Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function

Arq Bras Cardiol. 2009 Dec;93(6):576-81, 623-9. doi: 10.1590/s0066-782x2009001200011.
[Article in English, Portuguese]

Abstract

Background: Sedation with midazolam and meperidine is widely used in transesophageal echocardiography. However, no mean dose is established for each individual case.

Objective: To correlate the mean midazolam and meperidine doses for proper sedation for transesophageal echocardiography with age range, body surface area, and left ventricular ejection fraction.

Methods: Retrospective study comprising 1,841 patients undergoing sedation based on the Ramsay scale, with a solution containing midazolam 1.5 mg (1.5 ml), meperidine 1 mg (1 ml) and distilled water (7.5 ml). Four age groups were analyzed: G1: < 24 years; G2: 25 to 44 years; G3: 45 to 64 years; and G4: > 65 years. Body surface area was calculated using the formula {[(height x 100)0.725] x (weight(0.425)) x 0.0071}. As regards the left ventricular ejection fraction, two groups were studied: GA: < 55%; and GB: > 55%. The statistical analysis was carried out using the Kruskal-Wallis test for the correlation with age and left ventricular ejection fraction, and simple linear correlation for body surface area.

Results: As regards age, the mean doses of sedation required were significantly lower in G3 and G4 (p<0.01). The analysis of left ventricular ejection fraction showed that this was significantly lower in GA (p<0.01). The linear correlation coefficient between dose of sedation and body surface area was 0.09 (null).

Conclusion: The mean dose of sedatives required was lower in older individuals and in those with left ventricular systolic dysfunction. No correlation with body surface area was found.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / administration & dosage*
  • Anesthetics, Intravenous / administration & dosage
  • Body Surface Area
  • Conscious Sedation / methods
  • Conscious Sedation / standards*
  • Drug Dosage Calculations*
  • Drug Therapy, Combination
  • Echocardiography, Transesophageal*
  • Epidemiologic Methods
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Male
  • Meperidine / administration & dosage
  • Midazolam / administration & dosage
  • Middle Aged
  • Reference Values
  • Stroke Volume / drug effects*
  • Young Adult

Substances

  • Analgesics, Opioid
  • Anesthetics, Intravenous
  • Hypnotics and Sedatives
  • Meperidine
  • Midazolam