[Hypnosis in transesophageal echocardiography. The experience in a Pediatric Cardiology and Congenital Heart Disease Unit]. / L'ipnosi nell'ecocardiografia transesofagea. L'esperienza di un Centro di Cardiologia Pediatrica e delle Cardiopatie Congenite.

BACKGROUND: The purpose of this study was to use hypnosis in patients with congenital heart disease undergoing transesophageal echocardiography (TEE). METHODS: From January 2016 to July 2017, 50 adult patients undergoing TEE were randomly assigned to two groups: TEE in hypnosis (n = 23), TEE in sedation (n = 27). Vital parameters (heart rate [HR], blood pressure [BP], oxygen saturation [SO2] before, during and after the procedure) and drug administration were recorded. The State-Trait Anxiety Inventory was performed before and after TEE, the memory and experience of TEE through a structured interview were assessed. RESULTS: All patients in the hypnosis group performed TEE without any sedation. As for anxiety before TEE, no significant differences were observed between groups; after TEE all patients were less anxious than at the beginning (p<0.001) with a greater decrease in patients of the hypnosis group (p<0.001). Before TEE, there were no significant differences also in HR, BP and SO2. During TEE in both groups a similar increase in HR and BP was found (p<0.001), whereas SO2 values remained stable. In the responses to the structured interview, 94% of patients in the sedation group remembered everything vs 36% of the hypnosis group (p<0.05). No differences were found in the other answers between the two groups. CONCLUSIONS: Hypnosis in TEE is useful to improve the emotional experience of patients with congenital heart disease.

Examination of the anxiety level in patients undergoing transesophageal echocardiography.

BACKGROUND: The aim of this study was to determine the levels of anxiety in patients with transesophageal echocardiography (TEE). METHODS: The research was carried out at a university's Heart Hospital, echocardiography laboratory between the dates of January-October 2014. Data were collected with Patient Identification Form, State and Trait Anxiety Inventory. The level of state and trait anxiety was measured by Spielberger's State-Trait Anxiety Inventory. Signed forms of consent for the study were obtained from patients after the ethics committee approval. Descriptive statistics, t-test, Kruskal-Wallis, Mann-Whitney U test and Pearson correlation coefficient were used for statistical data analysis. RESULTS: The study included 102 patients who were admitted to the cardiology department for TEE. The mean age of the patients was 44.12±16.86 years and 52.9% were men. About 46.5% of them graduated from primary school, 74.5% were married, and 52.0% has moderate income. Approximately half the patients reported that they had received information for TEE. State anxiety scores of patients ranged from 31 to 66 (mean±SD; 46.7±8.7), and their trait anxiety scores ranged from 28 to 52 (mean±SD; 44.4±4.3). Low educational level, female gender, and hospitalized patients' state anxiety point were very high and statistically significant. CONCLUSION: Anxiety level should be determined in this patients, and appropriate nursing care should be done for high anxiety score patients.

Feasibility and clinical benefit of cognitive-behavioral intervention for preparing patients for transesophageal echocardiography.

OBJECTIVE: Despite premedication, anxiety in patients undergoing transesophageal echocardiography (TEE) is prevalent, often causing adverse physiological and psychological effects and contributing to decreased patient compliance. We aimed to evaluate the feasibility of cognitive-behavioral intervention (CBI) in patients undergoing TEE and to assess its impact on the severity of anxiety, patient's and physician's comfort, and administered dose of sedatives. METHODS: Our study was designed as a prospective, single-center, single-blinded, case-controlled pilot study. The study group comprised 49 patients (26 men, 66±8 years old) referred for TEE. Before the examination, 26 randomly selected patients underwent CBI. Sedatives were administered, if necessary. After the examination, patient anxiety and patient's and physician's comfort were evaluated using dedicated questionnaires and scores. Intergroup comparison was performed using Student's t-test for independent variables and Mann-Whitney U test and Pearson's chi-square test or Fisher's exact test for categorical variables. RESULTS: The mean level of pre-TEE distress and anxiety were significantly lower in patients receiving CBI than in those without intervention (p=0.022). Furthermore, the application of CBI significantly reduced patient's discomfort (p<0.001) and resulted in increased comfort of physician (p<0.001) during TEE. The need of sedative administration (31% vs. 91%, p<0.001) and its mean dose was significantly lower in patients receiving CBI (1.6±0.5 mg vs. 2.7±1.6 mg midazolam, p=0.009). CONCLUSIONS: CBI is feasible in patients undergoing TEE. It decreases patient's anxiety and discomfort and increases physician's comfort. It also results in reduced use of sedatives during the examination.

