Results of a moderate sedation program with propofol for transesophageal
echocardiography performed by non-anesthesiologist professionals.
Abstract
Introduction and objectives The advantages of sedation in patients
undergoing transesophageal echocardiography (TEE) are well established,
but the increasing number of TEE studies may limit the capacity of
Anesthesiology services. In this study we analyze the effectiveness and
safety of a moderate sedation program carried out by
non-anesthesiologist professionals (NAP). Methods Descriptive and
prospective study that included all consecutive patients undergoing a
TEE procedure under moderate sedation by NAP and by anesthesiologists
(AP) from September 2018 to September 2019. Patients were selected
according to a specific algorithm agreed upon with the Anesthesiology
department. We analyze current indications for TEE, complication rates,
and recovery times associated with sedation. Results We performed 267
procedures in 252 patients (54% male, 69yo). Main indications were
screening or monitoring of surgical and percutaneous cardiac
interventions (47.9%), endocarditis (28.5%) and stroke (20.6%).
Patients in the NAP group were younger (59 vs 71 yo), less hypertensive
(43% vs 61%), with less lung disease (4% vs 24%), lower risk of
difficult airway (1% vs 22%) and lower comorbidity (ASA scale ≥III
13% vs 77%). Complications were more frequent in the AP group (26% vs
9%), mainly mild respiratory (19% vs 9%). Multivariate adjustment
showed events were associated with the presence of lung disease and
higher ASA degree. Recovery time was longer in the AP sedation group
(20min vs 15min). Conclusions TEE indications are changing and involve
larger and more complex studies. Moderate sedation with propofol
performed by NAP is safe in selected patients, with adequate recovery
times.