title: The impact of focused transthoracic echocardiography in the pre-operative clinic.
abstract: Patients with suspected or symptomatic cardiac disease, associated with increased peri-operative risk, are often seen by anaesthetists in the pre-assessment clinic. The use of transthoracic echocardiography in this setting has not been reported. This prospective observational study investigated the effect of echocardiography on the anaesthetic management plan in 100 patients who were older than 65 years or had suspected cardiac disease. Echocardiography was performed by an anaesthetist, and was validated by a cardiologist. Overall, the anaesthetic plan was changed in 54 patients. Haemodynamically significant cardiac disease was revealed in 31 patients, resulting in a step-up of treatment in 20 patients, including: cardiology referral (four patients); altered surgical (two) and anaesthetic (four) technique; use of invasive monitoring (13); planned use of vasopressor infusion (10); and postoperative high dependency care (five). Reassuring negative findings in 69 patients led to a step-down in treatment in 34 patients: altered anaesthetic technique (six); procedure not cancelled (10); cardiology referral not made (10); use of invasive monitoring not required (seven); and high dependency care not booked (11). We conclude that focused transthoracic echocardiography in the pre-operative clinic is feasible and frequently alters management in patients with suspected cardiac disease.
authors.affiliation: Department of Anaesthesia and Perioperative Medicine, Royal Hobart Hospital, Hobart, Tas., Australia.
authors.forename: D J
authors.initials: DJ
authors.lastname: Canty
authors.forename: C F
authors.initials: CF
authors.lastname: Royse
authors.forename: D
authors.initials: D
authors.lastname: Kilpatrick
authors.forename: L
authors.initials: L
authors.lastname: Bowman
authors.forename: A G
authors.initials: AG
authors.lastname: Royse
mesh_terms: D000367:Age Factors; D000368:Aged; D000758:Anesthesia; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D023381:Endpoint Determination; D005240:Feasibility Studies; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010347:Patient Care Planning; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*