The adequacy of basic intraoperative transesophageal echocardiography performed by experienced anesthesiologists

Transesophageal echocardiography (TEE) may improve intraoperative decision- making and patient outcome if it is performed and interpreted correctly. Af ter revising our TEE examination to fulfill the published guidelines for ba sic TEE practitioners, we prospectively evaluated the ability of our cardia c anesthesiologists (all very experienced with TEE) to record and interpret this revised examination. Educational aids and regular TEE performance fee dback were provided to the anesthesiologists. Their interpretations were co mpared with the independently determined results of experts. Compared with their own historical controls (42% recording rate), all anesthesiologists s howed significant improvement in their ability to record a basic intraopera tive TEE examination resulting in 81% (P < 0.0001) of all required images b eing recorded: 88% before cardiopulmonary bypass, 77% immediately after byp ass, and 64% after chest closure. Seventy-nine percent of the images record ed at baseline were correctly interpreted, 6% were incorrectly interpreted, and 15% were not evaluated. Our attempt to assess compliance with publishe d guidelines for basic intraoperative TEE resulted in a marked improvement in our intraoperative TEE practice. Most, but not all, standard cross-secti ons are recorded or interpreted correctly, even by highly experienced and m otivated practitioners.