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Year : 2022  |  Volume : 2  |  Issue : 4  |  Page : 156-159

Prefer to avoid sedatives in patients with acute hepatotoxicity due to rodenticide ingestion: Knowledge, attitude, and practice survey of doctors from Tamil Nadu

1 Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India
2 Centre for Biostatistics and Evidence-Based Medicine, Vellore, Tamil Nadu, India
3 Department of Gastroenterology, Apollo Hospitals; The Secretary, The Tamil Nadu Chapter of Indian Society of Gastroenterology, Chennai, Tamil Nadu, India

Correspondence Address:
Ashish Goel
Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ghep.ghep_25_22

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Background and Aim: While sedative drugs are not hepatotoxic, the use of sedative drugs in patients with acute liver dysfunction may lead to unrecognized sedative overdose, or trigger or aggravate encephalopathy. This study hopes to draw more attention to the need to correctly interpret and use the expert guidelines in this regard. The aim of this study was to assess the knowledge, attitude, and practice of doctors regarding sedative use in patients with acute liver dysfunction secondary to rodenticide poisoning in Tamil Nadu. Subjects and Methods: This was a cross-sectional online survey carried out between December 2021 and May 2022 among doctors in Tamil Nadu involved in the care of patients with rodenticide poisoning regarding sedative use in patients with rodenticidal hepatotoxicity. Results: Responses were obtained from 168 doctors (including 86 gastroenterologists): ([152, 90.5%] from doctors in the government sector and [16, 9.5%] from private sector). Most (96, 57.1%) respondents had managed >10 patients of rodenticide poisoning in a year. Most doctors opined that the patients they cared for did not have access to urgent liver transplantation. One hundred and fifty-one (89.9%) doctors opined that sedative use could depress sensorium further and lead to unfavorable outcomes in these patients. About 79 (47%) patients would avoid using a sedative, if possible, in patients with acute liver dysfunction. They felt the indications for sedative use were to avoid fluctuations in raised intracranial pressure (134, 79.8%) and to facilitate invasive procedures (129, 76.8%) such as endotracheal intubation. When sedative was needed, 10 doctors (6%) favored the use of a reduced dose of sedative. Conclusions: In a resource-constrained setting, where emergency liver transplantation is not easily accessible, doctors prefer to avoid sedatives in patients with rodenticidal hepatotoxicity. Increased awareness of the need to avoid sedatives or restrict the use of sedatives may improve survival in these patients.

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