Dose efetiva de sedação em ecocardiograma transesofágico: relação com idade, área de superfície e função do ventrículo esquerdo

Abstract

Background: Sedation with midazolam and meperidine is widely used in transesophageal echocardiography. However, no mean dose is established for each individual case.Objective: To correlate the mean midazolam and meperidine doses for proper sedation for transesophageal echocardiography with age range, body surface area, and left ventricular ejection fraction.Methods: Retrospective study comprising 1,841 patients undergoing sedation based on the Ramsay scale, with a solution containing midazolam 1.5 mg (1.5 ml), meperidine 1 mg (1 ml) and distilled water (7.5 ml). Four age groups were analyzed: G1: ≤ 24 years; G2: 25 to 44 years; G3: 45 to 64 years; and G4: ≥ 65 years. Body surface area was calculated using the formula {[(height x 100) 0.725 ] x (weight 0.425 ) x 0.0071}. As regards the left ventricular ejection fraction, two groups were studied: GA: < 55%; and GB: ≥ 55%. The statistical analysis was carried out using the Kruskal-Wallis test for the correlation with age and left ventricular ejection fraction, and simple linear correlation for body surface area.Results: As regards age, the mean doses of sedation required were significantly lower in G3 and G4 (p<0.01). The analysis of left ventricular ejection fraction showed that this was significantly lower in GA (p<0.01). The linear correlation coefficient between dose of sedation and body surface area was 0.09 (null). Conclusion Effective Dose of Sedation in Transesophageal EchocardiographyRelation to Age, Body Surface Area and Left Ventricle FunctionGuilherme Moreira José, Carlos Eduardo Suaide Silva, Luiz Darcy Cortez Ferreira, Yara Prosdossini Soares de Novaes, Claudia Gianini Monaco, Manuel Adán Gil, Renata Rejane Linhares, Marcelo Sgrott Rodrigues, Antônio S. S. de Moraes, Juarez Ortiz. OMNI-CCNI Medicina Diagnóstica de São Paulo, São Paulo, SP -Brazil IntroductionTransesophageal echocardiography is performed via esophageal intubation, using a probe with one or more transducers at its tip. An approximately 5-hour fast is required for all patients undergoing the procedure whether using anesthesia or sedation 1 .The use of a local anesthetic agent (lidocaine hydrochloride 10% spray) and peripheral venipuncture are also recommended; usually, sedatives and analgesic agents are preferably administered intravenously 1 . The tolerance to the procedure, which is almost always uncomfortable, is increased with the use of sedation and analgesia by blocking the response to stress (quite useful in patients with heart diseases), and by reducing the laryngeal activity (very useful in patients with asthma, chronic bronchitis and heart diseases), discomfort and pain. It is also very useful for excessively anxious patients and those with neurological diseases or psychiatric disorders who are unable to cooperate. It can also be performed as per patient . Today, the drugs most frequently used for sedation in transesophageal echocardiography are the benzodiazepines (diazepam and midazolam), and for analgesia, the opioids (meperidine and fentanyl) and propofo...

The efficacy and safety of conscious sedation applied with midazolam in the transesophageal echocardiography procedure

“…Transesophageal echocardiography (TEE) is a relatively invasive examination procedure that is used in the diagnosis and treatment of several cardiac diseases. In addition to the local anaesthesia applied to the oropharyngeal region, a sedative anaesthesia is preferred for the elimination of patient anxiety during the procedure, to allow the TEE probe to pass to the oropharyngeal region, to reduce pain, increase the success of procedure, and provide retrograde amnesia (1,2). The decision for which anaesthesia is to be applied is made by the anaesthetist and cardiologist together and usually moderate anaesthesia or conscious sedation is selected.…”