that comparatively investigated propofol and control treatment in terms of efficacy and safety on administration at the end of surgery and examinations to prevent EA in children under sevoflurane anesthesia were searched. The sources accessed included PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Furthermore, manual searches were performed to identify studies; the last review was conducted on March 21, 2022. When the risk of bias assessment of trials was performed with the Cochrane Risk of Bias Tool, we calculated risk ratios (RRs) with 95% confidence intervals (CIs) for EA incidence and mean differences (MDs) with 95% CI for continuous data.ResultsWe included 12 RCTs with 1103 children. EA incidence (RR: 0.51, 95% CI: 0.39 to 0.67) and Pediatric Anesthesia Emergence Delirium scores (MD: −3.14, 95% CI: −4.37 to −1.92) were lower in the propofol group. Subgroup analyses showed lower EA incidences with 3 mg/kg propofol (RR: 0.22, 95% CI: 0.13 to 0.38) without extension of the PACU time (MD: 4.97, 95% CI: −0.84 to 10.78) in the laryngeal mask airway (LMA; RR: 0.52, 95% CI: 0.36 to 0.77) and spontaneous breathing (RR: 0.36, 95% CI: 0.21 to 0.62) groups.DiscussionWe confirmed that a prophylactic dose of propofol prevented EA and decreased its severity in children under sevoflurane anesthesia. Furthermore, several conditions such as 3 mg/kg propofol, LMA, and spontaneous breathing, potentially contributed to EA prevention. Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=274692, identifier: PROSPERO (No. CRD42021274692).

Efficacy and Safety of Deep Sedation and Anaesthesia for Complex Endoscopic Procedures-A Narrative Review.

Propofol sedation for advanced endoscopic procedures is a widespread technique at present, which generates controversy worldwide when anaesthetic or non-anaesthetic personnel administer this form of sedation. There is some evidence for safe administered propofol sedation by non-anaesthetic personnel in patients undergoing endoscopy procedures, but there are only few randomised trials addressing the safety and efficacy of propofol in patients undergoing advanced procedures. A serious possible consequence of propofol sedation is the rapid and unpredictable progression from deep sedation to general anaesthesia mostly when elderly and frail patients are involved in the diagnosis or treatment of various neoplasia. This situation requires rescue measures with skilled airway management. The aim of this paper is to review the safety and efficacy aspects of sedation techniques, with special reference to propofol administration covering the whole patient journey, including preassessment, sedation options and discharge when advanced endoscopic procedures are performed.

Comparison of the safety and efficacy of propofol and dexmedetomidine as sedatives when used as a modified topical formulation

Purpose: To evaluate the safety and efficacy of propofol and dexmedetomidine as sedatives in patients with anticipated difficult airways, used as a modified topical preparation.Methods: A total of 432 patients were enrolled in this study. They were classified as ASA I and ASA II. The patients were equally divided into group A (propofol group) and group B (dexmedetomidine group). A modified Awake Fiberoptic Intubation (AFOI) was carried out for these patients, followed by airway assessment and evaluation of clinical outcome based on intubation scores, adverse events, and postoperative data.Results: Patients in both groups had successful intubation at the first attempt. There was no significant difference in baseline characteristics between the two groups. The SARI scores which characterized the overall score for tracheal intubation were 4.6 and 4.2 for groups A and B, respectively. With respect to rescue infusion and consciousness, 11 patients (5.09 %) in group A required rescue, as against 5 patients (2.31 %) in group B. Seven (7) patients (3.24 %) in group A (propofol group) had severe airway obstruction, while only 4 patients (1.85) in group B had the same adverse reaction. Patients in group B had more satisfactory and favourable outcomes than those in group A who were treated with modified AFOI.Conclusion: The use of dexmedetomidine based on modified topical anaesthesia is safe and comfortable in terms of patient convenience and difficult airway management. Thus, dexmedetomidine is a safe, feasible and effective method for managing difficult airway when applied using the modified AFOI.

