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  2. Keyword: Conscious Sedation
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Original Article

The Impact of Anxiety on Patients Referred for Transesophageal Echocardiography

João Afonso Astolfi Martins et al. Amanda de Vasconcelos Eng Edgar Lira Filho Claudio Henrique Fischer … Claudia Gianini Monaco Alessandra Joslin Oliveira Fernando Rodrigues da Camara Oliveira Marcelo Luiz Campos Vieira Samira Saady Morhy Ana Clara Tude Rodrigues

Abstract

Background

Anxiety is an important factor that influences patient experience during medical procedures. Transesophageal echocardiography (TEE) is an exam that requires sedation, which can exacerbate anxiety and affect its practice.

Objective

To assess variables that influence the degree of anxiety experienced by patients undergoing TEE and its correlation with sedation.

Methods

We assessed patients of both sexes, age >18 years, referred for TEE. We applied an anxiety questionnaire (none, mild, moderate, and high) and collected demographic, clinical, and physiological data. For comparison purposes, patients were divided into the following 2 groups: no/mild anxiety and moderate/severe anxiety.

Results

We studied 63 patients, 41 (66%) of whom were male. The majority were White (87.3%), and the mean age was 52.5 ± 14.7 years. Only 35% of patients had comorbidities, the most frequent being hypertension (63.6%), and 70% patients were undergoing TEE for the first time. The main indication for TEE was valvular disease (30%). The majority of patients (62%) reported some degree of anxiety, as follows: 25 (40%) mild, 10 (16%) moderate, and 4 (6%) severe. Patients with moderate/severe anxiety (p = 0.03) and younger patients (p = 0.001) required higher doses of midazolam for sedation.

Conclusion

Anxiety was common in patients referred for TEE, and it appeared to be less influenced by clinical variables. However, we concluded that more anxious and younger patients required higher doses of sedation.

  • Anxiety
  • Conscious Sedation
  • Echocardiography
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Creative Commons Attribution (CC BY) Creative Commons license
14/05/2025 DOI: 10.36660/abcimg.20250005i Views 1
ABC
Original Article

Comparative Study between Subcutaneous and Endovascular Defibrillator Recipients Regarding Tolerance to the Implant Procedure and Perception of Quality of Life

Pablo Esteban Auquilla-Clavijo et al. Naiara Calvo-Galiano Marina Povar-Echeverría Teresa Oloriz-Sanjuan … Francisco Diaz-Cortejana Antonio Asso-Abadia

Abstract

Background

The totally subcutaneous implantable cardioverter-defibrillator (S-ICD) is a safe alternative to the conventional transvenous ICD (TV-ICD) system to prevent sudden death.

Objective

To compare the impact of the type of ICD system and surgical technique on patients’ quality of life, as well as the severity of discomfort and pain, between S-ICD and TV-ICD recipients.

Methods

Consecutively implanted patients with an S-ICD system were matched with patients with a TV-ICD system. In addition, patients undergoing S-ICD implantation after removal of a TV-ICD due to complications were included. Quality of life (measured with the 12-item short-form health survey) and severity of pain and discomfort were evaluated. Statistical significance was defined as p < 0.05.

Results

A total of 64 patients implanted with S-ICD or TV-ICD under local anesthesia and conscious sedation were analyzed. Patients with S-ICD and TV-ICD systems did not differ significantly in quality of life scores. S-ICD patients had a higher level of perioperative pain; no differences were found regarding severity of intraoperative pain. The magnitude of aesthetic discomfort and sleep disturbances did not differ between groups. An S-ICD was implanted in 7 additional patients after removal of a TV-ICD. All but one of these patients recommended the S-ICD system.

Conclusions

The type of ICD system and the surgical technique have negligible impact on patients’ quality of life. These results suggest that conscious sedation, provided by an experienced electrophysiology team, could be considered as an alternative to general anesthesia to manage patients undergoing S-ICD implantation.

  • Comparative Study
  • Conscious Sedation
  • Defibrilators
  • Defibrillators Subcutaneous Implantable
  • Implantable
  • Quality of life
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Creative Commons Attribution (CC BY) Creative Commons license
14/06/2021 DOI: 10.36660/abc.20190312
ABC
Editorial

Importance of the Anesthetic Technique and Analgesia in the Implantation of Subcutaneous and Endovascular Defibrillator: An Aspect Often Ignored

Jorge Elias Neto

Originally introduced by Mirowski 50 years ago, the implantable cardioverter-defibrillator (ICD) has become a cornerstone to preventing SCD related to ventricular tachyarrhythmias.

However, besides their lifesaving capacities, the transvenous leads carry their own risk.

