In cirrhotic patients having suspected portal hypertension, sedation with propofol infusion during  hepatic venous pressure gradient (HVPG) estimations is generally safe. But, it may cause significant alterations of HVPG readings, says a prospective observational cohort study published in Hepatology International.

Fahim Ebrahimi et al. undertook this study to explore the hemodynamic effects of propofol, a standard intravenous sedative drug, on HVPG measures in 37 cirrhotic adults with suspected portal hypertension and undergoing invasive estimation of HVPG. HVPG estimations were done in awake conditions as well as under sedation with an infusion of propofol.

The major endpoint was diagnostic accuracy of HVPG estimations with and without propofol sedation while diagnostic accuracy after error adjustment was the secondary endpoint. The mean HVPG in awake condition and during sedation is shown in Table 1:

While the estimates of free hepatic vein pressure did not alter following propofol infusion, the wedged hepatic vein pressure values dropped in an average by 2.05 mmHg that was proportional to HVPG magnitude. In 83.8% (31/37) of people, portal hypertension with HVPG ≥ 12 mmHg was noted. Under sedation with propofol infusion, 2 participants (5.4%) with borderline values might have been inaccurately classified as < 12 mmHg.

After adjusting for average difference of 10%, an accurate classification of study participants was done. The intraclass correlation coefficient between HVPG estimations in awake conditions and under propofol sedation was 0.927. Thus, sedation with propofol affects HVPG readings that might have substantial implications on clinical decision-making, particularly in cases with borderline values.