Perioperative use of transesophageal echocardiography by anesthesiologists: Impact in noncardiac surgery and in the intensive care unit

Abstract

Background: The American Society of Anesthesiologists (ASA) has published practice guidelines for the use of perioperative transesophageal echocardiography (TEE) but the role and impact of TEE performed by anesthesiologists outside the cardiac operating room (OR) is still poorly explored. We report our experience in the use of TEE in the noncardiac OR, the recovery room and in the intensive care unit (ICU) in a university hospital, and analyze the impact of TEE on clinical decision making.Methods: Two hundred fourteen patients were included and TEE indications were classified prospectively according to the ASA guidelines. The examinations and data sheets were reviewed by two anesthesiologists with advanced training in TEE. For each examination, it was noted if TEE altered the management according to five groups: 1) changing medical therapy; 2) changing surgical therapy; 3) confirmation of a diagnosis; 4) positioning of an intravascular device; and 5) TEE used as a substitute to a pulmonary artery catheter.Results: Eighty-nine (37%), 67 (31%) and 58 (27%) patients had category I, II and III indications. The impact was more significant in category I where TEE altered therapy 60% of the time compared with 31% and 21% for categories II and III (P < 0.001). The most frequent reason for changing management was a modification in medical therapy in 53 instances (45%).Conclusion: Our results confirm a greater impact of TEE performed by anesthesiologists on clinical management for category I compared to category II and III indications in the noncardiac OR surgical setting and in the ICU.

Ecocardiografia transesofágica em anestesiologia: caracterização do perfil de uso em um hospital terciário

“…Denault et al 20 published a paper showing that TEE was able to change the anesthetic-surgical procedure in up to 60% of cases in Class I patients, 31% in Class II, and in patients currently classified as Class III (i.e., those not eligible for intraoperative TEE), 21% had benefits and changes in the management of their cases. Similar results were obtained by other European studies that also associated the use of TEE with the same classification 21,22 .…”

Utilidade da ecocardiografia transeofageana durante hipotensão arterial grave em cirurgia não cardíaca

“…Denault and Couture 16 , in a retrospective study of 214 noncardiac surgery and ICU patients, demonstrated the utility of TEE for management adjustments necessary to modify medical therapy. Kolev 17 studied the influence of TEE on intraoperative decision-making using the ASA guidelines.…”

Transesophageal echocardiography-related complications

“…2 Information obtained from TEE can have a significant impact in cardiac [3][4][5][6][7][8][9] and non-cardiac surgery, [10][11][12] as well as in making decisions in the ICU. 11,13,14 Considering the widespread application of this technique, it is important to address the issue of safety. In this article, we present a comprehensive review of the literature pertaining to TEE complications reported during examinations undertaken in cardiology suites, operating rooms, and ICUs.…”

“…Tracheal intubation (2), CHF (1), pharyngeal hemorrhage (2), dysarrythmia (3), vertigo (1), jaw subluxation (1), vomiting (4), intolerance (12), others (2) Seward, 1992 31 3,827 100/0 2.9 (111) 0.026 (1) 0.94 (36) Laryngospasm (5), hypoxia (13), dysarrythmia (22), CHF (2), transient hypotension (13), transient HTN (15), bloodtinged sputum (9), others (31) Chan, 1991 117 1,500 100/0 0.47 (7) 0 0.73 (11) Tracheal intubation (4), auricular fibrillation (2), bronchospasm (1) Daniel, 1991 2 10,419 88.7/11.3 2.8 (291) 0.0098 (1)…”