The efficacy of propofol and etomidate for sedation in endoscopic bronchial ultrasound- A randomized controlled study

There is paucity of Indian data regarding the use of sedation for endobronchial ultrasound. We compared the efficacy of etomidate and propofol in patients undergoing endoscopic bronchial ultrasound for the achievement of satisfactory sedation. Seventy patients aged more than 18 years posted for endoscopic bronchial ultrasound under sedation for diagnostic and therapeutic purpose were included in this randomised double- blind controlled study. Patients were randomly allocated to propofol and etomidate group. Comparison of cardiovascular adverse events and haemodynamic parameters were the primary objectives. Comparison of gag reflex, visual analogue scale score and recovery from sedation using Modified Aldrete Score were the secondary objectives. Patient satisfaction in terms of visual analogue scale score was the same in both propofol and etomidate groups. Endoscopist’s satisfaction was significantly higher in etomidate group as compared to propofol group. The post-operative hypotension was significantly lower in etomidate group as compared to propofol group. The post-operative bradycardia was significantly lower in etomidate group as compared to propofol group.Endoscopist’s satisfaction and the haemodynamic control was better in etomidate group as compared to propofol group during endobronchial ultrasound.

Propofol's Efficacy and Outcomes on Anxious Children's Behavior in the Course of Dental Therapy: An Interventional Trial.

Introduction:Tranquility therapies have recently been more popular as a means of reducing anxiety amongst children in the course of painful diagnostic and therapeutic procedures. As a result, a variety of techniques (oral tranquility, intravenous (IV) tranquility) have been developed to assist practitioners in order to deal with such instances. The goal of this trial was to see how effective propofol could be in calming anxious youngsters during the course of dental therapy. The interventional investigation was undertaken at the Hazaribag College of Dental Sciences and Hospital in Jharkhand.Materials and Methods:To assess the outcomes of intravenous propofol on their performance in the course of therapy, 40 children within the age group of 3–6 years pursuing good physical health but uncooperative in nature (negative or definitely negative, bestowing to Frankel's performance scale) were comprised in the study. The performance rating scale was utilized to assess their performance throughout the therapy (BRS). In addition, the point of tranquility was assessed beforehand. Mann–Whitney U test was utilized to equate male and female points of performance along with gradations of drowsiness. The P value for significance was fixed at 0.05.Results:All participants' performance and point of tranquility in the course of therapy were promising, and therapy was accomplished for everyone. Mann–Whitney U test revealed no statistically significant differences in point of performance, or gradation of drowsiness amid males and females. Pearson's correlation coefficient revealed a strong positive association of therapy time with awakening time.Conclusion:Intravenous propofol deep tranquility in the presence of an anesthesiologist was found to be beneficial in restraining nervous and recalcitrant youngsters in the course of dental therapy.

Propofol Alone versus Propofol in Combination with Midazolam for Sedative Endoscopy in Patients with Paradoxical Reactions to Midazolam.

Background/AimsThe efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxical reactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients who previously experienced paradoxical reactions. MethodsThis was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions to midazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation) or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction. ResultsA total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II (n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did not differ between groups. ConclusionsPropofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam was readministered.

Should lidocaine routinely be used to prevent pain on propofol injection during induction of general anaesthesia or sedation?

Anaesthetists commonly debate whether lidocaine should be added to propofol for anaesthetic induction. The benefits include pain relief and improved patient satisfaction, but disadvantages include the effect on the emulsion itself, the efficacy of propofol once it has been mixed, and the effect on growth of bacteria in the syringe.

Safety and efficacy of propofol alone or in combination with other agents for sedation of patients undergoing colonoscopy: an updated meta-analysis.

The aim of this meta-analysis was to assess the efficacy and safety of propofol sedation for colonoscopy in comparison with traditional sedative agents. We performed a systematic search of PubMed, Embase, Scopus, Web of Science CENTRAL (Cochrane Central Register of Controlled Trials) and Google Scholar databases to identify eligible randomized controlled trials (RCTs) published before November 2019, and compared the effect of traditional sedative agents (TA) with the effect of propofol/propofol combined with TAs for routine colonoscopy. We included 22 eligible trials in our analysis, with a total of 2575 participants. We found strong associations between propofol use and short recovery (SMD MD, -1.15 [-1.55, -0.75], p<0.00001), procedure duration (SMD -0.28 [-0.55, -0.02], p<0.05), discharge times (SMD= -0.71 [-1.06, -0.36], p<0.0001), and sedation scores (SMD 1.29 [0.36, 2.22], p<0.05). Propofol in combination with traditional agents led to a significant decrease in discharge time compared with the discharge times of traditional sedatives alone (SMD=-0.69 [-1.07, -0.31], p<0.0004). The effects of propofol on cecal intubation rates, and occurrences of hypotension and apnea were similar to those of TAs. Our results suggest that propofol can be used as a safe alternative to TAs, and can significantly shorten procedure duration, recovery and discharge times, and improve sedation depth.

