Assessment of Psychomotor Response after Sedation in Hepatic Patients Undergoing Upper Gastrointestinal Tract Endoscopy: Midazolam Versus Propofol

Introduction: Patients with hepatic impairment are frequently referred for endoscopic procedures. These patients can be a challenging problem in terms of procedural sedation, by virtue of altered pharmacokinetics in particular, the cerebral sensitivity to sedative drugs may be increased.Aim. of the Study: Compare the safety of sedation with either Midazolam or Propofol in cirrhotic patients without clinically overt hepatic encephalopathy undergoing upper GIT endoscopy to determine whether the number connection test (NCT) time was prolonged postsedation.Methods: Prospective double blind randomized control study using either midazolam (Group M: n=40, 0.03 mg/kg body weight) or propofol (Group P. n=40, initial dose of 0.50 mg/kg, followed by 10 mg/minute) for sedation of cirrhotic patients (Child-Pugh grade A or B) undergoing upper GIT endoscopy. Following explanation, the patients were asked to perform the Number Connection Test (NCT) as quickly as possible, one hour before sedation (NCT1) and two hours after sedation (NCT2), the completion time (in seconds) of the test was recorded.Results: In group-M, the difference between mean pre- and postsedation NCT times was significant, where p value was 0.01 and 95% CI= 1.73-12.16. In group-P, the difference between mean NCT1 and NCT2 was insignificant (p-value = 0.06 and 95% CI= 1.95-5.11). In comparison between group- M and group-P, the difference between mean postsedation NCTs in both groups showed significant difference where p value = 0.00 and 95% CI= 3.53-9.46.Conclusion: Sedation with i.v. midazolam diminished level of psychomotor response in cirrhotic patients, as reflected by significantly increases the time to complete the NCTS and this effect was not seen with propofol.