INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHY DURING NONCARDIAC SURGERY

Objective: To investigate the use and impact of transesophageal echoca rdiography (TEE) during noncardiac surgery. Design: Retrospective stud y. Setting: A university teaching hospital. Participants and Intervent ions: The medical records and the videotapes of 123 intraoperative IEE examinations were reviewed. Measurements and Main Results: TEE was us ed for non-consultative indications in 68 patients and in consultation in 55 patients. Information that would not have been detected intraop eratively by other means included intracardiac defects, valvular and a ortic pathology, the presence or absence of ventricular dysfunction or intracardiac thrombi, and embolization during surgery. Findings durin g the initial TEE examination and the TEE evaluation of intraoperative events resulted in a major impact on patient management in 15% of pat ients. The majority of patients in whom TEE had any impact (the sum of major minor, and limited impact groups) were classified as American S ociety of Anesthesiologists (ASA) class 3 or 4. Patients in whom TEE h ad any impact were significantly older than patients in whom TEE had n o impact (66.5 +/- 13.4 years v 58.1 +/- 16.2 years; p < 0.05). No pat ient experienced a complication related to intraoperative IEE. Conclus ion: It appears that TEE in patients undergoing noncardiac surgery is efficacious in rapidly disclosing new findings and information during periods of hemodynamic instability. It may have a significant impact o n intraoperative patient management and may be beneficial in patients older than 66 years of age. Copyright (C) 1998 by W.B. Saunders Compan y.