Purpose: To determine the relative impact of each category-based TEE indication according to the ASA guidelines. Methods: In 851 patients undergoing cardiac surgery, TEE clinical indications were classified as category I or II according to the ASA guidelines. Category I indications are patients in which TEE is considered useful and category II are those where TEE is potentially useful but indications are less clear. All TEE examinations were reviewed by two anesthesiologists with advanced training in TEE. For each patient, the clinical impact of TEE in the clinical management was assessed using five criteria: 1) change of medical therapy; 2) change in the surgical procedure; 3) confirmation of a suspected diagnosis; 4) positioning of an intravascular device, and 5) substitute to a pulmonary artery catheter (PAC).Results: TEE had greater utility in category I than in category II indications (15/53 (28%) vs 110/798 (14%) respectively) (P < 0.01). The nature of the clinical impact was as follows: modification of medical therapy in 67/125 (53%), modification of planned surgical intervention in 38/125 (30%), confirmation of a diagnosis in 34/125 (27%). The impact on therapy was higher in complex surgical procedures (39%) than in valvular replacement (19%) (P < 0.01) and coronary artery bypass surgery (10%) (P < 0.001).Conclusions: Our findings validate the usefulness of the ASA practice guidelines demonstrating a greater impact of TEE on clinical management for category I indications than for category II. TEE also had a greater clinical impact in complex surgical procedures and in valvular replacement.Objectif : Déterminer l'effet relatif de l'indication de l'ETO basée sur chacune des catégories relevant des recommandations ASA.Méthode : Chez 851 patients devant subir une intervention chirurgicale cardiaque, les indications cliniques de l'ETO ont été classées en catégorie I ou II selon les recommandations de l'ASA. Dans la catégorie I, ce sont les patients pour qui l'ETO est considérée utile et dans la catégorie II, ceux pour qui l'ETO est probablement utile, les indications n'étant pas aussi claires. Tous les examens d'ETO ont été révisés par deux anesthésiologistes de formation poussée en ETO. Les répercussions cliniques de l'ETO sur le traitement clinique de chaque patient ont été évaluées selon cinq critères: 1) la modification du traitement médical 2) un changement de technique chirurgicale 3) la confirmation d'un diagnostic présumé 4) la mise en place d'un appareil intravasculaire 5) un substitut au cathéter de l'artère pulmonaire (CAP).Résultats : L'ETO a présenté une plus grande utilité avec les indications de catégorie I qu'avec celles de caté-gorie II (15/53 (28 %) vs 110/798 (14 %) respectivement) (P < 0,01). La nature de l'effet clinique a été : une modification de traitement médical chez 67/125 (53 %), un changement d'intervention chirurgicale chez 38/125 (30 %), la confirmation d'un diagnostic chez 34/125 (27 %). Les conséquences sur le traitement ont été plus grandes pour des interventions chirurgicale...

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Background: The American Society of Anesthesiologists (ASA) has published practice guidelines for the use of perioperative transesophageal echocardiography (TEE) but the role and impact of TEE performed by anesthesiologists outside the cardiac operating room (OR) is still poorly explored. We report our experience in the use of TEE in the noncardiac OR, the recovery room and in the intensive care unit (ICU) in a university hospital, and analyze the impact of TEE on clinical decision making.Methods: Two hundred fourteen patients were included and TEE indications were classified prospectively according to the ASA guidelines. The examinations and data sheets were reviewed by two anesthesiologists with advanced training in TEE. For each examination, it was noted if TEE altered the management according to five groups: 1) changing medical therapy; 2) changing surgical therapy; 3) confirmation of a diagnosis; 4) positioning of an intravascular device; and 5) TEE used as a substitute to a pulmonary artery catheter.Results: Eighty-nine (37%), 67 (31%) and 58 (27%) patients had category I, II and III indications. The impact was more significant in category I where TEE altered therapy 60% of the time compared with 31% and 21% for categories II and III (P < 0.001). The most frequent reason for changing management was a modification in medical therapy in 53 instances (45%).Conclusion: Our results confirm a greater impact of TEE performed by anesthesiologists on clinical management for category I compared to category II and III indications in the noncardiac OR surgical setting and in the ICU.

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