Sedation During Transoesophageal Echocardiography

Background and aim: Transoesophageal echocardiography (TEE) is widely used. There is no consensus on the optimal sedation for TEE. We hypothesised that in patients undergoing TEE propofol more frequently causes a potentially dangerous drop in blood pressure than a combination of pethidine a nd m idazolam. Therefore a single centre prospective randomised trial was performed.
Methods: A total of 201 patients who underwent TEE were randomised into two groups receiving either intravenous (IV) propofol (<50 years old: 50–60 mg bolus plus further boluses of 20–30 mg as required for sufficient sedation; >50 years old: 30–40 mg bolus plus further boluses of 10–20 mg as required) or a combination of IV pethidine and midazolam (IV bolus of 25 mg pethidin and 1–2 mg midazolam, further boluses of 1 mg midazolam as required). We recorded blood pressure, oxygen saturation, heart rate, duration of procedure, and complications. Patient comfort was assessed by use of a short questionnaire once consciousness was regained.
Results: The incidence of a reduction in systolic blood pressure of ≥ 30 mm Hg and to <100 mm Hg systolic was 9% in the propofol group and 6% in the pethidine/midazolam group (p = 0.43). The changes in systolic blood pressure (propofol group: –5.80% [standard deviation 20.48%], pethidine/ midazolam group: –2.27% [SD 18.20%], p = 0.13) and diastolic blood pressure ( propofol g roup: −1.28% [SD 1 4.12%], pethidine/midazolam g roup: –1.00% [SD –3.46–1.46%], p = 0.43) were not significantly different either, nor were changes in oxygen saturation and heart rate (p = 0.37 and 0.06, respectively).
There was no significant difference regarding patient satisfaction and comfort (dizziness, nausea, headache, feeling that the procedure was unpleasant, anxiety during procedure) between the groups except f or the wish for deeper anaesthesia, which was more frequent in the propofol group (p = 0.03).
Conclusions: The risk of a drop in blood pressure was on a verage 5 0% higher for propofol than for pethidine/midazolam. However, this did not reach statistical significance. Both sedation regimens turned out to be safe and well tolerated (ClincalTrials.gov number NCT01567657).