Toman Huseyin, Erkılınc Atakan, Kocak Tuncer, Guzelmeric Fusun, Savluk Omer Faruk, Dogukan Mevlut, Acar Goksel
Department of Anesthesiology and Reanimation, Canakkale Onsekiz Mart University, School of Medicine, Canakkale, Turkey.
Clinic of Anesthesiology and Reanimation, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul; Turkey.
Med Glas (Zenica). 2016 Feb 1;13(1):18-24. doi: 10.17392/825-16.
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.
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.
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).
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.
经食管超声心动图（TEE）检查时，因咽喉-食管插管，患者可能会出现恶心、呼吸急促、躁动、情绪困扰和疼痛，使用镇静镇痛药物可能会部分缓解这些症状。本研究旨在比较咪达唑仑、咪达唑仑-阿芬太尼联合用药和丙泊酚用于计划进行诊断性TEE检查患者镇静和镇静镇痛的临床效果。
本研究前瞻性纳入了90例ASA风险分级为I-II-III级的成年随机患者。M组给予2.5mg咪达唑仑，MA组给予1mg咪达唑仑和5μg/kg阿芬太尼，P组给予0.5mg/kg丙泊酚静脉推注。必要时给予追加剂量。对接受TEE检查的患者，从追加剂量需求、拉姆齐镇静评分（RSS）、改良Aldrete评分（MAS）、恢复时间和住院时间等方面进行评估。
P组追加剂量需求更大（p<0.05），且在恢复室和医院的停留时间更短（p<0.05）。插入TEE探头时，P组的RSS明显高于其他M组和MA组（p<0.05）。
在TEE检查期间，与追加剂量需求和呼吸暂停观察的要求相反，丙泊酚的使用似乎具有优势，因为它能提供更快速有效的镇静深度，无需昂贵的拮抗剂，且能使患者早日出院。此外与单独使用咪达唑仑相比，咪达唑仑联合阿芬太尼的使用似乎更具优势。
