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Review paper

Sedation for transesophageal echocardiography: comparison of propofol, midazolam and midazolam-alfentanil combination

By
Toman Huseyin ,
Toman Huseyin
Contact Toman Huseyin

Department of Anesthesiology and Reanimation, Canakkale Onsekiz Mart University, School of Medicine , Canakkale , Turkey

Atakan Erkılınc ,
Atakan Erkılınc

Clinic of Anesthesiology and Reanimation, Kartal Kosuyolu High Specialty Education and Research Hospital , Istanbul , Turkey

Tuncer Kocak ,
Tuncer Kocak

Clinic of Anesthesiology and Reanimation, Kartal Kosuyolu High Specialty Education and Research Hospital, , Istanbul , Turkey

Fusun Guzelmeric ,
Fusun Guzelmeric

Clinic of Anesthesiology and Reanimation, Kartal Kosuyolu High Specialty Education and Research Hospital , Istanbul , Turkey

Omer Faruk Savluk ,
Omer Faruk Savluk

Clinic of Anesthesiology and Reanimation, Kartal Kosuyolu High Specialty Education and Research Hospital , Istanbul , Turkey

Mevlut Dogukan ,
Mevlut Dogukan

Department of Anesthesiology and Reanimation, Adiyaman University Training and Research Hospital , Adiyaman , Turkey

Goksel Acar
Goksel Acar

Clinic of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital , Istanbul , Turkey

Abstract

Aim
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).
Conclusion
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.

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