Inhibition by general anesthetic propofol of compound action potentials in the frog sciatic nerve and its chemical structure.

Although the intravenous general anesthetic propofol (2,6-diisopropylphenol) has an ability to inhibit nerve conduction, this has not been fully examined. Various agents inhibit compound action potentials (CAPs) in a manner dependent on their chemical structures. To determine propofol's chemical structure that is important in nerve conduction inhibition, we examined the effects of propofol and its related compounds on fast-conducting CAPs recorded from the frog sciatic nerve by using the air-gap method. Propofol concentration-dependently reduced the peak amplitude of the CAP with a half-maximal inhibitory concentration (IC50) value of 0.14mM. A similar inhibition was produced by other phenols, 4-sec-butylphenol and 4-amylphenol (IC50 values: 0.33 and 0.20mM, respectively). IC50 values for these and more phenols (4-isopropylphenol, 4-tert-butylphenol, and 4-ter-amylphenol; data published previously) were correlated with the logarithm of their octanol-water partition coefficients. A phenol having ketone group (raspberry ketone) and alcohols (3-phenyl-1-propanol and 2-phenylethylalcohol) inhibited CAPs less effectively than the above-mentioned phenols. The local anesthetic (LA) benzocaine reduced CAP peak amplitudes with an IC50 of 0.80mM, a value larger than that of propofol. When compared with other LAs, propofol activity was close to those of ropivacaine, levobupivacaine, and pramoxine, while benzocaine activity was similar to those of cocaine and lidocaine. It is concluded that propofol inhibits nerve conduction, possibly owing to isopropyl and hydroxyl groups bound to the benzene ring of propofol and to its lipophilicity; propofol's efficacy is comparable to those of some LAs. These results could serve to develop propofol-related agents exhibiting analgesia when applied topically.

Effect of age factor on sedative efficacy of propofol given by closed-loop infusion in patients undergoing gynecological laparoscopic surgery

Objective To evaluate the effect of age factor on the sedative efficacy of propofol given by closed-loop infusion in patients undergoing gynecological laparoscopic surgery. Methods A total of 100 patients, weighing 55-75 kg, of American Society of Anesthesiologists physical statusⅠor Ⅱ, scheduled for elective gynecological laparoscopic surgery under general anesthesia, were divided into 2 groups (n=50 each) according to age: middle-aged group (45-64 yr) and elderly group (65-75 yr). Propofol was given by closed-loop infusion, and the target plasma concentration was automatically regulated to maintain bispectral index (BIS) value within the target range of 45-55.Remifentanil was given by target-controlled infusion at a target plasma concentration of 2-6 ng/ml to maintain anesthesia, and cisatracurium was injected intermittently to maintain muscle relaxation.The total consumption of propofol and remifentanil, regulating frequency of propofol, time ratio of BIS40-60, global score reflecting performance of closed-loop infusion system, emergence time and extubation time were recorded. Results Compared with middle-aged group, the time ratio of BIS40-60 was significantly increased, global score was decreased, the total consumption of propofol and remifentanil was significantly decreased, the regulating frequency of propofol was increased (P 0.05). Conclusion The sedative efficacy of propofol given by closed-loop infusion is influenced by age factors when used for gynecologic laparoscopic surgery, and the stability in elderly patients is superior to that in middle-aged patients. Key words: Propofol; Drug delivery systems; Age factors; Aged

The safety and efficacy of propofol as a replacement for amobarbital in intracarotid Wada testing of presurgical patients with epilepsy

