title: Sedation for transesophageal echocardiography: comparison of propofol, midazolam and midazolam-alfentanil combination.
abstract: OBJECTIVE
  The administration of trans esophageal echocardiography (TEE) may cause nausea, shortness of breath, agitation, emotional distress and pain in patients due to pharyngo-esophageal intubation, which may be partially relieved by sedoanalgesia. The aim of this study was to compare clinical effects of midazolam, midazolam-alfentanil combination and propofol sedation given for sedation and sedoanalgesia to patients with planned diagnostic TEE interventions.
  
  
  METHODS
  This study was prospectively completed with 90 randomized adult patients in ASA risk groups I-II-III. Group M were given 2.5 mg midazolam, group MA were given 1 mg midazolam and 5 μg/kg alfentanil and group P were given 0.5 mg/kg propofol intravenous bolus. If necessary, additional doses were administered. Patients administered with TEE were evaluated in terms of additional dose requirements, Ramsey Sedation Scale (RSS), modified Aldrete Scoring (MAS), recovery time and duration of stay in the hospital.
  
  
  RESULTS
  In the group P additional dose requirements were greater (p<0.05), as well as the duration of stay in the recovery unit and hospital were shorter (p<0.05). On insertion of the TEE probe, the RSS in the group P was clearly higher than in other groups M and MA (p<0.05).
  
  
  CONCLUSIONS
  During the TEE intervention, the use of propofol, contrary to requirements for additional dose and observation of apnea, appears to be advantageous due to providing more rapid and effective sedation depth without a need of expensive antagonist agents, and allowing early discharge of patients. Additionally, it seems that the use of midazolam combined with alfentanil, is more advantageous comparing to midazolam alone.
authors: Department of Anesthesiology and Reanimation, Canakkale Onsekiz Mart University, School of Medicine, Canakkale, Turkey.
authors: Huseyin
authors: H
authors: Toman
authors: Clinic of Anesthesiology and Reanimation, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul; Turkey.
authors: Atakan
authors: A
authors: Erkılınc
authors: Clinic of Anesthesiology and Reanimation, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul; Turkey.
authors: Tuncer
authors: T
authors: Kocak
authors: Clinic of Anesthesiology and Reanimation, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul; Turkey.
authors: Fusun
authors: F
authors: Guzelmeric
authors: Clinic of Anesthesiology and Reanimation, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul; Turkey.
authors: Omer Faruk
authors: OF
authors: Savluk
authors: Department of Anesthesiology and Reanimation, Adiyaman University Training and Research Hospital, Adiyaman; Turkey.
authors: Mevlut
authors: M
authors: Dogukan
authors: Clinic of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul; Turkey.
authors: Goksel
authors: G
authors: Acar
mesh_terms: D000328:Adult; D000368:Aged; D015760:Alfentanil / Q000008:administration & dosage*; D016292:Procedural Sedation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D011997:Recovery Room
chemical_list: D004338:Drug Combinations; D015760:Alfentanil; D008874:Midazolam; D015742:Propofol
keywords: alfentanil; midazolam; outpatient; propofol