MIDAZOLAM PREMEDICATION IMPROVES TOLERANCE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Patient premedication for transesophageal echocardiography (TEE) is st ill under debate, especially the use of sedatives. We performed a doub le-blind, placebo-controlled study to clarify the efficacy of low-dose intravenous midazolam as premedication for TEE. Placebo or midazolam (less than or equal to 50 kg, 2.0 mg intravenovsly; 50 to 80 kg, 2.5 m g; and greater than or equal to 80 kg, 3.0 mg intravenously) was given in addition to topical anesthesia to 200 consecutive in- and outpatie nts. Blood pressure, heart rate, and oxygen saturation were monitored. Patients were interviewed immediately, and 2 to 10 days after TEE. Si xteen patients received an additional dose of midazolam, and in 12 fol low-up was incomplete. Patients taking midazolam reported less gag ref lex at probe introduction and during TEE, as did the examiners (p <0.0 5 to 0.0001). Probe manipulations were found to produce less discomfor t after midazolam administration (p <0.005). Midazolam patients experi enced less dyspnea (p <0.01) despite a minimal decrease in oxygen satu ration of 2% (p < 0.0001). The following day patients taking midazolam reported less sore throats, and painful swallowing was less frequent (p <0.01 to 0.001). Systolic blood pressure decreased slightly in the midazolam group (132 +/- 24 to 121 +/- 20 mm Hg, p <0.0001). The rate of minor complications showed no difference. Thus, TEE probe introduct ion and manipulation was tolerated better after low-dose midazolam pre medication, and patients experienced less pharyngeal discomfort the da y after. Midazolam was well tolerated and the complication rate did no t increase. Thus low-dose, short-acting benzodiazepine premedication i mproves patient comfort during and after TEE and generous use can be r ecommended. (C) 1998 by Excerpta Medica, Inc.