General Anesthesia in Patients with Hepatic Encephalopathy and Acute Variceal Bleeding Undergoing Endoscopic Treatment: A Retrospective Study

Abstract

Abstract Background: The management of cirrhotic patient with encephalopathy and acute variceal bleeding（AVB） remains a clinical challenge with a high mortality. Early endoscopic therapies are frequently applied in patients with AVB. However, the application of general anesthesia in endoscopic surgery for patients with hepatic encephalopathy (HE) is pretty challenging. The present study aimed to evaluate the possible effect of general anesthesia with tracheal intubation on patient complicated with encephalopathy and AVB during endoscopic procedure. Methods: Thirty-six cirrhotic patients with encephalopathy and AVB were retrospectively studied, 14 patients underwent endoscopic treatment under general anesthesia with tracheal intubation, and 22 patients received pharmacological treatment, or and endoscopic therapy without general anesthesia served as control group. Routine clinical and laboratory data were collected. Results: The total mortality rate was 13.9% (5/36), 2(14.3%) in anesthesia group, 3 (13.6%) in control group. The child-Pugh class of death cases were all grade C，3 (60%) of them were in the stage IV of HE. The stage of HE was all improved in the two groups, 12 (85.8 %) patients were totally recovered from consciousness disturbance in anesthesia group and 16 (72.7 %) in control group respectively, the difference between the two groups was not significant (P＞0.05). Except the death cases, there were still 3 patients in control group had impaired consciousness at discharge. Child-Pugh score, Child-Pugh class and the stage of HE in anesthesia group were significantly improved at discharge compared with those before operation. Conclusions: General anesthesia does not aggravate the severity of encephalopathy, and endoscopic treatment under general anesthesia with tracheal intubation is effective for HE patients complicated with AVB.