Conscious Sedation: For a TEE, Is It Always Required?

Abstract

Conscious sedation is an anesthesia technique frequently used to facilitate transesophageal echocardiography, but it is not really necessary for performing routine adult cases. Children and complicated circumstances generally do warrant sedation. Using such anesthesia does increase complication rates and financial costs, therefore, omitting it should be considered when appropriate. Conscious sedation does diminish pain and anxiety, but results in patients being temporarily not decisional; without sedation they remain at full decisional capacity and can resume routine activities immediately after the procedure.

Modified mallampati classification in determining the success of unsedated transesophageal echocardiography procedure in patients with heart disease: simple but efficient

“…In the non-invasive cardiac diagnostic settings worldwide, a transesophageal echocardiography (TEE) can be performed with or without conscious sedation. According to the guidelines for performing a TEE, the procedure is well tolerated by an unsedated patient who is adequately given oral anaesthesia [ 1 ]. Comparing with a sedated TEE, the unsedated patients show a lower incidence of cardiopulmonary complications and also receive more in benefit in terms of recovery time and medical care cost [ 1 , 2 ].…”

Procedural sedation: not to be routine

“…Procedural sedation is clearly warranted for some patients, like those with cognitive impairment, children, less wellcontrolled persons, and/or whenever discomfort levels are high, as in complicated biopsy cases. Yet, administering sedative and/or analgesic drugs increase the risks and types of side effects [1][2][3][4][5][6][7][8][9][10]. These medications also add to the duration of the endoscopy, recovery time, physician presence, recovery room utilization, and cost [13,14].…”

“…The USA is an exception to the elsewhere frequent absence of such pharmacotherapy before endoscopies [5][6][7][8][9]. Despite the majority of cases currently performed under preprocedure medication, there is support for appropriate individuals to undergo examinations like these without sedation or analgesia [2][3][4][5][6][7][8][9][10].…”

“…However, many endoscopies are nevertheless safely, more quickly, and comfortably performed without sedatives or analgesics [2][3][4][5][6][7][8][9][10]. This type of pre-treatment is not always required nor so desirable; there are fewer cardiopulmonary complications and less cognitive or sedation concerns when omitting these pharmaceuticals [11].…”

“…Nonsedated individuals are more able to follow physician instructions at facilitating the endoscopy. Some patients like being awake and knowing their test results immediately [6,9,10].…”