title: Perioperative use of transesophageal echocardiography by anesthesiologists: impact in noncardiac surgery and in the intensive care unit.
abstract: 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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Montreal Heart Institute, Quebec, Canada. denault@videotron.ca
authors.forename: André Y
authors.initials: AY
authors.lastname: Denault
authors.forename: Pierre
authors.initials: P
authors.lastname: Couture
authors.forename: Sylvie
authors.initials: S
authors.lastname: McKenty
authors.forename: Daniel
authors.initials: D
authors.lastname: Boudreault
authors.forename: François
authors.initials: F
authors.lastname: Plante
authors.forename: Roger
authors.initials: R
authors.lastname: Perron
authors.forename: Denis
authors.initials: D
authors.lastname: Babin
authors.forename: Jean
authors.initials: J
authors.lastname: Buithieu
mesh_terms: D000776:Anesthesiology / Q000193:education; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units