N Sutaria, D Northridge, M Denvir; Western General Hospital, Edinburgh

Transoesophageal echocardiography (TOE) has become established as a safe and effective imaging technique and is performed by cardiologists and sonographers using intravenous sedation. We investigated the variability in the practice of TOE in the UK and whether published guidelines on the administration of sedation by non-anaesthetists were being followed. Questionnaires were received from 45 centres (30 tertiary, 15 DGH) which included 31 consultants, 11 registrars and 3 technicians with TOE experience ranging from 20 to 2000 scans (median 300). 49% of operators routinely used sedation in all patients, 80% used sedation in most (>90%). Midazolam was used universally, mean dose 4 mg (range 2–10), in 71% this was by titration rather than bolus. 93% routinely used lignocaine throat spray. 100% of responders had immediate access to flumazenil, resuscitation equipment and suction. 60% had facilities for tilting head down. The procedure was performed with a second member of staff in 44% and with 2 other staff in 66%. 64% attempted to maintain verbal communication in all cases and 58% reported patients frequently becoming verbally unresponsive. An oxygen supply was present in the procedure room in 93%. Contrary to the published guidelines, routine administration of inspired oxygen and use of pulse oximetry was reported in only 20% and 31% of responses respectively. Furthermore, four operators (8%) did not require intravenous access in all patients, and 47% rarely or never monitored arterial blood pressure. 30% of responders used prophylactic antibiotics in selected cases. 74% of operators had not received training in the administration of sedation and only 31% were aware of any guidelines.

Conclusions: There is wide variation in the practice of TOE in the UK. Most people regularly performing TOEs with intravenous sedation have not been trained in the administration of sedation …