[…]

  • Analgesia
  • Anesthesy
  • Cardioversor–Defibrillator Implantable/trends
  • CDI Subcutaneous/trends
  • Conscious Sedation
  • Quality of life
  • Tachycardia, Ventricular
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Creative Commons Attribution (CC BY) Creative Commons license
14/06/2021 DOI: 10.36660/abc.20210184 Views 2
Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function
ABC
Artigo Original

Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function

Guilherme Moreira José et al. Carlos Eduardo Suaide Silva Luiz Darcy Cortez Ferreira Yara Prosdossini Soares de Novaes … Claudia Gianini Monaco Manuel Adán Gil Renata Rejane Linhares Marcelo Sgrott Rodrigues Antônio S. S. de Moraes Juarez Ortiz

BACKGROUND: Sedation with midazolam and meperidine is widely used in transesophageal echocardiography. However, no mean dose is established for each individual case. OBJECTIVE: To correlate the mean midazolam and meperidine doses for proper sedation for transesophageal echocardiography with age range, body surface area, and left ventricular ejection fraction. METHODS: Retrospective study comprising 1,841 patients undergoing sedation based on the Ramsay scale, with a solution containing midazolam 1.5 mg (1.5 ml), meperidine 1 mg (1 ml) and distilled water (7.5 ml). Four age groups were analyzed: G1: 65 years. Body surface area was calculated using the formula {[(height x 100)0.725] x (weight0.425) x 0.0071}. As regards the left ventricular ejection fraction, two groups were studied: GA: 55%. The statistical analysis was carried out using the Kruskal-Wallis test for the correlation with age and left ventricular ejection fraction, and simple linear correlation for body surface area. RESULTS: As regards age, the mean doses of sedation required were significantly lower in G3 and G4 (p<0.01). The analysis of left ventricular ejection fraction showed that this was significantly lower in GA (p<0.01). The linear correlation coefficient between dose of sedation and body surface area was 0.09 (null). CONCLUSION: The mean dose of sedatives required was lower in older individuals and in those with left ventricular systolic dysfunction. No correlation with body surface area was found.

  • Conscious Sedation
  • meperidine
  • midazolam
  • Transesophageal echocardiography
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Creative Commons Attribution (CC BY) Creative Commons license
05/05/2010 DOI: 10.1590/S0066-782X2009001200011 Views 1

How to cite this article

EndNote RIS

Electronic Document Format (Vancouver)

Martins JAA, Eng AV, Lira Filho E, Fischer CH, Monaco CG, Oliveira AJ, Oliveira FRC, et al. The Impact of Anxiety on Patients Referred for Transesophageal Echocardiography. ABC Imagem Cardiovascular 2025;38(2):e20250005.

Electronic Document Format (ABNT)

Martins, João Afonso Astolfi; Eng, Amanda de Vasconcelos; Lira Filho, Edgar; Fischer, Claudio Henrique; Monaco, Claudia Gianini; Oliveira, Alessandra Joslin; Oliveira, Fernando Rodrigues da Camara; Vieira, Marcelo Luiz Campos; Morhy, Samira Saady; Rodrigues, Ana Clara Tude. The Impact of Anxiety on Patients Referred for Transesophageal Echocardiography. ABC Imagem Cardiovascular, v. 38, n. 2, e20250005, May. 2025.

Electronic Document Format (APA)

Martins, J. A. A., Eng, A. V., Lira Filho, E., Fischer, C. H., Monaco, C. G., Oliveira, A. J., Oliveira, F. R. C., Vieira, M. L. C., Morhy, S. S., & Rodrigues, A. C. T. (2025). The Impact of Anxiety on Patients Referred for Transesophageal Echocardiography. ABC Imagem Cardiovascular, 38(2), e20250005.

Electronic Document Format (ISO)

Martins, João Afonso Astolfi and Eng, Amanda de Vasconcelos and Lira Filho, Edgar and Fischer, Claudio Henrique and Monaco, Claudia Gianini and Oliveira, Alessandra Joslin and Oliveira, Fernando Rodrigues da Camara and Vieira, Marcelo Luiz Campos and Morhy, Samira Saady and Rodrigues, Ana Clara Tude. The Impact of Anxiety on Patients Referred for Transesophageal Echocardiography. ABC Imagem Cardiovascular [online]. 2025, vol. 38, n. 2, [cited 2026-10-14], e20250005. Available from: <https://journals.cardiol.br/en/article/the-impact-of-anxiety-on-patients-referred-for-transesophageal-echocardiography/>. ISSN 2318-8219

EndNote RIS

Electronic Document Format (Vancouver)

Auquilla-Clavijo PE, Calvo-Galiano N, Povar-Echeverría M, Oloriz-Sanjuan T, Diaz-Cortejana F, Asso-Abadia A. Comparative Study between Subcutaneous and Endovascular Defibrillator Recipients Regarding Tolerance to the Implant Procedure and Perception of Quality of Life. Arquivos Brasileiros de Cardiologia 2021;116(6):1139-48.

Electronic Document Format (ABNT)

Auquilla-Clavijo, Pablo Esteban; Calvo-Galiano, Naiara; Povar-Echeverría, Marina; Oloriz-Sanjuan, Teresa; Diaz-Cortejana, Francisco; Asso-Abadia, Antonio. Comparative Study between Subcutaneous and Endovascular Defibrillator Recipients Regarding Tolerance to the Implant Procedure and Perception of Quality of Life. Arquivos Brasileiros de Cardiologia, v. 116, n. 6, p. 1139-1148, Jun. 2021.