ObjectiveThe intracarotid sodium amytal procedure (the “Wada test”) has for many years been the gold standard for language and memory lateralization and remains an important part of presurgical analysis for patients with medically intractable seizures. Due to shortages in the key sedative (amobarbital), neuropsychologists have turned to alternatives such as propofol. Our aim was to investigate the safety and efficacy of propofol relative to amobarbital in the Wada test. MethodsWe performed a retrospective review of the 97 Wada procedures performed at University of Iowa Hospitals and Clinics from 2007 through mid-2015. ResultsPropofol produced similar lateralization rates as amobarbital for both language and memory. Similar rates of patients in each group went on to have the resection surgery. With regard to safety, there were no differences found in average rate or severity of adverse effects. None of the demographic characteristics reviewed were predictive of increased risk for either drug. SignificanceThese findings support previous studies indicating that propofol is as safe and efficacious as amobarbital, and can continue to be used in Wada procedures with confidence.

Relationship between UGT1A9 gene polymorphisms, efficacy, and safety of propofol in induced abortions amongst Chinese population: a population-based study.

The present study aimed to investigate the influence of UGT1A9 gene polymorphisms on the efficacy of propofol in patients undergoing the painless induced abortion method. A total of 156 women seeking voluntary pregnancy termination procedures were selected for the study, and subsequently underwent painless induced abortions, following anesthesia by means of propofol administration. PCR-restriction fragment length polymorphism (PCR-RFLP) was performed to detect the polymorphisms of UGT1A9 gene at –440C/T, –1818C/T, and –1887T/G loci. The time, effect-site concentration, and bispectral index (BIS) for the Observer’s Assessment of Alertness/Sedation (OAA/S) (up to 4 points) were observed and recorded in patients following discontinuation of propofol. The time and effect-site concentration for BIS reaching 80 in patients following the discontinuation of propofol were observed and recorded. Postoperative observations of adverse reactions, such as nausea, vomiting, and respiratory depression were all made record of. In comparison with patients with UGT1A9 –440C/T CT and TT, those with UGT1A9 –440C/T CC displayed shorter durations of OAA/S by up to 4 points, shorter BIS times reaching 80, as well as higher corresponding effect-site concentrations. No significant differences were detected in the patients with –440C/T, –1818T/C, and –1887T/G in incidence of nausea, vomiting, and respiratory depression. The findings of the study highlighted correlation between UGT1A9 –440C/T gene polymorphisms and positive propofol efficacy in patients undergoing painless induced pregnancy termination procedures.

Comparison of efficacy of propofol given by closed-loop infusion for surgery in pediatric patients of different ages

Objective To compare the efficacy of closed-loop infusion of propofol for surgery in pediatric patients of different ages. Methods Forty-five pediatric patients of both sexes, weighing 10-63 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective urologic surgery under general anesthesia, were divided into 3 groups (n=15 each) according to the age: infant group (1-3 yr), pre-school group (4-6 yr) and school-age group (7-12 yr). The bispectral index (BIS) monitor was connected to the closed-loop anesthesia delivery system, and the system automatically regulated the target plasma concentration of propofol to achieve a target BIS value of 45-55 during maintenance of anesthesia.Remifentanil was given by target-controlled infusion at a target plasma concentration and rocuronium was intravenously injected when necessary during surgery.BIS40-60 time percentage (percentage of time of BIS value maintaining at 40-60 in time of closed-loop infusion), median performance error (MDPE), median absolute performance error (MDAPE), wobble and global score were recorded.The consumption of propofol, mean target plasma concentration and regulating frequency and consumption of remifentanil and rocuronium were recorded during surgery.Extubation time or laryngeal mask airway removal time, time to eye-opening and time of regaining consciousness were recorded. Results The BIS40-60 time percentage was significantly higher, MDPE, MDAPE, wobble and global score were lower in pre-school and school-age groups than in infant group (P 0.05). There was no significant difference in the consumption of propofol, mean target plasma concentration, regulating frequency, consumption of rocuronium, extubation time or laryngeal mask airway removal time, time to eye-opening or time of regaining consciousness among the 3 groups (P>0.05). Conclusion Closed-loop infusion of propofol produces better stability for surgery in pre-school and school-age children than in infants. Key words: Propofol; Drug dilivery systems; Child

Safety of Propofol in Cirrhotic Patients Undergoing Upper Endoscopy (EGD): A Systematic Review and Meta-Analysis

