31Oct 2014

Evaluation of Different Sedative Approaches for Cirrhotic Patients during Upper Gastrointestinal Endoscopy

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Background: Sedation and analgesia comprise important elements during endoscopic examinations to sedate and achieve the comfort of patients but patients with liver cirrhosis could be at increased risk to develop complications which are related to sedation as most sedative drugs are metabolized by the liver. Aim of the work: The aim of the present study is to evaluate different sedative approaches for cirrhotic patients during upper gastrointestinal endoscopy (UGIE). Patients and methods: This study was carried out on 99 patients with liver cirrhosis referred for diagnostic and / or therapeutic UGIE. They were divided equally according to the scheduled pre-endoscopic sedation into three groups: Midazolam plus Fentanyl group, Propofol plus Fentanyl group and Ketamine group. All patients were subjected to detailed history taking, thorough physical examination, routine laboratory investigations, abdominal ultrasound and ECG, with monitoring of mean arterial blood pressure (MAP), heart rate and oxygen saturation (before, during and after endoscopy) to assess safety, efficacy and recovery time of the used sedative drugs. Results: Our results revealed that there was no statistically significant difference between the studied groups regarding age, weight, sex and Child-Pugh score distribution. Considering MAP and heart rate; there was a high statistically significant difference between Ketamine group and the other two groups during and after the procedure (P< 0.001). Efficacy of propofol plus fentanyl sedation was 100 % followed by midazolam plus fentanyl group and Ketamine group (efficacy was 97 % and 91 % respectively). Propofol plus fentanyl group had the shortest recovery time (11.4±2.6 minutes) followed by midazolam plus fentanyl group (23.8±5.6 minutes) and Ketamine group (31.3±6.0 minutes). Conclusion: Sedation with propofol plus fentanyl for patients with liver cirrhosis undergoing UGIE was safer, more efficacious with better comfort for patients as well as endoscopists and had shorter recovery time with early discharge than midazolam plus fentanyl and Ketamine sedation.

[Waseem M. Seleem, M.Semary, Khadeja M. El Hossieny and Ashraf Metwally (2014); Evaluation of Different Sedative Approaches for Cirrhotic Patients during Upper Gastrointestinal Endoscopy Int. J. of Adv. Res. 2 (10). 0] (ISSN 2320-5407). www.journalijar.com

Waseem M. Seleem

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