Therapeutic impact of intra‐operative transoesophageal echocardiography during noncardiac surgery*

Abstract

SummaryThe impact of transoesophageal echocardiography on haemodynamic management during elective noncardiac surgery was assessed during this observational prospective database analysis. Ninety-nine consecutive patients were studied, who were at risk of intra-operative myocardial ischaemia or haemodynamic instability (Class II indications) and were undergoing vascular, visceral or chest surgery. A total of 165 new echocardiographic findings were recorded. Based on these findings changes in drug therapy were made in 47% and changes in fluid therapy in 24% of patients. Left ventricular wall motion abnormalities were seen in 32% and other relevant diagnoses made in 10%. Echocardiography showed a significant impact on drug therapy in patients with pre-operative systolic wall motion abnormalities (vasodilators: OR = 7.1, CI 95% = 2.1 ⁄ 24.0; vasopressors: OR = 3.3, CI 95% = 1.2 ⁄ 9.1) and patients with a history of left heart failure (vasodilators: OR = 5.2, CI 95% = 1.0 ⁄ 31.4). Fluid therapy was significantly influenced by echocardiographic findings during liver and lung transplantation (50% compared with 24% during other surgical interventions, p < 0.05).

A systematic review of transthoracic and transesophageal echocardiography in non-cardiac surgery: implications for point-of-care ultrasound education in the operating room

“…[9][10][11][12][13][14][15][16][17][18][19][20] All the studies were reported as comprehensive examinations, which was reflected in the broad diversity of diagnoses. As described previously, preoperative exams occurred immediately prior to induction of anesthesia and data from pre-assessment clinic exams were not included.…”

Intraoperative Transesophageal Echocardiography: Review and Evolution

“…Influence of TEE on fluid therapy during liver transplantation is also well documented in literature, up to 50% in some series [59]. Although transgastric views are limited, the short axis view gives a better assess to the circumference of the left ventricle by overpassing posterior retraction of the stomach [60].…”

A review of echocardiography in anaesthetic and peri-operative practice. Part 1: impact and utility

“…Assessment of preload and myocardial contractility is an essential accompaniment to the successful modern management of the highrisk surgical patient. Echocardiography can accurately predict fluid responsiveness and enable informed changes in vasoactive drugs [51,[61][62][63][64][65]. Unlike alternative flow-based monitors that display a numerical value, echocardiography can display real-time changes in valvular function or the development of ventricular wall motion abnormality.…”

“…Segmental wall motion abnormalities are alarmingly common, seen in 20-32% of patients undergoing surgery, and there is a clear association with coronary ischaemia and cardiac events [66]. Prompt detection and treatment can result in the resolution of myocardial ischaemia, and TOE has been demonstrated to be effective when used in this manner [51]. Transoesophageal echocardiography is twice as sensitive to left ventricular wall motion abnormalities when compared with ECG monitoring, although clinical and enzyme correlation with intra-operative findings is currently lacking [67].…”