Tag Archives: sedation

Recommendations for safe practice in transoesophageal echocardiography: a  summary document from the BSE education committee Dear Sirs, Transoesophageal echocardiography (TOE) is an established diagnostic technique, which is used with increasing frequency in a number of clinical settings. By definition it is semi-invasive with potential for significant complications.1 It therefore requires a high level of expertise and should only be performed by trained individuals. TOE often requires the use of sedation and it is recognised that there is wide variation in practice between cardiac units in the UK.2 It has become mandatory for NHS Trusts to

Safe combined intravenous opiate/benzodiazepine sedation for transoesophageal echocardiography Dear Sirs The recent article by Manika et al.1 regarding sedation for transoesophageal echocardiography (TEE) recommends a national agreed strategy for TEE sedation that incorporates both an opiate and a benzodiazepine. The survey data presented show only 6% of the UK hospitals questioned the use of opioids in combination with midazolam, perhaps with good reason. Bailey et al.2 investigated the effects of midazolam and the opiate fentanyl in volunteers. When midazolam alone was used, no significant respiratory effects were seen. Fentanyl alone prod

Gastroenterology guidelines The British Society of Gastroenterology (BSG) guidelines suggest that the opiate is used before the benzodiazepine.3 The BSG guidelines also suggest a maximum dose of 5 mg midazolam and 50 mg pethidine. Mankia et al. seem to permit 10 mg midazolam and 75 mg pethidine in their proposed protocol. Such doses would seem excessive unless you have confidence in your ability to provide assisted ventilation. In the survey nobody appears to have used more than 50 mg pethidine and, therefore, practitioners appear to set their own sensible cut-off points. In gastroscopy, sedation is often avoided, however, the TEE is of a mu