Hypnosis for sedation in transesophageal echocardiography: a comparison with midazolam.

BACKGROUND: Transesophageal echocardiography (TEE), being a displeasing intervention, usually entails sedation. We aimed to compare the effects of hypnosis and midazolam for sedation in TEE. DESIGN AND SETTINGS: A prospective single-blinded study conducted on patients scheduled for TEE between April 2011 and July 2011 at a university in Istanbul, Turkey. METHODS: A total of 41 patients underwent sedation using midazolam and 45 patients underwent hypnosis. Patients were given the State-Trait Anxiety Inventory (STAI) test for anxiety and continuous performance test (CPT) for alertness before and after the procedure. The difficulty of probing and the overall procedure rated by the cardiologist and satisfaction scores of the patients were also documented. RESULTS: Anxiety was found to be less and attention more in the hypnosis group, as revealed by STAI and CPT test scores (P < .05 and P < .001, respectively). CONCLUSION: Hypnosis proved to be associated with positive therapeutic outcomes for TEE with regard to alleviation of anxiety and maintenance of vigilance, thus providing more satisfaction compared to sedation with midazolam.

Intraoperative transesophageal echocardiography with a special focus on a patient undergoing advanced robotic-assisted procedures.

Intraoperative echocardiography (IOE) has earned a major role in surgical decision-making and helps the cardiac surgeon decide and proceed with appropriate intervention based on the visualized pathology. With the advent of minimally invasive surgical techniques and robotic-assisted operations, more emphasis and dependence has been placed on IOE. We describe our experience with IOE during mitral valve repair at our center, which is one of the pioneer centers for these telemanipulation techniques.

[Subjective tolerance to transesophageal echocardiography]. / Subjektive Toleranz der transösophagealen Echokardiographie.

Transesophageal echocardiography (TEE) is a new semi-invasive diagnostic tool in cardiology. We studied tolerance of TEE. 95 out of 121 consecutive patients were interviewed using a detailed, structured questionnaire (42 questions). Most patients (97%) received midazolam prior to TEE. TEE was tolerated well by 89% (n = 84) of the patients. Patients receiving a higher dose of midazolam (> 0.04 mg/kg bodyweight) tolerated TEE better than those in the lower-dose group (p < 0.0005), but they experienced side effects more often (p < 0.05) and did not tolerate fatigue as well (p < 0.0005). TEE was tolerated less well by younger patients (age < or = 45 years); they experienced more often local irritation than older patients due to the endoscope (52% versus 20% in older patients, p < 0.005) and complained more often about dysphagia (70% versus 24%) and sore throat (60% versus 19%) (p < 0.0005) after TEE. Patients < or = 45 years reported more side effects by midazolam than older patients, such as palpitations (30% versus 2%), hiccups (17% versus 0%), poor concentration (20% versus 3%), nausea (13% versus 2%), ataxia (17% versus 3%) or fatigue (88% versus 59%) (p < 0.05 to 0.0005). Females were more often afraid of TEE (53%) and the endoscope (56%) than males (35% and 23%, p < 0.08 and p < 0.002) and also disliked the endoscope more often (42%) than men (19%, p < 0.03). Some women complained about headaches after TEE (10%), whereas men did not (p < 0.05). Thus, TEE, after premedication with midazolam, is subjectively well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)