Impact of Intraoperative Transesophageal Echocardiography During Noncardiac Surgery

• Published in: Journal of cardiothoracic and vascular anesthesia 2006-12, Vol.20 (6), p.768-771
• Main Authors: Schulmeyer, María Carolina Cabrera, Santelices, Emilio, Vega, Raúl, Schmied, Silvia
• Format: Article
• Language: English
• Subjects: Abdomen - surgery; Aged; Aged, 80 and over; Blood Pressure; Cardiovascular Diseases - complications; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - diagnostic imaging; Echocardiography, Transesophageal - utilization; Female; Heart Rate; hemodynamic; Humans; Intraoperative Care - instrumentation; intraoperative transesophageal echocardiography; Male; Middle Aged; monitoring; Monitoring, Intraoperative - instrumentation; Monitoring, Intraoperative - methods; noncardiac surgery; Odds Ratio; Predictive Value of Tests; Prospective Studies; Risk Assessment
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2006.05.004

Objective: The purpose of this study was to test if parameters measured by intraoperative transesophageal echocardiography (TEE) could be useful to evaluate the hemodynamic status of high-risk cardiovascular patients and if this information was sufficient to make changes in intraoperative management. Design: Prospective clinical study. Setting: Single-university hospital. Participants: Ninety-eight patients undergoing noncardiac surgery. Interventions: Every patient was assessed with a baseline examination of 2-dimensional, color, pulsed, and continuous Doppler images. Intraoperative changes in any of the evaluated and measured parameters led to a specific change according to the protocol. Measurements and Main Results: After continuous monitoring with TEE during surgery, all patients were assigned to 1 of the following groups: (1) TEE was of no use, (2) TEE-directed intraoperative management changes, (3) intraoperative TEE-directed changes in postoperative management, and (4) TEE successfully used as a substitute for pulmonary artery catheter monitoring. Two patients (2%) were assigned to group 1, 47 (48%) patients to group 2, 25 (25%) patients to group 3, and 24 (24%) patients to group 4. The most frequent modifications in intraoperative management were changes in drug therapy and fluid administration. Postoperative management changes were mostly made because of new diagnosis (14%) and new left ventricular wall motion abnormalities (9%). Conclusion: These results strongly suggest that objective measurements made by intraoperative TEE are effective in unveiling relevant clinical findings and useful information in high-risk patients undergoing noncardiac surgery.