Role of Transesophageal Echocardiography in General Anesthesia

Abstract

Transesophageal echocardiography (TEE), a relatively non-invasive method, is an ideal intraoperative monitoring tool. In this review, we evaluated all potential applications of TEE in general anesthesia. The uses of intraoperative TEE have expanded over the years. TEE’s main application is in the intraoperative assessment and monitoring of the cardiac function. Its impact in clinical decision making has been demonstrated in non-cardiac surgery in the operating room and as a rescue in case of hemodynamic instability and cardiac arrest. TEE may also provide more complete quantitative hemodynamic monitoring of intracardiac pressures as the pulmonary artery catheter. Newer intraoperative TEE application includes imaging of extra-cardiac structures such as the kidney, the intrahepatic inferior vena cava, the lungs, the pleura space, and the epidural space. Several scanning protocols have been proposed ranging from a focused to a comprehensive cardiac assessment. Current guidelines for intraoperative use of TEE include basic and advanced TEE exam. Intraoperative TEE is a very powerful tool in the hands of the TEE trained anesthesiologist. It has a positive safety profile but requires a significant initial manpower and financial investment. While less expensive equipment has become available, specific training is necessary and requires a significant time commitment.