Introduction: EGD is recommended for patients with cirrhosis for screening and surveillance of varices. Underlying encephalopathy and decreased liver clearance may cause cardiopulmonary adverse events and worsening of hepatic encephalopathy in cirrhotic patients undergoing procedural sedation. With increasing use of Propofol for endoscopic procedures, it is important to assess its safety in these patients. Our aim was to examine available studies to derive pooled rates for the safety and efficacy of Propofol in cirrhotic patients undergoing EGD. Methods: Electronic database search was conducted in Medline, Embase, Cochrane for eligible studies that compared safety profile of Propofol between cirrhotics and controls (no cirrhosis). Following outcomes were examined to evaluate the safety profile of propofol: cardiopulmonary adverse events, procedure time, time to recovery, dosage, and number connection test (NCT) to assess cognitive impairment. Pooled rates of variables were reported as Odds ratio (OR) with 95% confidence interval and heterogeneity was reported as I2 statistics. Results: A total of 7 studies were found eligible and analysis with a total of 723 patients. (cirrhosis: 509 and control: 215). Rate of adverse events related to cardiopulmonary system were numerically higher in patients with cirrhosis (15.5% vs 12.09%), however, this was not statistically significant (pooled OR 1.06, 95% CI: 0.65-1.74, p 0.44). There was no significant difference in procedure time in cirrhotics compared to controls (mean weighted difference 1.76 minutes, 95% CI -1.81 to 5.34, p 0.33). Mean NCT score before and after procedure in the cirrhosis group was 82.93 seconds and 76.66 seconds, respectively (p=0.003). Weighted mean difference in NCT scores between the cirrhotic and control group before and after procedure was 49.27 seconds and 43.68 seconds, respectively suggesting no significant change in NCT scores in patients with cirrhosis. Mean dosage of Propofol in cirrhotics compared to controls was 99.26mg to 100.28mg (p=0.97). There was no significant difference in recovery time between two groups (mean weighted difference 0.10 minutes, 95% CI: -0.91 to 1.12, p 0.84). Conclusion: This meta-analysis suggests that Propofol does not adversely affect cognitive scores or recovery time in cirrhosis compared to controls when used for EGD. The cardiopulmonary side effects were also similar in both groups. Therefore propofol can be used safely for procedural sedation in patients with cirrhosis undergoing EGD.Figure: CARDIOPULMONARY COMPLICATIONS.Figure: RECOVERY TIME.Figure: PROCEDURE TIME.

Sites and Functional Consequence of Alkylphenol Anesthetic Binding to Kv1.2 Channels.

Inhalational general anesthetics, such as sevoflurane and isoflurane, modulate a subset of brain Kv1 potassium channels. However, the Kv1.2 channel is resistant to propofol, a commonly used intravenous alkylphenol anesthetic. We hypothesize that propofol binds to a presumed pocket involving the channel's S4-S5 linker, but functional transduction is poor and, therefore, propofol efficacy is low. To test this hypothesis, we used a photoactive propofol analog (meta-aziPropofol = AziPm) to directly probe binding and electrophysiological and mutational analyses in Xenopus oocytes to probe function. We find that AziPm photolabels L321 in the S4-S5 linker of both the wild-type Kv1.2 and a mutant Kv1.2 (G329T) with a novel gating phenotype. Furthermore, whereas propofol does not significantly modulate Kv1.2 WT but robustly potentiates Kv1.2 G329T, AziPm inhibits Kv1.2 WT and also potentiates Kv1.2 G329T. Kv1.2 modulation by AziPm was abolished by two mutations that decreased hydrophobicity at L321 (L321A and L321F), confirming the specific significance of the S4-S5 linker in the mechanism of general anesthetic modulation. Since AziPm binds to Kv1.2 G329T and shares the propofol ability to potentiate this mutant, the parent propofol likely also binds to the Kv1.2 channel. However, binding and alkylphenol-induced transduction are seemingly sensitive to the conformation of the S4-S5 linker site (altered by G329T) and subtle differences in the chemical structures of propofol and AziPm. Overall, the results are consistent with a mechanism of general anesthetic modulation that depends on the complementarity of necessary ligand binding and permissive ion channel conformations that dictate modulation and efficacy.