Background and study aim: Patients with hepatic impairment are at higher risk for sedation complications. The aim of this study is to determine the impact of propofol in comparison to midazolam on the occurrence of sub-clinical hepatic encephalopathy in liver cirrhotic patients undergoing upper gastrointestinal endoscopy (UGE).
Patients and Methods: ‎‎‎ The study population involved 70 patients. Group A included 10 non-hepatic patients who underwent UGE without sedation. Group B included 30 patients with CLD received midazolam.  Group C included 30 patients with CLD received propofol. The level of encephalopathy was determined by number connection test (NCT).‎
Results: In group B there was mild decrease in systolic blood pressure during and after than before UGE with compensatory tachycardia. Also, there was some decrease in oxygen saturation during UGE (>90%) which resolved after oxygen flow. Patients of group C showed decrease in systolic blood pressure at onset of injection of propofol with mild tachycardia. There was mild decrease in oxygen saturation during procedure more significant than what happened in midazolam group with no need for intubation. Regarding NCT one hour after and delta change of NCT, they showed significant increase in group B versus group C. Times of procedure and recovery were significantly prolonged in group B in comparison to group C‎.
Conclusion: Midazolam exacerbates sub-clinical encephalopathy. The hypotension and tachycardia during the procedure were more significant in midazolam group than propofol group. Subjects receiving propofol showed shorter induction, time of procedure and recovery periods ‎‎.