Transesophageal Echocardiography and Noncardiac Surgery

Abstract

The use of transesophageal echocardiography (TEE) for monitoring during cardiac and noncardiac surgery has increased exponentially over the past few decades. TEE has evolved from a diagnostic tool to a monitoring device and a procedural adjunct. The close proximity of the TEE transducer to the heart generates high-quality images of the intracardiac structures and their spatial orientation. The use of TEE in noncardiac and critical care settings is not well studied, and the evidence of the benefits of its use in these settings is lacking. Despite the widespread availability of TEE equipment in US hospitals, less than 30% of anesthesiologists are formally trained in the use of perioperative TEE. In this review, the safety and indications of TEE are reviewed and detailed analysis of the best available evidence in this regard is presented. Landmark trials evaluating the use of TEE and its therapeutic impact in noncardiac surgical setting are critically reviewed. This article details recommendations to familiarize anesthesiologists with TEE technology to exploit it to its fullest potential to achieve better patient monitoring standards and eventually improve outcome. Training of greater numbers of anesthesiologists in TEE is needed to increase awareness of the indications and contraindications. Until relatively inexpensive TEE equipment is available, the initial cost of equipment acquisition remains a significant prohibitive factor limiting its widespread use.

Transesophageal Echocardiography during Cardiac Arrest in Orthopedic Surgery Patients: A Report of Two Cases and a Review of the Literature

“…An additional prospective outcome study, found that asymptomatic patients with mild to moderate aortic stenosis had an event-free survival defined as death or aortic valve surgery of 95±2, 75±3, and 60 ±5% at 1, 3, and 5 years and concluded that outcome is worse in this population than previous data has suggested [11]. The identification of severe valvular heart disease contributing to cardiac arrest represents an additional diagnositic consideration that cannot be overlooked Perioperative transesophageal echocardiography has broadened its application beyond the cardiac surgical population, with mounting evidence of benefit to patients undergoing noncardiac surgery [6]. Specifically, TEE may be useful in diagnosing and managing patients with cardiovascular collapse, hypovolemia, coronary ischemia, pericardial diseases, and complex valvular heart disease [14].…”

Ecocardiografía transesofágica (ETE) durante cirugía no cardíaca

“…La primera onda E (early) corresponde al llene temprano del VI y la onda A (auricular) corresponde a la sístole auricular. También se ha visto que la disfunción diastólica se asocia con un mayor número de eventos hemodinámicos postoperatorios, como hipotensión e hipertensión [11][12][13][14][15][16][17] . La Ecocardiografía también permite calcular el gasto cardíaco (GC), parámetro reconocido como un muy buen índi-ce de función cardíaca global y predictor de complicaciones perioperatorias.…”

Transesophageal Monitoring in Anaesthesia: An Update

“…TEE can also assist in the donor selection process [10]. During single sequential lung transplantation, TEE is used as a hemodynamic monitor to assess the effects of one-lung ventilation and pulmonary artery clamping as well as guide the need for extracorporeal support post transplantation [11 • ].…”