Impact of intraoperative transesophageal echocardiography during noncardiac surgery.
OBJECTIVE
The purpose of this study was to test if parameters measured by intraoperative transesophageal echocardiography (TEE) could be useful to evaluate the hemodynamic status of high-risk cardiovascular patients and if this information was sufficient to make changes in intraoperative management.


METHODS
Prospective clinical study.


METHODS
Single-university hospital.


METHODS
Ninety-eight patients undergoing noncardiac surgery.


METHODS
Every patient was assessed with a baseline examination of 2-dimensional, color, pulsed, and continuous Doppler images. Intraoperative changes in any of the evaluated and measured parameters led to a specific change according to the protocol.


RESULTS
After continuous monitoring with TEE during surgery, all patients were assigned to 1 of the following groups: (1) TEE was of no use, (2) TEE-directed intraoperative management changes, (3) intraoperative TEE-directed changes in postoperative management, and (4) TEE successfully used as a substitute for pulmonary artery catheter monitoring. Two patients (2%) were assigned to group 1, 47 (48%) patients to group 2, 25 (25%) patients to group 3, and 24 (24%) patients to group 4. The most frequent modifications in intraoperative management were changes in drug therapy and fluid administration. Postoperative management changes were mostly made because of new diagnosis (14%) and new left ventricular wall motion abnormalities (9%).


CONCLUSIONS
These results strongly suggest that objective measurements made by intraoperative TEE are effective in unveiling relevant clinical findings and useful information in high-risk patients undergoing noncardiac surgery.
Schulmeyer
María Carolina Cabrera
MC
Department of Anesthesiology, Air Force Hospital of Santiago, and University of Valparaiso, Santiago, Chile. Carol218@vtr.net
Santelices
Emilio
E
Vega
Raúl
R
Schmied
Silvia
S
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D005260:Female; D006339:Heart Rate; D006801:Humans; D007430:Intraoperative Care / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment