title: Utility of transesophageal echocardiography during severe hypotension in non-cardiac surgery.
abstract: OBJECTIVE
  Severe and refractory hypotension is an infrequent perioperative situation during non-cardiac surgery, but determining its etiology is essential for successful management and therapy.
  
  
  METHODS
  Adults undergoing non-cardiac surgery were prospectively enrolled in this study. Severe hypotension was defined as a drop from 30% of baseline systolic arterial pressure unresponsive to adequate fluids administration and to ephedrine, according to the anasthesiologist criteria. A multiplanar transesophageal echocardiography (TEE) probe was inserted, prior to any other invasive hemodynamic monitor.
  
  
  RESULTS
  Forty two adults (68 ± 12 years) were studied, 84% during elective non-cardiac surgery. Abdominal (open and laparoscopic), thoracic and orthopaedic surgeries were performed most frequently. In all patients, TEE was useful for determining the etiology of severe hypotension. Hypovolemia was diagnosed in 18 patients (42%). Low ejection fraction (EF < 30%) was detected in 5 cases and was successfully treated with vasoactive drugs. Dynamic left ventricular outflow tract obstruction, associated with systolic anterior motion of the mitral valve, was diagnosed in 5 patients; in another 6 patients severe embolism was detected during hip and knee surgery. Myocardial ischemia causing persistent hypotension was detected in 5 patients; in 3 patients, cardiac tamponade was the etiology of severe hypotension. Two patients died; both had severe myocardial ischemia.
  
  
  CONCLUSIONS
  Perioperative TEE was performed quickly, proving to be a useful technique in the context of hypotension during non-cardiac surgery. The heart and great vessels could be observed directly and functionally evaluated. Thus, the etiology of severe hypotension could be easily determined and managed.
authors.affiliation: Fach Hospital, Universidad de Valparaíso, Santiago, Chile. carol218@vtr.net
authors.forename: Cabrera
authors.initials: C
authors.lastname: Schulmeyer
authors.forename: Jorge
authors.initials: J
authors.lastname: Farías
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rajdl
authors.forename: Jaime
authors.initials: J
authors.lastname: de La Maza
authors.forename: Marcela
authors.initials: M
authors.lastname: Labbé
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging* / Q000209:etiology*; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D012720:Severity of Illness Index