Role of intraoperative transesophageal echocardiography in patients undergoing noncardiac surgery

Abstract

Major perioperative cardiac complications, including cardiac death, nonfatal myocardial infarction and nonfatal cardiac arrest, can occur in patients undergoing noncardiac surgery. To reduce the risk of these complications, some authors have reported on the utility of intraoperative transesophageal echocardiography as a complementary monitoring tool in noncardiac surgery. However, although this approach is now well established in patients undergoing cardiac surgery, there are no guidelines for intraoperative transesophageal echocardiography application in noncardiac surgery, and little literature exists on patient outcome, logistics, financial impact, medico-legal implications and safety. In this review, we discuss published information about the use of intraoperative transesophageal echocardiography during noncardiac surgery with an attempt to clarify whether this approach may offer potential benefits compared with conventional intraoperative monitoring systems. In addition, perioperative risk determinants in noncardiac surgery are briefly summarized and information derived from intraoperative transesophageal echocardiography for evaluation of cardiac morphology and function is schematically presented.

Ecocardiografía transesofágica (ETE) durante cirugía no cardíaca

“…La sensibilidad y especificidad de la Ecocardiografía para la detección de nuevos eventos isquémicos es alta, pero la gran utilidad de la ETE está en que no sólo permite detectar episodios de isquemia intraoperatoria, sino que también permite manejar los volúmenes durante el clampeo aórtico y ajustarlos al momento de desclampear. También es útil para evaluar el efecto de fármacos como betabloqueadores, y en el caso de indicar fármacos vasoactivos rápidamen-te es posible visualizar sus efectos en la contractilidad miocárdica 18 . Otra virtud de la ecocardiografía es la detección de la hipovolemia, uno de cuyos signos característicos es "el beso de los músculos papilares" (Figura 4).…”

“…En estos casos, independiente de las patologías de base del paciente, se ha demostrado la alta utilidad de la eco para lograr un diagnós-tico etiológico y así manejar la causa del deterioro de la hemodinamia. Además su uso permite manejar y guiar la terapia que se indique al paciente, el uso de volumen, y el efecto en el miocardio de las diferentes drogas vasoactivas [18][19][20][21][22] . Es importante tener en cuenta que hipotensión no es sinónimo de hipovolemia.…”

Transesophageal Echocardiography for the Noncardiac Surgical Patient

“…TEE allows online monitoring of myocardial function to differentiate the several components causing hypotension and is helpful in guiding the treatment approach. 15 Laparoscopic Surgery and Cardiomyopathy…”

Core competency review: Aortic stenosis and noncardiac surgery

“…Some anesthesiologists advocate the use of intraoperative transesophageal echocardiography (TEE) to monitor ventricular filling in patients with severe AS. [24][25][26] Intraoperative TEE provides real-time assessment of the cause of left ventricular dysfunction and allows the anesthesiologist to manipulate hemodynamics to address the dysfunction. Intraoperative TEE prompted significant changes in therapy for 4 of 7 patients with AS in a larger cohort of noncardiac surgical patients monitored with TEE.…”