GI Endoscopy Sedation in Patients with Cirrhosis: Routine or Unpredictable?

Excerpt

Sedating patients with cirrhosis undergoing gastrointestinal (GI) endoscopy procedures poses unique challenges. While the derangement of synthetic and metabolic functions of the liver affects the pharmacokinetics of the sedative medications, the degree of encephalopathy can influence the pharmacodynamic properties of these drugs. Moreover, since the severity of ascites can compromise respiration, drainage is occasionally needed before the procedure. An increased frequency of abnormal gastroesophageal reflux in patients with cirrhosis is a possible effect of esophageal dysmotility. Impairment of gastric emptying and accommodation results in early satiety [1]. As a result of gastroparesis, patients with cirrhosis experience symptoms such as postprandial abdominal pain, nausea, and vomiting [2]. Cardiac afterload is reduced due to a fall in the peripheral vascular resistance. …