The Role of Transesophageal Echocardiography in the Intraoperative Period

Abstract

The goal of hemodynamic monitoring and management during major surgery is to guarantee adequate organ perfusion, a major prerequisite for adequate tissue oxygenation and thus, end-organ function. Further, hemodynamic monitoring should serve to prevent, detect, and to effectively guide treatment of potentially life-threatening hemodynamic events, such as severe hypovolemia due to hemorrhage, or cardiac failure. The ideal monitoring device does not exist, but some conditions must be met: it should be easy and operator-independently to use; it should provide adequate, reproducible information in real time. In this review we discuss in particular the role of intraoperative use of transesophageal echocardiography (TOE). Although TOE has gained special relevance in cardiac surgery, its role in major non cardiac surgery is still to be determined. We particularly focus on its ability to provide measurements of cardiac output (CO), and its role to guide fluid therapy. Within the last decade, concepts oriented on optimizing stroke volume and cardiac output mainly by fluid administration and guided by continuous monitoring of cardiac output or so called functional parameters of cardiac preload gained particular attention. Although they are potentially linked to an increased amount of fluid infusion, recent data give evidence that such pre-emptive concepts of hemodynamic optimization result in a decrease in morbidity and mortality. As TOE allows a real time direct visualization of cardiac structures, other potentially important advantages of its use also outside the cardiac surgery operation room can be postulated, namely the ability to evaluate the anatomical and functional integrity of the left and the right heart chambers. Finally, a practical approach to TOE monitoring is presented, based on a local experience.

National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review

“…Fuller evaluation of these technologies is needed in the setting of PPH. 47,48 Similarly, noninvasive hemoglobin monitors are commercially available, but concerns about accuracy and precision may limit their clinical utility in the obstetric setting. 49 …”

Anaesthetic Management of The Patient Undergoing Cardiopulmonary Bypass Graft Surgery After Pneumonectomy

“…However, assessment of volume responsiveness with echocardiography can be categorized as being very safe because of its minimal invasiveness. TEE evaluates the volume status by calculating the stroke volume index, tmitral E/A ratio, left ventricular CO, and the superior vena cava index (21) .…”

Intraoperative Transesophageal Echocardiography: Review and Evolution

“…It's now part of the decision-making process, providing determinant information; TEE can change the surgical procedure, anesthetic plan, confirm a suspected diagnosis, assist in positioning of intravascular devices and may extend far for additional follow-up. Intraprocedural TEE can be divided in surgical-based procedure and catheter-based procedure [1][2][3][4].…”

“…However, its use during non-cardiac surgeries is less established, the latest guidelines of the American Society of Anesthesiologists (ASA) and Society of Cardiovascular Anesthesiologists (SCA) agreed that TEE should be used in noncardiac surgery when patients have known or suspected cardiovascular pathology that might result in hemodynamic, pulmonary or neurologic compromise, and if experts and equipment available in conditions of unexplained life-threatening circulatory instability persists despite corrective therapy [1,3,5]. Yet, the use of iTEE in noncardiac surgery won its own role here, since it is now routinely an assessment tool in monitoring patients in high instable risk surgeries.…”