Impact of Focused Intraoperative Transthoracic Echocardiography by Anesthesiologists on Management in Hemodynamically Unstable High-Risk Noncardiac Surgery Patients

Abstract

Focused TTE by anesthesiologists can provide new information that may alter the hemodynamic management of unstable high-risk noncardiac surgery patients in the operating room.

Perioperative Echocardiographic Diagnosis of Regional Wall Motion Abnormalities: Not All of Them are Ischemic!

“…3 The same group further used focused TTE to examine 50 patients during intraoperative hemodynamic instability and found that TTE changed management in 33 patients (66%). 4 A recent systematic review examining the impact of focused TTE in noncardiac surgery and critical care found 18 publications (13 prospective and 5 retrospective), 13 of which reported a positive impact on patient management. 5 The same group reported separately on the impact of echocardiography in the diagnosis and management of patients after cardiac surgery.…”

Perioperative Point of Care Cardiac Ultrasound for Anesthetists

“…Extending this learning to perioperative caregiver caring for noncardiac surgical patients has also led to better patient outcomes. [15][16][17][18] The anesthesia residents usually have access to ultrasound platforms, because of the current practice of ultrasound-guided central venous and arterial access, ultrasound-guided regional nerve blocks, ultrasound-guided gastric volume, and optic nerve sheath and airway measurements. Thus, the only necessity at the moment is a training program in perioperative point-of-care cardiac ultrasound for hemodynamic assessment.…”

Transthoracic Echocardiography and the Field of Cardiothoracic Anesthesiology: Where Do We Stand?

“…Kratz et al reported the use of intraoperative TTE on 50 consecutive patients who developed hemodynamic instability during a period of noncardiac surgery; management decisions were altered in 66% of all patients based on the TTE findings, including for 4 patients diagnosed with left ventricular failure, 2 with right ventricular failure, and 6 with varying degrees of previously undiagnosed aortic stenosis. 4 Even though these factors likely are considered by anesthesiologists who are intervening on a patient with an unstable condition, it is unlikely that diagnosis of right-sided heart failure would be made promptly in a patient undergoing noncardiac surgery without echocardiography. Notably, they reported no interruption of general surgical procedures while performing TTE.…”

“…Notably, they reported no interruption of general surgical procedures while performing TTE. 4 Perhaps the most important consideration is that TTE may even alter patient outcomes to the point of adding a survival advantage. A study of more than 200 intensive care patients who were critically ill with undifferentiated shock found a survival benefit at 28 days in the patients whose care was guided by "limited echocardiography" compared with patients who received standard medical care.…”