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Perioperative use of transesophageal echocardiography by anesthesiologists: impact in noncardiac surgery and in the intensive care unit

[L'utilisation périopératoire de l'échocardiographie transsophagienne par les anesthésiologistes : les répercussions en chirurgie non cardiaque et à l'unité des soins intensifs]

André Y. Denault, MD FRCPC^*, Pierre Couture, MD FRCPC^*, Sylvie McKenty, MD FRCPC, Daniel Boudreault, MD FRCPC, François Plante, MD FRCPC, Roger Perron, RRT, Denis Babin, MSc^* and Jean Buithieu, MD FRCPC

^* From the Department of Anesthesiology, Montreal Heart Institute and the Departments of Anesthesiology and
Medicine,
Centre Hospitalier de l'Université de Montreal (CHUM), Hôpital Notre-Dame, Montreal, Quebec, Canada.

Dr. André Y. Denault, Department of Anesthesiology, Montreal Heart Institute, 5000 Bélanger Street East, Montreal, Quebec H1T 1C8, Canada. Phone: 514-376-3330, ext. 3732; Fax: 514-376-8784; E-mail: denault{at}videotron.ca

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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