title: The effect of sedation during transoesophageal echocardiography on heart rate variability: a comparison of hypnotic sedation with medical sedation.
abstract: BACKGROUND
  There is no ideal sedation technique that can be used during transoesophageal echocardiography (TEE), and the data concerning the effects of available sedation techniques on heart rate variability (HRV) are limited.
  
  
  OBJECTIVE
  To compare the effects of sedation through hypnotherapy with medical sedation achieved by midazolam on HRV.
  
  
  METHODS
  We recruited 76 patients with an indication of TEE; the age range was 18-83 years. In Group T there were 26 patients who had the procedure under topical pharyngeal anaesthesia, in Group D there were 23 patients who received midazolam, and in Group H there were 27 patients receiving hypnosis. All patients had an IV access; throughout the procedure heart rate, rhythm electrocardiography, and peripheric O2 saturation were monitored with a non-invasive monitor, and blood pressure measurements were taken every 3 min. Rhythm Holter recordings were obtained from all patients and TEE was performed.
  
  
  RESULTS
  When time domain parameters for HRV were compared in all three groups, the hypnosis group had significant increases in pNN50 and RMSSD compared to Groups D and T (p < 0.05). As concerns frequency domain parameters, there were no significant differences between groups where low frequency (LF) was decreased in hypnosis group and high frequency (HF) was increased (p > 0.05). However, LF/HF was decreased statistically significantly (p < 0.05) when compared with the midazolam group.
  
  
  CONCLUSIONS
  Contrary to standard sedation in TEE patients, when hypnosis is used autonomic cardiac tone is modified to a significant extent. Hypnotic sedation achieves this by increasing the parasympathetic activity, decreasing the sympathetic activity, and changing the sympathovagal interaction balance.
authors.affiliation: Department of Cardiology, Bahçeşehir Medical University, Fatih Medical Park Hospital, Istanbul, Turkey. yukseldogan@hotmail.com.
authors.forename: Yuksel
authors.initials: Y
authors.lastname: Dogan
authors.forename: Gulay A
authors.initials: GA
authors.lastname: Eren
authors.forename: Evrim
authors.initials: E
authors.lastname: Tulubas
authors.forename: Vecihi
authors.initials: V
authors.lastname: Oduncu
authors.forename: Alparslan
authors.initials: A
authors.lastname: Sahin
authors.forename: Serkan
authors.initials: S
authors.lastname: Ciftci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006991:Hypnosis, Anesthetic; D008297:Male; D008874:Midazolam / Q000494:pharmacology*; D008875:Middle Aged; D055815:Young Adult
chemical_list: D008874:Midazolam
keywords: heart rate variability; hypnotic sedation; midazolam; transoesophageal echocardiography