title: Transesophageal echocardiography in anesthesiology: characterization of use profile in a tertiary hospital.
abstract: OBJECTIVE
  Since its introduction in the 80s, transesophageal echocardiography (TEE) not only gained popularity but also experienced great advances in technology and currently it is an extremely valuable tool in the intraoperative period. In Brazil, there are no published data on the profile of its use in the intraoperative period by anesthesiologists. The objective of this study was to describe the use of intraoperative TEE in an Anesthesiology Service in a tertiary private hospital.
  
  
  METHODS
  Retrospective study from completed medical charts in all cases where the patient was monitored with TEE. Monitoring was applied in patients classified as I-II according to the American Society of Echocardiography and presenting no contraindication to the examination. At the end of procedure, after examination, a note on the chart classified monitoring according to its usefulness in the intraoperative period into three groups: group 1, no interference of TEE in anesthetic or surgical approach; group 2, TEE prompted change in anesthetic approach regarding the administration of volume, introduction and/or modification of vasoactive drugs (here, TEE generated change of anesthetic approach in conjunction with other monitors, but it was the deciding factor); group 3, TEE led to a change in approach or review of surgical procedure performed.
  
  
  RESULTS
  From January 2009 to January 2011, 164 intraoperative TEE were performed in our service, with 41 pediatric and 123 adult patients. In all patients, the test was successful and there were no problems regarding the introduction of transesophageal tube. In pediatric sample, group I had 10 patients (24.4%), group II had 27 patients (65.8%), and group III had 4 patients (9.8%). Among adults, group I had 38 patients (30.9%), group II had 81 patients (65.9%), and group III had 4 patients (3.2%).
  
  
  CONCLUSIONS
  Despite this small sample size compared to the literature, and the limitations of this study, there was agreement with other reports related to changes in anesthetic-surgical approach based on intraoperative TEE. Our data also strongly suggest that transesophageal echocardiography is an extremely useful tool for monitoring patients at high cardiovascular risk, even when undergoing noncardiac surgery. Larger studies conducted in our country are needed, as there are no other studies in literature defining the use profile of TEE or even clearly setting out how it has been used in our field.
authors.affiliation: São Paulo Serviços Médicos de Anestesia, Hospital Sírio Libanês, São Paulo, SP, Brazil. alexskin@terra.com.br
authors.forename: Alexander Alves
authors.initials: AA
authors.lastname: da Silva
authors.forename: Arthur
authors.initials: A
authors.lastname: Segurado
authors.forename: Pedro Paulo
authors.initials: PP
authors.lastname: Kimachi
authors.forename: Enis Donizete
authors.initials: ED
authors.lastname: Silva
authors.forename: Fernando
authors.initials: F
authors.lastname: Goehler
authors.forename: Fabio
authors.initials: F
authors.lastname: Gregory
authors.forename: Claudia
authors.initials: C
authors.lastname: Simões
mesh_terms: D000368:Aged; D000758:Anesthesia; D002648:Child; D017548:Echocardiography, Transesophageal / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D062606:Tertiary Care Centers