Abstract 10827: Use of an Automated Sedation Assessment Tool Reduces Complications in Patients Undergoing Moderate Sedation for Transesophageal Echocardiography
Background: Conscious sedation (CS) is typically given for patients undergoing transesophageal echocardiography (TEE). Complications arising from CS (typically ventilatory impairment or hypotension), are heightened due to secretions related to esophageal intubation and the common co-morbidities in patients referred for TEE including acute stroke, atrial fibrillation with accompanying heart failure, and sepsis where endocarditis is of concern, which are more prevalent in hospitalized patients. These CS-related complications are initially managed by administration of reversal agents, and when severe, may require endotracheal intubation and/or volume resuscitation.
Methods: We developed an automated computerized sedation-scoring instrument (SedRisk) to predict which patients are more likely to develop a CS-related complication, and in these high-risk patients, consult an anesthesiologist to administer and oversee sedation. Patients were scored on a 0-22 point scale based on Mallampati class, American Society of Anesthesiologists Class, and other clinical parameters predicting airway and sedation-risk, and categorized patients into low and high sedation risk. A CS-related complication was considered present if the patient required the usage of a reversal agent, or developed significant hypotension or an airway-related event. Outcomes were recorded before and after initiation of the SedRisk tool.
Results: The overall frequency of CS-events was 1.5% prior to SedRisk (14/951 consecutive cases). In the 220 consecutive patients screened using SedRisk, there were no CS-events recorded in the 168 (76%) patients identified as low-risk. In the 52 (24%) patients deemed high-risk, CS-events were present in 5 (9.6%, p<0.001 versus low-risk), and were managed in a more appropriate environment by an anesthesiologist working with a cardiologist than would have occurred by a cardiologist acting alone.
Conclusions: CS-related complications are infrequent, but predictable using the SedRisk screening tool. High-risk patients can be identified in advance of TEE, and more safely undergo CS by consultation with an anesthesiologist, thus minimizing potential catastrophic complications.
- © 2011 by American Heart Association, Inc.