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Transesophagical Echocardiography Safety.
Cardiac Rate and Arterial O2
Saturation Modifications

Sanchez-Rubio, Juan; Galache, José G.;
Chopo, José M.; Marquina, Adolfo;
Molinero, Edmundo; Moreno, Eva;
Artal, Angel; Cay, Eduardo; Placer, Luis J.

Hospital Universitario Miguel Servet, Zaragoza, Spain

SUMMARY
Aim: Establishing the TEE effects on cardiac rate (CR) and arterial O2 saturation (O2S); determine clinical repercussions; identify those patients that could profit from O2 administration.
Methods: Prospective study of 100 consecutive patients who followed TEE without previous treatment. CR and O2S were used as variables, and measured prior, during and 5 minutes (min) after TEE, independently analysing clinical markers and personal history with Mann-Whitney and t- Student tests.
Results: Sample CR and mean O2S media are shown in the table. (Table 1)

There are statistically significant differences between basal and during-TEE CR (9 bpm, p<0.001), and between during- and post-TEE CR (5 bpm, p<0.001). No significant differences in O2S were observed. No differences are seen relating CR and O2S to age (mean 56 years, 19-82), sex (63% male, 37% female), study duration (average 11min, 20-4) or functional class (class I-II vs III). Chronic obstructive pulmonary disease(COPD) patients present minor basal O2S (91.5% vs 95.5% p< 0.027) and major descent during TEE (88.5% vs 94.5% p<0.004). No differences were found regarding clinical diagnosis (18 prosthesis, 15 cerebral stroke, 15 endocarditic, 6 dissections, 14 Atrial septal defects, 22 valvulopathy, 10 other). No interesting clinical events were detected.
Conclusions: TEE produces a taquicardization not related to O2S changes and without clinical repercussion. No differences linked to functional class, study duration or clinical diagnosis are seen, except for COPD patients. No O2S monitoring, nor O2 supplement during routine TEE are needed, except for COPD patients that could profit from O2 supply.

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INTRODUCTION
   Transesophageal echocardiography (TEE) is now a widely practised procedure and its use is a routine in most of Departments of Cardiology. TEE presents a very low incidence of complications such as bacteraemia, arrhythmia or esophageal trauma. In relation with this technique arterial oxygen desaturation has been observed, but there are a few studies in this direction and we don't know exactly its clinical repercussions. We must remember that many patients who undergo TEE are elderly and may have heart disease.

AIM
   Establishing the TEE effects on cardiac rate (CR) and arterial O2 saturation (O2S); determine their clinical repercussions; identify those patients at more risk of hemodinamical complications who could profit from O2 administration.

METHODS
   Prospective study of 100 consecutive patients who followed TEE. All patients received premedication with xylocaina throat spray. Those patients with known requirement for oxygen treatment were excluded. CR and O2S were used as variables, and measured prior, during and 5 minutes (min) after TEE. We performed an independently analysing for several clinical markers and personal history: age, sex, New York Heart Association class, Chronic obstructive pulmonary disease (COPD), study duration and indication for TEE. Statistical analysis was performed with Mann-Whitney and t-Student tests.

RESULTS
   Sample CR and mean O2S media are shown in Table 1. There are statistically significant differences between basal and during-TEE CR (79,4 bpm vs. 88,5 bpm p<0.001), and between during- and post-TEE CR (88,5 bpm vs. 83,3 bpm p<0.001). No significant differences in O2S were observed. No differences were seen relating CR and O2S to age (mean 56 years, 19-82), sex (63% male, 37% female), study duration (average 11min, 20-4) or functional class (class I-II vs. III, no patient was class IV). Chronic obstructive pulmonary disease patients presented minor basal O2S (91.5% vs. 95.5% p< 0.027) and major O2S descent during TEE (88.5% vs. 94.5% p<0.004). No differences were found regarding indications for ETE (see Table 2).

   No interesting clinical events were detected. Two procedures were suspended because insertion of the TEE probe was unsuccessfully attempted.

DISCUSSION
   TEE is a safe technique with a low incidence of complications. We have observed an increase of the CR and a no significant decrease in O2S at the beginning of the procedure, linked to insertion of the TEE probe and never in relation with clinical repercussions. Moreover, once the study is finished, CR and O2S recover rapidly and spontaneously. We haven't found any difference among all analysed groups, except for COPD patients, who starting from a lower O2S suffer a significant O2S descent during TEE. However, no clinical complications occurred in this group either.

CONCLUSIONS

1) Transesophageal echocardiography is a safe technique.
2) TEE produces a taquicardization not related to O2S changes and without clinical repercussion.
3) No differences linked to age, sex, functional class, study duration or indication for TEE are seen, except for COPD patients.
4) No O2S monitoring, nor O2 supplement during routine TEE are needed, except for COPD patients that could profit from O2 supply.

 

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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
President
Dr. Raúl Bretal
Scientific Committee
President
Dr. Armando Pacher
Technical Committee - CETIFAC
President
fgaro@fac.org.ar
fgaro@satlink.com
rbretal@fac.org.ar
rbretal@netverk.com.ar
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