Safety of transesophageal echocardiography in adults: study in a multidisciplinary hospital.
BACKGROUND
TEE is a semi-invasive tool broadly used and its utilization associated to sedatives drugs might to affect the procedure safety.


OBJECTIVE
to analyze aspects of TEE safety associated to the use of Midazolan (MZ) and Flumazenil (FL) and the influence of the clinical variables on the event rate.


METHODS
prospective study with 137 patients that underwent TEE with MZ associated to moderate sedation. We analyzed the following events: complications related with the topical anesthesia, with MZ use and with the procedure. Uni- and multivariate analyses were used to test the influence of the clinical variables: age, sex, stroke, myocardiopathy (MP), duration of the test, mitral regurgitation (MR) and the MZ dose.


RESULTS
All patients (65+/-16 yrs; 58% males) finished the examination. The mean doses of MZ and FL were 4.3+/-1.9 mg and 0.28+/-0.2 mg, respectively. The duration of the examination and the mean ejection fraction (EF) were 16.4+/-6.1 minutes and 60+/-9%, respectively. Mild hypoxia (SO2<90%) was the most common event (11 patients); 3 patients (2%) presented transient hypoxia due to upper airway obstruction by probe introduction and 8 (5.8%) due to hypoxia caused by MZ use. Transient hypotension (SAP<90mmHg) occurred in 1 patient (0.7%). The multivariate analysis showed that severe MR, MP (EF<45%) and high doses of MZ (>5mg) were associated with events (p<0.001). The EF was 40%, in the group with MP and 44% in the group with severe MR and it can be a factor associated with clinical events in the last group.


CONCLUSIONS
TEE with sedation presents a low rate of events. There were no severe events and there was no need to interrupt the examinations.
Cury
Alexandre Ferreira
AF
Hospital Israelita Albert Einstein, São Paulo, SP, Brasil. alexandrecury@ig.com.br
Vieira
Marcelo Luiz Campos
ML
Fischer
Claudio Henrique
CH
Rodrigues
Ana Clara Tude
AC
Cordovil
Adriana
A
Monaco
Claudia
C
Naccarato
Gustavo Alberto
GA
Tavares
Glaucia
G
Lira Filho
Edgar Bezerra
EB
Guimarães
Laise Antonia
LA
Morhy
Samira Saady
SS
D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D001938:Brazil / Q000453:epidemiology; D016292:Procedural Sedation / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D017548:Echocardiography, Transesophageal / Q000009:adverse effects* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005442:Flumazenil / Q000008:administration & dosage / Q000009:adverse effects*; D006769:Hospitals, General; D006801:Humans; D000860:Hypoxia / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000473:pathology; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects
D018686:Anesthetics, Intravenous; D005442:Flumazenil; D008874:Midazolam