title: Impact of intraoperative transesophageal echocardiography during noncardiac surgery.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Air Force Hospital of Santiago, and University of Valparaiso, Santiago, Chile. Carol218@vtr.net
authors.forename: María Carolina Cabrera
authors.initials: MC
authors.lastname: Schulmeyer
authors.forename: Emilio
authors.initials: E
authors.lastname: Santelices
authors.forename: Raúl
authors.initials: R
authors.lastname: Vega
authors.forename: Silvia
authors.initials: S
authors.lastname: Schmied
mesh_terms: 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