Trial Comparing Sedation for Endoscopy With Propofol Versus Midazolam in Cirrhotics
Trial Comparing Sedation for Endoscopy With Propofol Versus Midazolam in Cirrhotics
To compare effects of sedation for upper gastrointestinal endoscopy with propofol and
 midazolam on psychometric tests and critical flicker frequency (CFF) in cirrhotics
Upper GI Endoscopy is routinely performed in patients with chronic liver disease to screen
 for complications related to portal hypertension such as esophageal and gastric varices and
 portal gastropathy. Sedation is frequently administered to facilitate patient
 tolerance.Patients with hepatic dysfunction who undergo endoscopy are at increased risk for
 complications related to sedation.Propofol has a favorable pharmacokinetic profile in
 comparison with benzodiazepines and opioids, which makes it especially appropriate for
 sedation in endoscopy.In previous studies cognitive functions were assessed by various paper
 and pencil tests. However learning affects the paper and pencil tests if repeated at short
 interval of time.CFF analysis was found to be sensitive and objective in the quantification
 of low-grade HE, and there is a significant correlation between CFF and the portosystemic
 encephalopathy syndrome (PHES) battery.Considering this, we designed a prospective randomized
 controlled study with cirrhotic outpatients to compare effects of sedation for upper
 gastrointestinal endoscopy with propofol versus midazolam on psychometric tests and critical
 flicker frequency in cirrhotics
Inclusion Criteria:

 -  Known chronic liver disease (Child-Pugh class A , B or C ) who presented for upper GI
 endoscopy for routine variceal screening.

 -  The diagnosis of liver disease will be based on available past history, serological
 testing, radiological imaging, and liver histology when available.

 -  Staging of cirrhosis will be determined by MELD score and by Child-Pugh score . All
 patients will complete a standard preprocedure history and physical examination to
 establish current degree of encephalopathy and ascites.

 Exclusion Criteria:

 -  Active GI bleeding

 -  Overt encephalopathy

 -  Active alcohol intake during the past 6 weeks

 -  Significant co morbid illness such as heart, respiratory, or renal failure and any
 neurologic diseases such as alzheimer's disease, parkinson's disease and nonhepatic
 metabolic encephalopathies.

 -  Patients with known allergy to sedative

 -  hepatocellular carcinoma

 -  Previous TIPS or shunt surgery,

 -  Patients on psychoactive drugs, such as antidepressants or sedatives

 -  Patients with an American Society of Anesthesiology (ASA) physical status of class IV
 or V

 -  Patients with visual or mental impairment who will unable to complete the psychometric
 testing or CFF