Transesophageal echocardiography in unsedated outpatients: technique and patient tolerance

Transesophageal echocardiography is an important new imaging technique for the evaluation of heart disease. To maximize the number of patients who can be scanned in one outpatient session and to minimize the facilities needed, we elected to perform the technique on unsedated patients. To assess the tolerance of patients to this policy, we designed a questionnaire to evaluate the patients' own assessment of the technique. Overall, the technique was well tolerated by 79% of 204 patients, although 37% found swallowing the transducer unpleasant. The procedure was not tolerated as well by younger patients. When asked whether they would prefer to be sedated or unsedated, 83% preferred to be unsedated for an outpatient scan, and 73% preferred to be sedated for an inpatient scan. We concluded that the technique is well tolerated by most unsedated patients. Because a few patients preferred sedation, some outpatient facilities for patient recovery were necessary. We now ask young patients, selected inpatients, and patients undergoing repeat studies whether they would prefer sedation, but we otherwise perform the technique on unsedated patients.