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October 17, 2009
2:00 PM - 4:00 PM
Room Area L
Use of TSE "Mask" by Non-Anesthesiologists To Improve Oxygenation of High-Risk Patients during TEE
  **   James Tse, M.D., Ph.D., Sylviana Barsoum, M.D., Sal Zisa, M.D., Mary Corless, R.N., Shaul Cohen, M.D.
Anesthesia, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey
INTRODUCTION: Most patients undergoing transesophageal echocardiography (TEE) outside OR receive topical anesthesia, O 2 via nasal cannula (NC) and light sedation provided by cardiologists. However, even light sedation may cause O 2 desaturation (Desat) in patients with severe cardiac diseases. A NC delivers inadequate O 2 when the mouth is kept open with a bite block. A plastic sheet (TSE "Mask") has been shown to convert a NC into a face tent 1-3 . It has been used in the Echo Lab in past two years. We would like to study the effectiveness of this face tent.

METHODS: This is a retrospective review of TEE records (9/07–7/08) of patients who received topical anesthesia (15 cc viscous lidocaine and benzocaine spray x 3), NC O 2 (3-5 l/min) and sedation with midazolam (0.5-4 mg) and/or meperidine (12.5-50 mg). A TSE "Mask" was prepared using a clean clear specimen bag covering patient's nose and mouth 1-3 . Four groups (G) of patients were identified. G1 received NC O 2 2-4 l/min. G2-4 received NC O 2 5 l/min. G3 developed desaturation with sedation and then received a TSE "Mask". G4 received a TSE "Mask" prior to sedation. Paired and unpaired Student's t-test were used for statistical analysis. A p value <0.05 is considered as statistically significant. Data are presented as Mean±S.D.

RESULTS: There were no differences in age, body weight and amounts of midazolam and meperidine recived among groups. G1 (n=24) had a room air (RA) O 2 Sat of 95±2% that was improved (97±2%) with NC O 2 (3 l/min). They experienced slight O 2 Desat (96±3%) with sedation but maintained at 97±2% throughout the procedure. G2 (n=273) had RA O 2 Sat of 97±3% that was improved (99±2%) with NC O 2 (5 l/min) and experienced no O 2 Desat (99±2%) with sedation. G3 (n=40) had a lower RA O 2 Sat of 95±3% (vsG2). It was improved (97±2%) with NC O 2 . G3 experienced significant O 2 Desat (92±3%) with sedation. Their oxygenation was significantly improved with a TSE "Mask" (97±2%) and was maintained after insertion (97±2%) and prior to removal of TEE probe (97±2%). G4 (n=34) had a significant lower baseline RA O 2 Sat (92±4%) (vs. G1-3). Their oxygenation was significantly improved with NC O 2 (95±3%) that was further significantly improved with a TSE "Mask" (98±2%) and maintained throughout the procedure (98±2%).[table1]CONCLUSION: Data show that TSE "Mask" improves oxygenation in sedated patients and prevents O 2 desaturation during TEE. Patients recived NC O 2 5 l/min maintained their oxygenation better than those who received NC O 2 3 l/min. This simple face tent may improve patient safety and should be routinely used for high-risk patients during TEE.

REF: 1. Anesth 102:484, 2005. 2. Anesth 107:A922, 2007. 3. Anesth 109:A1723, 2008.

From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists.
Effects of TSE "Mask" on Oxygen Saturation
Room Air O2 SatNC O2 flow (l/min)O2 Sat NC O2O2 Sat NC O2+SedationO2 Sat NC O2+TM+SedationO2 Sat TEE inO2 Sat TEE end
Group 1(n=24)95±2% *397±2%#*96±3% *N/A97±2% *97±3% *
Group 2 (n=273)97±3%599±2% #99±2%N/A99±2%98±2%
Group 3 (n=40)95±3% *597±2% #*92±3% @97±2% &97±2% &97±2% &
Group 4 (n=34)92±4% *595±3% #*N/A98±2% @98±2% @97±2% @
RA room air; NC nasal cannula; TM TSE "Mask"; TEE in TEE probe inserted; TEE end Prior to remving TEE probe; * Significantly different from G2; # Significantly different from RA; @ Significantly different from NC O2; & Significantly different from Sedation (p<0.0001).