Impairment of psychomotor responses after conscious sedation in cirrhotic patients undergoing therapeutic upper GI endoscopy

Vasudevan, A.E.; Goh, K.L.; Bulgiba, A.M. (2002) Impairment of psychomotor responses after conscious sedation in cirrhotic patients undergoing therapeutic upper GI endoscopy. American Journal of Gastroenterology, 97 (7). pp. 1717-1721. ISSN 0002-9270

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    Abstract

    OBJECTIVES: The aim of this study was to determine whether the number connection test (NCT) times of a group of cirrhotic patients without clinically overt hepatic encephalopathy and a group of healthy patients without liver disease who were undergoing endoscopy were prolonged after sedation with short acting i.v. benzodiazepines. METHODS: All patients were administered the NCT in a standard fashion for 30 min before sedation for an upper GI endoscopy and then 2 h after sedation postprocedure. Two NCTs were carried out before and 2 h after sedation, and the mean of the tests pre- and postsedation calculated. Based on the upper limit of the 95 CI of the presedation NCT of patients without liver disease as the cut-off level for hepatic encephalopathy, the proportion of cirrhotic patients with subclinical encephalopathy before and after sedation were also deter-mined. RESULTS: A total of 61 consecutive cirrhotic patients who underwent therapeutic upper GI endoscopy completed the study. The mean presedation NCT time was 43.5 s (95 CI = 39.0-48.1 s) and the mean postsedation NCT time 60.0 s (95 CI = 50.7-69.3 s). The difference between the mean pre- and postsedation NCT times was 16.4 s (95 Cl = 9.8-23.1 s; p < 0.001). A total of 38 consecutive patients without clinical or biochemical evidence of liver disease who presented for upper GI endoscopy completed the NCT as described for the group of cirrhotic patients. The mean (+/- SD) baseline NCT time was 34.7 +/- 7.9 s (95 CI = 32.1-37.2 s), whereas the mean postsedation NCT time was 33.7 +/- 8.5 s (95 CI = 30.9-36.5 s). This difference was not statistically significant (p = 0.177). Using the upper limit of the 95 Cl of the mean (37.4 s) of the presedation time in the patients without liver disease as the cut-off between normal and encephalopathy, the number of cirrhotic patients with abnormal presedation NCT times was 33 patients (54.1), and this number rose to 46 patients (75.4) after sedation with midazolam. This increase in proportion of cirrhotic patients with prolonged NCT time was statistically significant (p < 0.001). CONCLUSIONS: Sedation with i.v. midazolam prolongs NCT times in cirrhotic patients but not in healthy individuals without liver disease. The proportion of patients with prolonged NCT times increased in patients with cirrhosis following sedation, whereas this did not occur in those without liver disease.

    Item Type: Article
    Creators:
    1. Vasudevan, A.E.
    2. Goh, K.L.
    3. Bulgiba, A.M.(Department of Social and Preventive Medicine, Faculty of Medicine Building, University of Malaya, 50603 Kuala Lumpur, MALAYSIA)
    Journal or Publication Title: American Journal of Gastroenterology
    Additional Information: Vasudevan, AE Goh, KL Bulgiba, AM
    Uncontrolled Keywords: Gastroenterology
    Subjects: R Medicine
    Divisions: Faculty of Medicine
    Depositing User: Awang Bulgiba Awang Mahmud
    Date Deposited: 03 May 2012 10:02
    Last Modified: 03 May 2012 10:02
    URI: http://eprints.um.edu.my/id/eprint/3093

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