title: Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function.
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).
  
  
  CONCLUSIONS
  The mean dose of sedatives required was lower in older individuals and in those with left ventricular systolic dysfunction. No correlation with body surface area was found.
authors.affiliation: OMNI-CCNI Medicina Diagnóstica de São Paulo, São Paulo, SP, Brasil.
authors.forename: Guilherme Moreira
authors.initials: GM
authors.lastname: José
authors.forename: Carlos Eduardo Suaide
authors.initials: CE
authors.lastname: Silva
authors.forename: Luiz Darcy Cortez
authors.initials: LD
authors.lastname: Ferreira
authors.forename: Yara Prosdossini Soares de
authors.initials: YP
authors.lastname: Novaes
authors.forename: Claudia Gianini
authors.initials: CG
authors.lastname: Monaco
authors.forename: Manuel Adán
authors.initials: MA
authors.lastname: Gil
authors.forename: Renata Rejane
authors.initials: RR
authors.lastname: Linhares
authors.forename: Marcelo Sgrott
authors.initials: MS
authors.lastname: Rodrigues
authors.forename: Antônio S S de
authors.initials: AS
authors.lastname: Moraes
authors.forename: Juarez
authors.initials: J
authors.lastname: Ortiz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001830:Body Surface Area; D016292:Procedural Sedation / Q000379:methods / Q000592:standards*; D054796:Drug Dosage Calculations; D004359:Drug Therapy, Combination; D017548:Echocardiography, Transesophageal; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008614:Meperidine / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D012016:Reference Values; D013318:Stroke Volume / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008614:Meperidine; D008874:Midazolam