Observation on the application effects of low-dose midazolam combined with sufentanil on inpatients undergoing transesophageal echocardiography examination

LI Xuze; WANG Jing; FENG Rui; ZHANG Chunxia; YIN Hongning; LIU Haitao; KANG Rongtian

doi:10.3969/j.issn.1674-3806.2024.04.02

Abstract：Objective To observe the application effects of low-dose midazolam combined with sufentanil on inpatients undergoing transesophageal echocardiography(TEE)examination.Methods A total of 260 inpatients under-going TEE examination in the Second Hospital of Hebei Medical University from February 2017 to September 2017 were included by adopting a prospective cohort study method.The inpatients were divided into simple topical anesthesia group(group C,54 cases),midazolam group(group M,27 cases)and midazolam combined with sufentanil group(group MS,179 cases).All the patients in the three groups were given topical anesthesia using tetracaine plasmagel at the oropharynx.Group C was not given any other treatment.Group M was given intravenous injection of midazolam at dose of 0.03 mg/kg.Group MS was given intravenous injection of midazolam at dose of 0.03 mg/kg and intravenous injection of sufentanil at dose of 0.1 μg/kg.Group M and group MS were decided whether to add drugs during the operation based on the patients'response.Non-invasive systolic blood pressure(NSBP),heart rate(HR),and pulse oxygen saturation(SpO2)were recorded in the three groups after the patients entered the examination room(T0),when the probes were successfully inserted(T1)and 5 minutes after successful probe insertion(T2).The difficulty of probe insertion,TEE examination time,intraoperative adverse events and examiners'satisfaction were recorded.After examination,the modified Aldrete scale was used to judge the recovery degree of the patients.The patients were followed up for their degree of satisfaction with anesthesia and for the occurrence of postoperative adverse reactions 24 hours after surgery.Results There were significant differences among the three groups in the difficulty of probe insertion,examiners'satisfaction scores and patients'postoperative satisfaction with anesthesia scores(P＜0.05).Compared with those in group C at the same time point,NSBP and SpO2 in group M and group MS at T1 and T2 time points were decreased,and HR in group MS at T1 and T2 time points was decreased,and the differences were statistically significant(P＜0.05).Compared with that in group M at the same time point,SpO2 in group MS at T2 time point was decreased,and the difference was statistically significant(P＜0.05).In group C,compared with that at T0 time point,HR was increased at T1 and T2 time points.In group MS,compared with that at T0 time point,HR was decreased at T2 time points.In group M and group MS,compared with that at T0 time point,NSBP was decreased at T1 and T2 time points.In group MS,compared with that at T0 time point,SpO2 was decreased at T1 and T2 time points.The differences were statistically significant(P＜0.05).There were no significant differences in the incidence rates of intraoperative adverse events among the three groups(P＞0.05),and the three groups did not experience any bradycardia and tachycardia that needed to be treated during surgery.The patients'incidence rate of postoperative nausea in group C was significantly higher than that in group M and group MS,and the patients'incidence rate of postoperative pharyngeal discomfort in group C was significantly higher than that in group MS(P＜0.05).After timely treatment of intraoperative adverse events and postoperative adverse reactions,all the patients returned to normal,and no adverse consequences occurred.Conclusion On the basis of topical anesthesia,both low-dose midazolam and midazolam combined with sufentanil can be safely and effectively applied in hospitalized patients undergoing TEE examination,and midazolam combined with sufentanil has better effects,but attention should be paid to possible hypoxemia.