title: Safety of transesophageal echocardiography in adults: study in a multidisciplinary hospital.
abstract: 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.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brasil. alexandrecury@ig.com.br
authors.forename: Alexandre Ferreira
authors.initials: AF
authors.lastname: Cury
authors.forename: Marcelo Luiz Campos
authors.initials: ML
authors.lastname: Vieira
authors.forename: Claudio Henrique
authors.initials: CH
authors.lastname: Fischer
authors.forename: Ana Clara Tude
authors.initials: AC
authors.lastname: Rodrigues
authors.forename: Adriana
authors.initials: A
authors.lastname: Cordovil
authors.forename: Claudia
authors.initials: C
authors.lastname: Monaco
authors.forename: Gustavo Alberto
authors.initials: GA
authors.lastname: Naccarato
authors.forename: Glaucia
authors.initials: G
authors.lastname: Tavares
authors.forename: Edgar Bezerra
authors.initials: EB
authors.lastname: Lira Filho
authors.forename: Laise Antonia
authors.initials: LA
authors.lastname: Guimarães
authors.forename: Samira Saady
authors.initials: SS
authors.lastname: Morhy
mesh_terms: 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
chemical_list: D018686:Anesthetics, Intravenous; D005442:Flumazenil; D008874:Midazolam