Safety profile and patient satisfaction of the routine use of propofol in gastrointestinal endoscopy.

BACKGROUD: Routine use of sedation in upper gastrointestinal endoscopy is uncommon in Nepal. There is no study on use of propofol sedation in routine endoscopy examination in Nepal. This study was conducted in order to assess the patient satisfaction and safety profile in patient undergoing routine upper GI endoscopic examination on outpatients. OBJECTIVE: To study safety profile and patient satisfaction of use of propofol in patients undergoing upper GI endoscopy. METHOD: A prospective, observational study was conducted in the endoscopy unit of Dhulikhel hospital, Kathmandu University Hospital from July 2011 to 2012 July. Patients who were referred to upper GI endoscopy were offered to sedation under propofol. Informed consent was taken after explaining side effects, advantages and risk-benefit to the clients. The propofol was administered by the endoscopy nurse under guidance and supervision of the endoscopy performing physician. Data were collected and analyzed using SPSS version 16.0 with 0.05 level of significance. RESULT: Total of 203 patients included in the study. Among 203 patients, 21.2% were males and 78.8% were females; 83.7% were of less than of 60 years age and 16.3% above 60 years of age. The mean total dose of propofol required was 136.08 ± 48.82 mg. Total of 29.1 % of cases required O2 administration during the procedure time due to transient drop in O2 saturation. Total of 4.4% of cases required fluid administration due to transient fall in blood pressure. Total of 68.0% of cases were completely sedated; 28.6% had minor restless and 3.4% showed agitation during induction period of propofol sedation. Total of 99.5% of patients reported pleasant experience while 0.5% reported unpleasant. Among 203 respondents, 98.5% responded they would prefer to do the procedure under propofol sedation in the future; 1.5% responded they did not want sedations in the future. CONCLUSION: Upper GI endoscopy can safely be performed under propofol sedation administered by registered trained nurse under the supervision of endoscopist.

The ratio of aspartate aminotransferase to alanine aminotransferase (AST/ALT): the correlation of value with underlying severity of alcoholic liver disease.

BACKGROUND: Alcoholic liver disease is one of the most frequently diagnosed liver problems in the hospitalized patients in most tertiary care hospitals all over the world .The diagnosis of alcoholic liver disease is most of the time clinical. The AST/ALT ratio is a useful and reliable biochemical marker of liver injury due to alcohol. Whether the value of AST/ALT ratio correlates with clinical severity has not been studied. OBJECTIVES: To study values of AST/ALT ratio in correlation with clinical severity of illness due to alcoholic liver disease using Child-Pugh's grading. METHODS: This is a retrospective study. Inpatient records of all the patients admitted with diagnosis of alcoholic liver disease from July 2009 to 2011 June were analyzed. Data from 174 patients with the diagnosis of alcoholic liver disease-alcoholic hepatitis or alcoholic cirrhosis were retrieved; out of 174 patients, 138 were eligible for the study. The AST/ALT ratio and Child's grading of all the patients were calculated from the documented biochemical and clinical parameters on admission. Demographic profiles of all the patients were also recorded and analyzed. The data was analyzed using software SPPSS 16 version. RESULTS: A total of 138 patients diagnosed as alcoholic liver disease since July 2009 to June 2011 were analyzed. The male-female ratio was found to be 5.34: 1.The mean age of the patients at diagnosis was found to be 47.58 ± 12.83 years. Among 138 patients, Mongolians were found to have the highest prevalence of alcoholic liver disease (38.8%), followed by Newars ( 33.6%), Brahmin and Chhetri (19.1%) and Dalit (7.2%). With respect to AST/ALT ratio and Child's grading of ALD, the mean AST/ALT ratio was found to be 3.03 ± 2.24 in those patients who had Chlild's grade C; likewise the mean AST/ALT ratio was 2.28 ± 1.14, and 1.68 ± 0.83 in patients with Child B and Child A respectively. CONCLUSION: The higher value of AST/ALT ratio is indicative of more severe liver damage due to alcohol.