Can liver cirrhosis patients benefit from target controlled infusion of propofol for conscious sedation during endoscopic variceal ligation?


  • Jun-Xiang Li Department of Anesthesiology, Pidu District People’s Hospital, Chengdu, Sichuan Province, China
  • Jun-Chao Wu Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
  • Wei-Wei Lin Department of Anesthesiology, Pidu District People’s Hospital, Chengdu, Sichuan Province, China
  • Xiao Wang Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China



Endoscopic variceal ligation, Propofol, Sedation, Target controlled infusion


Background: The aim of the present study was to evaluate the feasibility of conscious sedation using target controlled infusion of propofol combined with a single dose of fentanyl during endoscopic variceal ligation in patients with liver cirrhosis.

Methods: Forty-eight patients with liver cirrhosis scheduled for endoscopic variceal ligation were randomly assigned to deep sedation group (DS group) with intravenous bolus of propofol and conscious sedation group (CS group) with target controlled infusion of propofol, 1 μg/kg fentanyl was intravenously injected in each patient before administration of propofol. Cardiorespiratory parameters were monitored, and the side-effects were recorded. The depth of sedation was assessed by both of the sale of observer′s assessment of alertness/sedation (OAA/S) and the bispectral index (BIS). The quality of sedation/analgesia was evaluated by the endoscopist and patients using Visual Analog Scores (VAS). The recovery level was evaluated with the Aldrete scales.

Results: No significant differences were found on demographic data and initial parameters in the two groups. Compared with the CS group, the changes of mean arterial pressure (MAP) and heart rate (HR) and the signs of respiratory depression were significant in the DS group (p<0.05). The recovery time in DS group (16.7±2.7 minutes) was much longer than that in the CS group (9.3±3.0 minutes, p<0.01). There was no difference in Visual Analogue Scale scores for endoscopist’s satisfaction between the two groups (9.2±0.6 versus 9.0±0.6, p>0.05), but a higher degree of satisfaction for patient was found in the DS group (9.3±0.6 versus 7.9±0.7, p<0.01).

Conclusions: Conscious sedation with target controlled infusion of propofol combined with a single bolus of fentanyl for endoscopic variceal ligation in patients with liver cirrhosis had better hemodynamic stability, less respiratory depression and shorter recovery time.


Terblanche J, Stiegmann GV, Krige JEJ, Bornman PC. Management of esophageal varices. Lancet. 1994;343:1079-84.

Terblanche J, Krige JEJ, Bornman PC. Endoscopic Sclerotherapy. Surg Clin N Am. 1990;70:341-59.

Stiegmann GV, Cambre T, Sun JH. A new endoscopic elastic band ligating device. Gastrointest Endosc. 1986;32:230-3.

Shaoul R, Higaze H, Lavy A. Evaluation of topical pharyngeal anaesthesia by benzocaine lozenge for upper endoscopy. Aliment Pharmacol Ther. 2006;24:687-94.

Assy N, Rosser BG, Grahame GR, Minuk GY. Risk of sedation for upper GI endoscopy exacerbating subclinical encephalopathy in patients with cirrhosis. Gastrointest Endosc.1999;49:690-4.

Vasudevan AE, Goh KL, Bulgliba AM. Impairment of psychomotor responses after conscious sedation in cirrhotic patients undergoing therapeutic upper GI endoscopic. Am J Gastroenterol. 2002;97:1717-21.

Friedrich K, Stremmel W, Sieg A. Endoscopist-administered propofol sedation is safe: a prospective evaluation of 10,000 patients in outpatient practice. J Gastrointestin Liver Dis 2012;21(3):259-63.

Robertson DJ, Jacobs DP, Mackenzie TA, Oringer JA, Rothstein RI. Clinical trial: a randomized, study comparing meperidine (pethidine) and fentanyl in adult gastrointestinal endoscopy. Aliment Pharmacol Ther. 2009;29:817-23.

Yoo YC, Park CH, Shin S, Park Y, Lee SK, Min KT. A comparison of sedation protocols for gastric endoscopic submucosal dissection: moderate sedation with analgesic supplementation versus analgesia targeted light sedation. Br J Anaesthesia. 2015;115(1):84-8.

Blouin RT, Seifert HA, Babenco HD, Conard PF, Gross JB. Propofol depresses the hypoxic ventilatory response during conscious sedation and isohypercapnia. Anesthesiol. 1993;79:1177-82.

Gray JM, Kenny GN. Development of the technology for ‘Diprifusor’ TCI systems. Anaesthesia. 1998;53(1):22-7.

Church JA, Stanton PD, Kenny GN, Anderson JR. Propofol for sedation during endoscopy: Assessment of a computer-controlled infusion system. Gastrointest Endosc. 1991;37:175-79.

Agrawal A, Sharma BC, Sharma P, Uppal R, Sarin SK. Randomized controlled trial for endoscopy with propofol versus midazolam on psychometric tests and critical flicker frequency in people with cirrhosis. J Gastroenterol Hepatol. 2012;27:1726-32.

Cavaliere F, Conti G, Moscato U, Meo F, Pennisi MA, Coata R et al. Hypoalbuminaemia does not impair Diprifusor performance during sedation with propofol. Br J anaesth. 2005;94:453-8.

Upton RN, Ludrook GI, Grant C, Martinez AM. Cardiac output is a determinant of the initial concentration of propofol after short-infusion administration. Anesth Analg. 1999;89:545-52.

Johnson KB, Egan TD, Layman J, Kern SE, White JL, Mcjames SW. The influence of hemorrhagic shock on propofol: a pharmacokinetic and pharmacodynamic analysis. Anesthesiol. 2003;99:409-20.

Sorbi D, Gostout CJ, Peura D. An assessment of the management of acute bleeding varices: a multicentre prospective member-based study. Am J Gastroenterol. 2003;98:2424-34.

Yacavone RF, Locke III GR, Gostou CJ, Rockwood TH, Thieling S, Zinsmeister AR. Factors influencing patient satisfaction with GI endoscopy. Gastrointest Endosc. 2001;53:703-10.

Pena LR, Marini H, Nicki NJ. Develop of an instrument to assess and predict satisfaction and poor tolerance among patients undergoing endoscopic procedures. Dig Dis Sci. 2005;50:1860-71.

Barakat AR, Sutcliffe N, Schwab M. Effect site concentration during propofol TCI sedation: a comparison of sedation score with two pharmacokinetic models. Anaesthesia. 2007;62:661-6.

Han TH, Lee JH, Kwak IS, Kil HY, Han KW, Kim KM. The relationship between bispectral index and targeted propofol concentration is biphasic in patients with major burns. Acta Anaesthesiol Scand. 2005;49:85-91.






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