Electronic Document Format (APA)

Auquilla-Clavijo, P. E., Calvo-Galiano, N., Povar-Echeverría, M., Oloriz-Sanjuan, T., Diaz-Cortejana, F., & Asso-Abadia, A. (2021). Comparative Study between Subcutaneous and Endovascular Defibrillator Recipients Regarding Tolerance to the Implant Procedure and Perception of Quality of Life. Arquivos Brasileiros de Cardiologia, 116(6), 1139-1148.

Electronic Document Format (ISO)

Auquilla-Clavijo, Pablo Esteban and Calvo-Galiano, Naiara and Povar-Echeverría, Marina and Oloriz-Sanjuan, Teresa and Diaz-Cortejana, Francisco and Asso-Abadia, Antonio. Comparative Study between Subcutaneous and Endovascular Defibrillator Recipients Regarding Tolerance to the Implant Procedure and Perception of Quality of Life. Arquivos Brasileiros de Cardiologia [online]. 2021, vol. 116, n. 6, [cited 2026-10-14], pp. 1139-1148. Available from: <https://journals.cardiol.br/en/article/comparative-study-between-subcutaneous-and-endovascular-defibrillator-recipients-regarding-tolerance-to-the-implant-procedure-and-perception-of-quality-of-life/>. ISSN 0066-782X

EndNote RIS

Electronic Document Format (Vancouver)

Elias Neto J. Importance of the Anesthetic Technique and Analgesia in the Implantation of Subcutaneous and Endovascular Defibrillator: An Aspect Often Ignored. Arquivos Brasileiros de Cardiologia 2021;116(6):1150-2.

Electronic Document Format (ABNT)

Elias Neto, Jorge. Importance of the Anesthetic Technique and Analgesia in the Implantation of Subcutaneous and Endovascular Defibrillator: An Aspect Often Ignored. Arquivos Brasileiros de Cardiologia, v. 116, n. 6, p. 1150-1152, Jun. 2021.

Electronic Document Format (APA)

Elias Neto, J. (2021). Importance of the Anesthetic Technique and Analgesia in the Implantation of Subcutaneous and Endovascular Defibrillator: An Aspect Often Ignored. Arquivos Brasileiros de Cardiologia, 116(6), 1150-1152.

Electronic Document Format (ISO)

Elias Neto, Jorge. Importance of the Anesthetic Technique and Analgesia in the Implantation of Subcutaneous and Endovascular Defibrillator: An Aspect Often Ignored. Arquivos Brasileiros de Cardiologia [online]. 2021, vol. 116, n. 6, [cited 2026-10-14], pp. 1150-1152. Available from: <https://journals.cardiol.br/en/article/importance-of-the-anesthetic-technique-and-analgesia-in-the-implantation-of-subcutaneous-and-endovascular-defibrillator-an-aspect-often-ignored/>. ISSN 0066-782X

EndNote RIS

Electronic Document Format (Vancouver)

José GM, Silva CES, Ferreira LDC, Novaes YPS, Monaco CG, Gil MA, Linhares RR, et al. Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function. Arquivos Brasileiros de Cardiologia 2010;93(6):623-9.

Electronic Document Format (ABNT)

José, Guilherme Moreira; Silva, Carlos Eduardo Suaide; Ferreira, Luiz Darcy Cortez; Novaes, Yara Prosdossini Soares de; Monaco, Claudia Gianini; Gil, Manuel Adán; Linhares, Renata Rejane; Rodrigues, Marcelo Sgrott; Moraes, Antônio S. S. de; Ortiz, Juarez. Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function. Arquivos Brasileiros de Cardiologia, v. 93, n. 6, p. 623-629, May. 2010.

Electronic Document Format (APA)

José, G. M., Silva, C. E. S., Ferreira, L. D. C., Novaes, Y. P. S. , Monaco, C. G., Gil, M. A., Linhares, R. R., Rodrigues, M. S., Moraes, A. S. S. , & Ortiz, J. (2010). Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function. Arquivos Brasileiros de Cardiologia, 93(6), 623-629.

Electronic Document Format (ISO)

José, Guilherme Moreira and Silva, Carlos Eduardo Suaide and Ferreira, Luiz Darcy Cortez and Novaes, Yara Prosdossini Soares de and Monaco, Claudia Gianini and Gil, Manuel Adán and Linhares, Renata Rejane and Rodrigues, Marcelo Sgrott and Moraes, Antônio S. S. de and Ortiz, Juarez. Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function. Arquivos Brasileiros de Cardiologia [online]. 2010, vol. 93, n. 6, [cited 2026-10-14], pp. 623-629. Available from: <https://journals.cardiol.br/en/article/effective-dose-of-sedation-in-transesophageal-echocardiography-relation-to-age-body-surface-area-and-left-ventricle-function/>. ISSN 0066-782X

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