Use of deep intravenous sedation with propofol and the laryngeal mask airway during transesophageal echocardiography.
OBJECTIVE
To describe the use of either deep intravenous sedation with propofol or light sedation with midazolam and topical anesthesia during transesophageal echocardiography (TEE) and to report the incidence of respiratory complications and their management.


METHODS
Retrospective study from March 2000 through August 2002.


METHODS
Single institution, specialized cancer center.


METHODS
All patients undergoing TEE examination in the specified time period (n = 42).


RESULTS
Eight patients received light sedation and 34 patients received deep intravenous sedation with propofol. An airway event occurred in one patient in the light sedation group and in six patients in the deep sedation group. The patient in the light sedation group was managed with the use of a face-mask and a manual resuscitation bag. All airway events in the deep sedation group were managed successfully using the laryngeal mask airway (LMA).


CONCLUSIONS
Deep sedation with intravenous propofol can provide both excellent patient comfort and optimal conditions for TEE examination, particularly in patients who may require more lengthy procedures or in whom other techniques have failed. Although the incidence of respiratory depression was higher in patients receiving deep sedation with propofol than in patients who were lightly sedated (17.6% versus 12.5%, respectively), all six patients who had respiratory depression while under deep sedation with propofol were successfully ventilated using the LMA trade mark, without the need to remove the TEE probe and without terminating the examination prematurely. In contrast, in the one patient in the light sedation group who had respiratory depression, the TEE probe had to be removed to ventilate the patient via a face mask, and the procedure was cancelled.
Ferson
David
D
Department of Anesthesiology and Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. dferson@mdanderson.org
Thakar
Dilip
D
Swafford
Joseph
J
Sinha
Ashish
A
Sapire
Kenneth
K
Arens
James
J
D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology; D000776:Anesthesiology; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D002309:Cardiology; D004359:Drug Therapy, Combination; D017548:Echocardiography, Transesophageal; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D015994:Incidence; D017214:Laryngeal Masks / Q000009:adverse effects; D008297:Male; D008874:Midazolam / Q000009:adverse effects; D008875:Middle Aged; D010612:Pharyngitis / Q000209:etiology; D015742:Propofol / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013781:Texas / Q000453:epidemiology; D017211:Treatment Failure
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol