The Quality and Safety of Sedation and Monitoring in Adults Undergoing Nonoperative Transesophageal Echocardiography

• Published in: The American journal of cardiology Vol. 194; pp. 40 - 45
• Main Authors: Kersey, Cooper B., Lele, Abhijit V., Johnson, Matthew N., Pattock, Andrew M., Liu, Linda, Huang, Gary S., Kirkpatrick, James N., Mazimba, Sula, Jobarteh, Sulayman, Kwon, Younghoon
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2023; Elsevier Limited
• Subjects: Abnormalities; Adult; Anesthesia; Anesthesiology; Apnea; Blood pressure; Body mass; Body mass index; Body size; Cardiology; Cardioversion; Documentation; Echocardiography; Echocardiography, Transesophageal - methods; Ejection fraction; Endocarditis; Fentanyl; Heart; Hemodynamics; Humans; Hypercapnia; Hypotension; Hypotension - epidemiology; Hypoxia; Medical personnel; Medical records; Pulmonary arteries; Pulmonary artery; Sleep disorders; Systolic pressure; Vasoactive agents; Vital signs
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2023.02.008

Sedation is an essential component of the transesophageal echocardiography (TEE) procedure for patient comfort. The use and the clinical implications of cardiologist-supervised (CARD-Sed) versus anesthesiologist-supervised sedation (ANES-Sed) are unknown. We reviewed nonoperative TEE records from a single academic center over a 5-year period and identified CARD-Sed and ANES-Sed cases. We evaluated the impact of patient co-morbidities, cardiac abnormalities on transthoracic echocardiogram, and the indication for TEE on sedation practice. We analyzed the use of CARD-Sed versus ANES-Sed in light of institutional guidelines; the consistency in the documentation of preprocedural risk stratification; and the incidence of cardiopulmonary events, including hypotension, hypoxia, and hypercarbia. A total of 914 patients underwent TEE, with 475 patients (52%) receiving CARD-Sed and 439 patients (48%) receiving ANES-Sed. The presence of obstructive sleep apnea (p = 0.008), a body mass index of >45 kg/m2 (p <0.001), an ejection fraction of <30% (p <0.001), and pulmonary artery systolic pressure of more than 40 mm Hg (p = 0.015) were all associated with the use of ANES-Sed. Of the 178 patients (19.5%) with at least 1 caution to nonanesthesiologist-supervised sedation by the institutional screening guideline, 65 patients (36.5%) underwent CARD-Sed. In the ANES-Sed group, where intraprocedural vital signs and medications were documented in all cases, hypotension (n = 91, 20.7%), vasoactive medication use (n = 121, 27.6%), hypoxia (n = 35, 8.0%), and hypercarbia (n = 50, 11.4%) were noted. This single-center study revealed that 48% of the nonoperative TEE used ANES-Sed over 5 years. Sedation-related hemodynamic changes and respiratory events were not infrequently encountered during ANES-Sed.