Rigid Laryngoscope-assisted Insertion of Transesophageal Echocardiography Probe Reduces Oropharyngeal Mucosal Injury in Anesthetized Patients

Abstract

Background: Intraoperative transesophageal echocardiography has become a routine part of monitoring in patients with cardiac disease. However, insertion of a transesophageal echocardiography probe can be associated with oropharyngeal, esophageal, and gastric injuries. The purpose of this study was to determine whether insertion of a transesophageal echocardiography probe under direct laryngoscopic visualization can reduce the incidence of oropharyngeal mucosal injury.Methods: Eighty patients undergoing surgery with general anesthesia were randomly allocated to either the conventional group, in which the probe was inserted blindly, or the laryngoscope group, in which a rigid laryngoscope was used to visualize the passage of the probe. The incidence of oropharyngeal mucosal injury, the number of insertion attempts, and odynophagia were assessed.Results: There was no significant difference in demographic and hemodynamic parameters between the 2 groups. The incidence of oropharyngeal mucosal injury was higher in the conventional group than in the laryngoscope group (55% vs. 5%, P < 0.05). The incidence of odynophagia was higher in the conventional group than in the laryngoscope group (32.5% vs. 2.5%, P < 0.05). The number of insertion attempts was also higher in the conventional group than in the laryngoscope group.Conclusion: Rigid laryngoscope-assisted insertion of the transesophageal echocardiography probe reduces the incidence of oropharyngeal mucosal injury, odynophagia, and the number of insertion attempts.

Facilitating Transesophageal Echocardiography Probe Placement by Esophageal Bougie in an Anesthetized Patient

“…4 Also, in a prospective study of 869 cardiac surgery patients, Hogue et al 5 reported an increased risk for aspiration and pneumonia (odds ratio of 4.68) when TEE monitoring was used. Herein, we present a novel insertion technique using a soft-tipped esophageal bougie as a guide for blind TEE probe insertion in a patient undergoing cardiac surgery.…”

Transesophageal echocardiography (TEE)-induced Mallory-Weiss laceration in a patient who underwent aortic and mitral valve replacement -A case report-

“…Daniel et al [4] reported on 201 cases of failure to insert a TEE probe and 98.5% of which was due to the lack of operator's experience. Rigid laryngoscope-assisted TEE insertion can also decrease injury to the oropharyngeal mucosal in anesthetized patients [7]. As discussed above, not moving the probe while folded and straightening the probe right after the procedure will lower the complication rate.…”

Practice guidelines for perioperative transesophageal echocardiography: Recommendations of the Indian association of cardiovascular thoracic anesthesiologists

“…The probe is lubricated generously with jelly 7. The probe is inserted by displacing the mandible anteriorly and advancing the probe gently in the midline; manipulation of the neck by flexion of the neck will help in some cases; if blind insertion of the probe is not easy, a laryngoscope may be used to expose the posterior pharynx and permit direct passage of the probe into the esophagus; undue force should never be applied at any stage during insertion of the probe; [4] once in the esophagus, the transducer should never be forced through a resistance 8. The tip of the transducer is allowed to return to the neutral position before advancing or withdrawing the probe and undue force is never applied when flexing the tip with the control wheels 9.…”