Safety of Transesophageal Echocardiography in Adults: Study in a Multidisciplinary Hospital

Background: TEE is a semi-invasive tool broadly used and its utilization associated to sedatives drugs might to affect the procedure safety. Objective: to analyze aspects of TEE safety associated to the use of Midazolan (MZ) and Flumazenil (FL) and the influence of the clinical variables on the event rate. Method: prospective study with 137 patients that underwent TEE with MZ associated to moderate sedation. We analyzed the following events: complications related with the topical anesthesia, with MZ use and with the procedure. Uni- and multivariate analyses were used to test the influence of the clinical variables: age, sex, stroke, myocardiopathy (MP), duration of the test, mitral regurgitation (MR) and the MZ dose. Results: All patients (65 +/- 16 yrs; 58% males) finished the examination. The mean doses of MZ and FL were 4.3 +/- 1.9 mg and 0.28 +/- 0.2 mg, respectively. The duration of the examination and the mean ejection fraction (EF) were 16.4 +/- 6.1 minutes and 60 +/- 9%, respectively. Mild hypoxia (SO2<90%) was the most common event (11 patients); 3 patients (2%) presented transient hypoxia due to upper airway obstruction by probe introduction and 8 (5.8%) due to hypoxia caused by MZ use. Transient hypotension (SAP<90mmHg) occurred in 1 patient (0.7%). The multivariate analysis showed that severe MR, MP (EF<45%) and high doses of MZ (>5mg) were associated with events (p<0.001). The EF was 40%, in the group with MP and 44% in the group with severe MR and it can be a factor associated with clinical events in the last group. Conclusion: TEE with sedation presents a low rate of events. There were no severe events and there was no need to interrupt the examinations. (Arq Bras Cardiol 2009; 93(5) : 443-447)